Frequently Asked Questions (FAQs)

What is disability-competent care (DCC)?

Disability-competent care comprises all the care and services a person with disabilities needs to function with maximum independence and self-sufficiency at home and in the community. Central to providing disability-competent care is respecting a person’s “dignity of risk.”

 

What is the Disability Care Practice (DCP) Model?

The Disability Care Practice (DCP) model incorporates all services and supports covered by Medicare and Medicaid; the model promotes integration of services across all settings (hospitals, medical offices, residential), types of care and support (MDs, NPs, RNs, therapists, behavioral health), including family (informal) and paid (formal) caregivers. The goal of the DCP model of care is to enable members to function with maximum independence and self-sufficiency in their homes and communities as they choose.

The DCP model consists of multiple best practices in every domain of disability-competent care within the context of patient-centered, patient-directed, team-based care for individuals.  The Individualized Plan of Care (or “IPC”; also known as the Individualized Care Plan or “ICP”) is the centerpiece of disability-competent care, and serves is the blueprint for primary care (including medical and mental health care), physical and occupational therapy, preventive care and community support (including durable medical equipment such as wheelchairs, and their maintenance; individualized seating and cushions for wheelchair users); transportation, and personal care assistants (PCAs) when they are needed.

 

For whom is this DCP model designed?

The model was originally designed primarily for adults with physical disabilities who are Medicaid and/or Medicare beneficiaries, and are either living in the community, or are making arrangements to live in the community; the model is designed to serve all individuals with disabilities, no matter where they live.

What is the “Triple Aim” intervention that you refer to in the context of disability-competent care?

The “Triple Aim” intervention for adults with disabilities improves the experience of care, increases the health of the target population, and reduces per capita costs via:

  • Seamless connection of primary, acute, long-term care and behavioral health services.
  • Person-centered, consumer-directed service planning and coordination.
  • Medicare and Medicaid payment integration.

 

What is unique about the DCP model/DCC?

The disability care practice (DCP) model is a unique, integrated, seamless model of medical care (including mental health), as well as all care supports and coordination, all centered around the Individualized Care Plan (ICP). It is characterized by the following four components:

1.Enhanced  primary  care services provided by multidisciplinary teams including physicians, advanced-practice nurses,  RNs, social workers, behavioral health specialists and rehab specialists, available as needed to prevent or treat (avoidable) medical complications, and reduce hospital and emergency room utilization.

2.Care coordination and management of home and community-based services, care transitions, coordination of physical and behavioral health, and problem-solving across all providers and settings of care on a 24/7 basis.

3.Personal care services (both agency model and consumer-directed) to enable enrollees to live independently.

4.Mobility services–especially wheelchair evaluation, purchase, repair and maintenance–to enable people to participate fully in community life.

 

What does “care delivery” mean in the DCP model?  What does it involve?

“Care delivery” means the provision of all care and support a person with physical disabilities may need at any time in life, in any setting, and includes:

  • Enhanced home and community-based primary care with episodic care capacity.
  • 24/7 availability of informed and knowledgeable clinicians with access to EHR.
  • Focus on early intervention to prevent complication or exacerbation of chronic conditions.
  • Inpatient care management with aggressive transition planning and follow-up.
  • Accessible physical facilities with essential adaptive equipment.

 

What does “care coordination” mean in the DCP model?

Care coordination is part of care delivery, especially as it refers to coordinating and supporting the individual’s care and making sure someone is the responsible for coordinating the care and support for the person’s care needs.  Care coordination includes:

  • Comprehensive, timely assessments and reassessments.
  • Coordination of decision-making across all settings of care and support.
  • Designated coordinator with experience in working with persons with disabilities.
  • Member-centered care and support team, involving family, clinicians and caregivers – identified by the member.

 

When you say the DCP model of care is consumer-or member-directed, what does that mean?

Care that is consumer or member-directed means just that — that the individual makes decisions about her or his goals for care (such as “I want to be able to attend church services on my own,” or “I want to be able to get to the community center on Thursday evenings”), and the care team is there to support her/his goals; it means care is personalized (via the Individualized Plan of Care or “IPC”) and the IPC incorporates the individual’s health care goals and preferences.  It means that the members of the person’s care team make sure there are safeguards in place that ensure that there is respect for the dignity of risk and informed decision-making on the part of the individual. It means that the provider plan makes every effort to enhance the individual’s independence by ensuring that medically or functionally necessary equipment and technology are in place and working. It also means that a participant in a DCP model of care or DCP program is involved in the operations, management, and/or governance of the provider plan, if s/he chooses to be. And it means that any/all complaints by a consumer participant are addressed and resolved fully and quickly.

