The Community-Centered Board Model of Managed Care for People with Developmental Disabilities

In recent years considerable attention has been focused on redefining the role of government in Americans' everyday lives. At the same time, managed care has emerged as a way to help people obtain the services they need at reasonable costs. These new ideas emphasize local choice and control; people within their own communities are thought to be better decision makers in every aspect of service delivery because they know and are directly accountable to their own communities. Where this new thinking has gone into practice, compelling examples of success have emerged (Berger & Neuhaus, 1977; Fukuyama, 1995; Putman, 1993). One example is the community-centered board model of managed care. More than three decades ago, Colorado changed its government-controlled service delivery system for people with developmental disabilities to private, not-for-profit, local citizen-led boards of community leaders, including members of the medical, legal, education, accounting, engineering, and other business and commerce industries. People with developmental disabilities and parents of children with developmental disabilities serve on the boards. The boards manage the employment, residential living arrangements, and community well-being of local citizens with developmental disabilities. While spending far less than the government-controlled system, community-centered boards have delivered far more. This article discusses a model for combining community-centered boards with a managed care structure to effectively deliver services to people with developmental disabilities. Colorado's community-centered boards are offered as a successful starting point for the implementation of this model. COLORADO'S COMMUNITY BOARD Managed care provides an opportunity to do business differently - to improve services and supports for people with developmental disabilities and to contain both current and future costs. In Colorado, managed care did not result in people with disabilities being sold off to the lowest bidder. The work of Colorado's community-centered boards has led to many accomplishments: * The state is first among all states in taxpayer cost-benefit savings on the basis of total costs and community employment, supported living, and community participation outcomes (Braddock, Hemp, Bachelder, & Fujiura, 1995). * The state is third among states in improving employment-related services and supports through policy changes (Hall, 1994). * The state is seventh among states in moving people with developmental disabilities into their communities with supports from high cost-low performance state institutions (Braddock et al., 1995). * The state is fifth among states in using federal funds for real homes in communities for people with developmental disabilities (Braddock et al., 1995). * The state is 41st among states in spending for people with developmental disabilities (Braddock et al., 1995). Design and Responsibilities Colorado's community-centered boards have been a single point of entry, one-stop-shopping model of managed care service delivery to people with developmental disabilities for more than three decades. Through well-developed resource coordination, people with disabilities and their families are carefully matched with service and support providers. Intake, referral, resource coordination, other forms of case management, quality assurance, cost utilization review, and outcome monitoring are the boards' responsibility. Problems The current Colorado Developmental Disabilities Services' slot-funding mechanism is the antithesis of managed care. Not surprisingly, long waiting lists for people without designated funding, or a "slot," and overfunding of people with slots are the result. In some circumstances, people with slots are overfunded as the positive effects of the providers' work mitigates the effects of the person's disability. Community-centered boards and providers cannot shift resources to others with greater needs or to others on the waiting lists who do not have a funded slot. …