Know Your Worth-Negotiating LTSS Rates
Uploaded on Sep 30, 2016 / 9 views / 35 impressions / 0 comments
Presentation from n4a's 2016 annual conference
Susan Sigmon, Vice President of Managed Long Term Care, Direction Home Akron Canton Area Agency on Aging & Disabilities, Uniontown, OH
Gary Cook, COO, Direction Home Akron Canton Area Agency on Aging & Disabilities, Uniontown, OH
A unique feature of the Ohio Duals Demonstration Project (MyCare Ohio) is the role played by Ohio's AAA's in implementing an integrated care delivery system. This waiver-mandated role of the AAA in Ohio does not guarantee exclusivity or protection from competition, and is not included in other duals demonstrations throughout the country. Moving from an extension of government into a competitive market, AAAs had to quickly develop cost structures and pricing models that adequately reflected their work (and risks) in the LTSS world. Participants in this session learned how to develop pricing in the absence of historical data, balanced against the constraints of what the managed care market will bear in a capitated system. Participants also learned how to construct a pay-for-performance pricing component as part of a bundled-payment strategy. It's critical to understand how to competitively position yourself as an integral part of the changing healthcare environment.