Major changes are taking place and legislative initiatives are anticipated in the near future that will impact the lives and aspirations of individuals with disabilities. Legitimate concerns and apprehension are matched by new challenges and opportunities that will emerge for individuals, families and providers.
Those were among a number of themes arising from The Resource Center's third annual TRC Symposium at Chautauqua, recently held in the Athenaeum Hotel and various TRC locations.
The opening speakers were Patrick Gauthier and Bill TenHoor from Advocates for Human Potential, a Massachusetts-based firm that works with governments and community-based organizations across the country. They addressed the Affordable Care Act and the changes that will take place once it is fully implemented.
At the end of the symposium, the guest speakers were given paintings created by individuals in TRC’s Traumatic Brain Injury Program in Dunkirk. Pictured are, from left, sitting, speakers Edye Schwartz and Thomas Cook, with artist Justin Tallchief; and, standing, speaker Patrick Gauthier; artist James Spicer; speaker Bill TenHoor; artist Frank Luce; and speaker Jerr Boschee.
Under this act, 32 million Americans who previously did not have health insurance will be covered. There will be no denial of coverage based on preexisting health conditions, and the lifetime cap on coverage will be eliminated. Medicaid eligibility will also be expanded.
"This form of managed care says there are no incentives until you make people well. You have to provide the right kind of care, in the right place, at the right time, for the right reasons," Gauthier said. "Provide better care, achieve better outcomes, for less than that pot of money, and then you will share on the savings."
TenHoor and Gauthier urged providers to stay in touch with their elected state government representatives as New York unrolls its new health care system, so that providers' concerns are taken into account as the system is developed.
The next presenter was C. Thomas Cook, the executive director of Rehabilitation for Wisconsin in Action, a collection of organizations supporting 75,000 Wisconsin residents with disabilities and economic disadvantages. Cook talked about what New York State can learn from the experiences of Wisconsin and other states in implementing managed care to support people with developmental disabilities.
He said that managed care is not necessarily a better or less-expensive way to provide services to people with disabilities.
"In our experience," said Cook, "it actually has reduced choice" for people with disabilities.
A panel presentation brought together three people with a range of disabilities who receive supports from The Resource Center.
"Thanks to Passages PROS," said Edward Christensen about TRC's Personalized Recovery Oriented Services program in Jamestown, "I have learned so much about myself and others with the same, and different, problems in our lives that make us hide in an alcoholic or drug-induced state or literally hide from other people. I'm getting stronger mentally, emotionally and physically every day."
Jocelyn Monaco, who lives in a community residence operated by TRC and works at TRC's Jamestown Work Center, spoke about her love for her job.
Andrew Lockwood, a young man who is on the autism spectrum, spoke proudly about how he graduated from Jamestown Community College with an associate's degree. He has found a job at Truck-Lite in Falconer, while he is pursuing his dream of becoming a published writer.
"He's living within his community," said Lockwood's mother, Julie McCarthy, "and it's because of programs at The Resource Center that he is able to do that."
The first post-lunch speaker was Edye Schwartz, the director of Systems Transformation for the New York Association of Psychiatric Rehabilitation Services. She spoke about the changes taking place in the mental health delivery system in New York State.
Despite the large amount of money spent on Medicaid beneficiaries with mental health challenges, these people have not been receiving comprehensive care coordination.
To provide more effective care at a reduced cost, and in a way that focuses on people with mental health challenges, New York State's Medicaid Redesign Team created Regional Behavioral Health Organizations (BHO). Under this initiative, New York State is scheduled to move from its current system to a system in 2014 aimed to improve the coordination and delivery of behavioral health care while also linking to the broader health care, rehabilitation and housing systems.
The new system will reward those providers who are able to be entrepreneurial and develop effective collaborations with new partners and payers.
The notion of entrepreneurship was a key focus of the day's final speaker, Jerr Boschee, the founder and executive director of The Institute for Social Entrepreneurs, located in Dallas, Texas. He encouraged not-for-profit agencies to identify and develop business strategies "having a financially viable organization and a significant social impact on the people they serve."
In order to have a secure future, not-for-profits such as TRC must strive to become self-sufficient by generating the money they need through earned income alone. TRC has been moving in this direction through the operations of its Work Centers, which last year did more than $50 million in business for a variety of federal, state and private customers.
In spite of TRC's efforts, many people with disabilities are still unemployed or underemployed.
"We have an available labor source that no one else is using," Boschee said. "We have to find a way to use them."
Providing employment to people with disabilities benefits the workers and is good for the economy. A 1982 study that determined the average job has a $52,000 annual effect on the economy. Adjusting for inflation, Boschee said that today, the average job has a $133,000 annual impact on the economy. Over a 40-year work career, that equates to a $5 million impact.
Heather Brown, TRC's assistant executive director for program operations, facilitated the session with Gauthier and TenHoor.
Drawing on Boschee's message from the first day, Gauthier encouraged TRC to develop a "highly replicable model that other folks in other states need" when it comes to delivering services to people with disabilities.
TenHoor concurred, suggesting TRC become a leader in tying together social services and health services.
Cook's morning session focused on managed care organizations and the expanded use of technology to improve the lives of people with disabilities. Service providers must educate their stakeholders on the changing landscape of services to people with disabilities. He urged TRC to work closely with its state-wide associations and other regional providers so that there is a united voice on issues as they come up.
Michelle Williams, TRC's director of mental health services, facilitated Dr. Schwartz's session, which focused on accountable care to people challenged by mental illness.
Dr. Schwartz said the stigma that continues to surround people with mental illness keeps them from being proactive in trying to get out into the community and strive for the kind of life they deserve.
Michael Volk, TRC's director of rehabilitation and employment services, facilitated Boschee's session, where much time was spent discussing "the tightrope between money and mission" and the challenge to develop new ways to support people with disabilities that also will reap financial rewards.
Paul Cesana, TRC's executive director, thanked the presenters for helping to try to move TRC "in new directions that we didn't think of before."
In appreciation for their visit to TRC, the presenters were given paintings made by artists that have been affected by traumatic brain injuries.
TRC hopes soon to have videos from the symposium on its website, www.resourcecenter.org, so that others may experience the ideas and enthusiasm shared by the speakers.