Professional Affairs Update

This year, the Professional Affairs Committee was given the charge to “Coordinate ways to aggregate performance based data services for SLPs in the pediatric service area and obtain evidence based practice

data to use to advocate for services and negotiations with payors”. This charge was developed as the NC Department Health and Human Services (/DHHS) will be transitioning to a managed care structure for all Medicaid recipients with a projected implementation date of July 2019.

North Carolina DHHS will procure and contract with two managed care plan models, known as Prepaid Health Plans (PHPs).

Commercials Plans (CPs) – Per the managed care legislation, DHHS is to contract with three CPs to provide integrated physical, behavioral, and pharmacy services under statewide contracts.

Provider-Led Entities (PLEs) – PLEs will be able to bid on individual regions in the state, and are not required to operate statewide. PLEs must cover a region in its entirety, and may bid for more than one region, provided the regions are contiguous. There are specific statutory rules regulating the ownership structure and governing body of PLEs. Hospitals and physician groups can form PLEs.

Managed care will require that all Medicaid beneficiaries choose a CP or PLE that will administrate all services for the patient. This will pose a significant challenge to providers as there will be a shift from volume-based care or fee for service to a value-based reimbursement structure or fee for value. Value-based reimbursement encourages healthcare providers to deliver the best, most effective care at the lowest cost. Value-based reimbursement and rate setting rely on quality measures and outcome data, which is lacking in the pediatric world of audiology and speech-language pathology. ASHA has developed National Outcomes Measurement System (NOMS) for adults, but this data has not been gathered for the pediatric population.

In order to develop an outcome-based value measure for the pediatric population in NC, Wayne Foster, Ph.D., CCC-SLP/A of Cheshire Center is gathering and analyzing longitudinal data for two, three and four-year-old children enrolled in speech/language services. Wayne’s analysis is based on obtaining a language sample for patients during the initial evaluation and determining the mean length of utterance for the child. Subsequently, a language sample is gathered and analyzed at 3- month intervals until the child has received speech therapy for one year.

If you want to learn more about this project or are interested in participating in this important effort to gather data for pediatric outcomes-based data, please contact Dr. Foster at wfoster@cheshirecenter.net.

Cynthia Flynt, Chairperson of the NCSHLA Professional Affairs Committee and President of Venture Rehabilitation Group

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