Moving Ohio into a new age for old age
Executive Budget promotes person-centered care, requires innovation
A message from Bonnie Kantor-Burman, Director, Ohio Department of Aging
The proposed Executive Budget has been called the boldest and most innovative approach to addressing state funding in current history. For the aging network, it requires us to creatively change the way we provide services, and places the people we serve in the forefront.
We expected that some of the provisions in the budget would be met with skepticism and trepidation. While creating this new, high performance system will lead to better outcomes for consumers, providers and communities alike, the new ideas and approaches that make it possible create uncertainties that need to be acknowledged and addressed.
PASSPORT Administrative Agencies (PAAs) are the front door to community-based long-term care services and supports for Ohio's elders. PAA site operating budgets cover initial program screening, assessment for eligibility and care management for consumers enrolled in the PASSPORT, CHOICES and Assisted Living waiver programs, as well as determining functional eligibility for nursing home care and certifying providers. The PAAs are doing an excellent job and have proven successes. We want to help them be competitive in an increasingly crowded marketplace. We want to transform the current system of service delivery into a person-centered, high performance, long-term care system of the future without impacting the consumer.
The Executive Budget increases the number of seniors in PASSPORT and Choices Medicaid waivers by 4,800 people while reducing PASSPORT per member per month (PMPM) spending 10.4 percent in FY 2012 and 6.4 percent in FY 2013. This has been characterized by some as a cut to services for each individual we serve. This simply isn't the case; what we aim to do is to reduce the amount we spend per person on average through an array of innovations and new efficiencies. Currently, the average monthly consumer cost per person across the state varies by as much as 59 percent, from a low of about $851 per consumer to a high of about $1,350. While some of this variance is reasonable, considering regional factors (e.g., market competition, prevailing wages) we believe we can tighten this range and reduce the overall costs of operating these programs.
In the current fiscal climate, we cannot get to where we need to be by doing the same things better. Ohio simply does not have the money to support the way we do things now. To provide Medicaid beneficiaries with the services they need, at a cost the Ohio's taxpayers can afford, we need to demand the highest level of efficiency and quality. This will require the department and the PAAs to take a candid look at real, measurable efficiencies, but the results will be worth it.
We will accomplish this by:
- More effectively monitoring that services being used are necessary;
- Developing care plans that are truly individualized;
- Analyzing and addressing factors that lead to increased costs; and
- Sharing data and best practices across PAA boundaries.
These efficiencies are manageable and will provide our elders with greater access to quality services. Ohio's aging network can achieve reductions in service plan costs while continuing to meet consumers' needs. One example is the new Enhanced Community Living (ECL) service within PASSPORT. ECL links older adults living in subsidized housing communities with support services that better meet the elders' service needs that are unscheduled and do not require a full hour of service, such as assistance going to the bathroom. This will allow PAAs to more efficiently schedule their providers and improve responsiveness.
Part of our plan to reduce PMPM costs is a 3 percent reduction in the rates paid to PASSPORT, Assisted Living and PACE service providers. Demonstrating the administration's commitment to promoting home-and community-based options to long-term care, this cut is less than the one ordered for nursing home operators (7 percent) and mid-range for all Medicaid service providers. Will current providers choose to leave the program if they get paid less? Probably. Will this result in some consumers' needs not being met? We don't think so. We believe that Ohio's long-term care provider network is robust and flexible and will be able to support these changes.
For more than five years, we have been working with stakeholders, including nursing homes and the PAAs, toward creating a unified long-term care system. We finally are ready to put this collaborative's unanimously passed recommendations in place. There is no doubt that the transformation to a person-centered approach to care will require systematic change in organizational practices, physical environments and relationships at all levels. Change can be difficult to embrace, but the future of Ohio requires that our fear of the new does not evolve into a hysterical protection of the status quo.
The Department of Aging's mission is to promote choice, independence and quality of life for aging Ohioans. We are on the cusp of providing a true culture change in how we care for our elders. We need to empower them with the ability to control their destiny and their dignity, as we march boldly into a new age for old age.