 

What does “dignity of risk” mean in the context of the DCP model?

“Dignity of risk” means respecting each individual’s autonomy and self-determination (or “dignity”) to make choices for himself or herself. The concept means that all adults have the right to make their own choices about their health and care, even if healthcare professionals believe these choices endanger the person’s health or longevity. Clinicians in the DCP model of care are charged with helping members implement and monitor the Individualized Care Plan (ICP) based on the individual’s choices.  For example, an individual may choose to continue smoking despite the known risks.  She or he may also continue to live alone, without a Personal Care Assistant (PCA), or with only intermittent support, even if others don’t “approve” or if they consider the choice unsafe.

 

What are the domains of disability-competent care?

The domains of care delivery (care/care coordination) currently include (and the list will grow based on needs of individuals):

  • Assessment
  • Care Planning and Service Planning
  • Quality Metrics
  • Primary care delivery, including behavioral health care
  • Mobility
  • Member Engagement & Involvement
  • Stratifying needs to resources
  • Cognitive Support
  • Long-term-care Services
  • Caregiver Supports

 

Who is behind the creation of the DPI?

Commonwealth Care Alliance/Commonwealth Community Care, Community Health Partnership,  and Independence Care System (ICS) — in Massachusetts, Wisconsin and New York, respectively, are the three pioneering organizations that have come together to create the Disability Practice Institute.

These three programs have decades of successful experience caring for Medicaid and dual beneficiaries with involved physical disabilities; indeed they are the only three existing small-scale prepaid clinical programs in the United States that have demonstrated success for positively changing the care for Medicaid and dual beneficiaries with physical disabilities. Currently financed by varying iterations of risk-adjusted Medicaid and Medicare global payments, the three care programs collectively feature disability-specific primary care redesign, individualized medical equipment and personal assistant service allocation and management approaches, enhanced care coordination, clinical competence in care for people with disabilities, and consumer engagement in design, management and governance. 

 

Why did you begin the Disability Practice Institute?

The three pioneering programs have been providing care and supports for people with disabilities for an aggregate 40 years.  They learned fundamental lessons that inspired them to create the DPI.  In brief, these lessons are that for people with disabilities:

  • Primary care is routinely ineffective or nonexistent – members require more time; present with multiple, complex issues; require more physical space, and adaptive equipment.
  • A predictable array of secondary complications cause functional decline, recurrent hospitalizations, poor outcomes and most costs.
  • Reliable personal care and appropriate durable medical equipment (especially wheelchairs) are essential and must be accessible to and integrated with medical care.
  • Individuals who are Medicaid-only and dually eligible for Medicaid and Medicare are clinically indistinguishable.

While there are other excellent programs and models of care, the advancement and ongoing refinement of disability competency in care delivery is needed to ensure persons with disabilities receive the care and support they need to live independently if they so choose. The DPI exists to develop, define and refine the components of disability-competent care, evaluate this care, and assist in replicating the DCP model at a local level.

 

How do the DCP programs pay for care coordination and home-based primary care in addition to all the other Medicaid and Medicare services?

The DCP model does provide new services not currently covered under the current Medicare and Medicaid regulations.  These enhanced services (care coordination) and increased access (24/7 home-based primary care when needed) are financed from the cost savings associated with avoidable hospitalizations.  The obvious example is that the monetary cost of hospitalization and/or (skin-flap) surgery for skin breakdown averages between $50,000 – $70,000 (for hospital-based costs alone; post-hospital/follow-up costs are additional). Add to this the personal costs to beneficiaries of the discomfort, and disruption of many months of lost productivity and independence.  By contrast, when individuals receive timely and appropriate care at any sign of skin breakdown (and of course, prior to this, all preventive care), costs (of all kinds) to everyone are dramatically reduced.  The DCP program requires no additional governmental support; instead the care system makes use of the Medicare and Medicaid payments to provide all needed care, services and supports, all of which are allocated by the primary care team, and driven by the goals and choices of the individual, as described in the Individualized Care Plan.

 

We welcome your input. For questions, more information, or to send us ideas or best practices, write to us at: info@disabilitypracticeinstitute.org