Affect community most health, mental health, social service and human service organizations will be affected by the Affordable Care Act (ACA), and agencies should be involved now in proactive community service planning. If you have services that provide direct health or mental health care, social services, skill building and support, you will want to study your state's plans for its implementation of the ACA.
Broad Changes in the Landscape
In most states, community based nonprofits will find that the ACA will re-shape how services are priorities, managed and funded. Many will find that:
The service delivery infrastructure changes. A larger percentage of services will be paid through Managed Care Organizations (MCOs) that are designated as key intermediaries for the ACA;
More community based services will be covered through third party payments handled by the MCOs;
Community agencies will need to beef up their data systems, often paying for costly information system design or purchase, and training;
A smaller percentage of services will be covered through grants and contracts;
Competition for services will increase with larger organizations more able to respond to the quality of care, data and information system requirements.
These represent broad, sweeping changes that will have a very significant impact on the service delivery systems in our states and communities.
How Health Information Exchanges Alter the Landscape
Most states are creating new Health Information Exchanges as part of the implementation of the Affordable Care Act. States and the information exchanges set the requirements for data that is being required and collected.
Most agencies are now handling patient care through electronic records, rather than the old paper filing systems. They are also collecting and reporting data related to diagnosis codes, care provided, quality benchmarks, etc. In many cases, community providers need to purchase new software and train staff, and the costs are rather substantial.
The benefit is that we will continue to save a lot of trees. The drawback in a number of states may be that it becomes increasingly difficult for smaller community based providers to pay-to-play.
What Agencies Can Do To Respond to These Changes
Policies that regulate these activities and provide transitional funding will be needed in order to ensure successful transition and the maintenance of robust community systems. The MCOs should have clear accountability requirements, caps on profits, and mandates for maintaining levels and quality of service. There should be requirements for timely payments to community providers. MCOs will be making considerable profits, and, as such, should be expected to bear much of the cost of the transition, training and technical assistance and building data systems. Where federal transition funding is being made available, it should cover costs for different levels of transition, to include the state's work, the MCOs and community agencies. In some states, you may find that the federal funding is spent primarily at the top levels, supporting state and
MCO transitions, with less spent for community providers. Strong advocacy by associations and networks can result in creating more equitable policies and funding.
The following are some of the key policy, planning and implementation issues to be addressed that will affect community based services in your state and local community:
1. Coverage levels for Medicaid Expansion, and the extent of expansion in your state;
2. Types of services being covered (the managed care organizations have some flexibility here);
3. Policies shaping the development of the Health Information Exchange (HIE);
4. Ways that the state is using federal planning and early implementation funds, and how much is being done to help community providers build capacity;
5. Information and data system requirements being made by the HIE;
6. Extent of technical assistance being provided by the state and HIE to counties and community service providers;
7. Level of cost sharing for development and implementation of systems;
8. Burden of information system development on community providers, especially small nonprofit organizations.
Make sure that your agency and providers in your field work to shape your state's policies that will determine which services are covered. Analyze what is needed by community agencies and work to have training and some of the data and information system costs covered through state and federal transition funding. Transition infrastructure development funding should be shared with the service delivery infrastructure, and not kept solely for development costs by your state and the MCOs.
Work with your state nonprofit association and provider groups. In these times, it is critical to hear the voices of state nonprofit associations, and associations of primary care, behavioral health and older adult service providers.
Consumer voices are also extremely important. These groups can analyze state level policy, strategies, and funding and make recommendations for services, the service delivery system, policies and funding.
Anne Hays Egan is an organizational development consultant, based near Santa Fe, NM. She has helped hundreds of nonprofits and communities to build capacity and successfully navigate change. She specializes in community service planning, organizational development and managing fiscal challenges. Nonprofit and community leaders across the U.S. have commended her work. Her speaking engagements and workshops are sought after, lively and engaging events. Anne has published widely in the field.
