Synergies and collaborations between disability and aging services providers are a natural fit in an integrated health care landscape. Both fields are committed to providing support that keeps people safe and comfortable in their homes and communities for as long as possible. Both are facing an increasingly constrained funding environment that has forced leaders to consider new health care partnerships as a potentially substantial source of revenue and sustainability.
Ability Resources, a Tulsa‑based center for independent living (CIL), and Indian Nations Council of Governments (INCOG), an eastern‑Oklahoma Area Agency on Aging (AAA), have teamed up to respond to the opportunities and challenges presented by these changes in service payment and delivery systems. Together, Ability Resources and INCOG formed The Oklahoma Aging and Disability Alliance, LLC to serve as a unified vehicle for cross-organizational collaboration and consolidated contracting with health care partners.
The alliance was formed to expand community services and receive payment for those services from health care entities such as hospitals and insurers. They have used the legal mechanism of a Limited Liability Company (LLC) to formalize their partnership for this initiative. The Alliance is exploring contracts to offer services such as case management, evidence‑based fall prevention, chronic disease self‑management programs and nursing home diversion. [Read the full case study here.]
Ability Resources and INCOG each have traditionally offered services that are complementary: The CIL provides services in peer counseling, advocacy, independent living (IL) skills training, information and referral, transportation, housing and case management while the AAA provides Older Americans Act services such as nutrition, in-home care, health and wellness, family caregiver support and other supportive services.
The LLC allows Ability Resources and INCOG to position their organizations as a unified entity that offers payers a wider array of services than they provide separately. They can meet the needs of a broader target population. This is attractive to health systems or other payers looking for community-based organizations with which to contract. INCOG AAA director Clark Miller noted, “Depending on the business opportunity, it gives both organizations options when looking at contracting–individually, or as a combined entity.”
Good Communication Formed through Long‑Standing Business Relationship
Recognizing there will be challenges in any business relationship, Carla Lawson of Ability Resources and Clark Miller of INCOG say they are committed to keeping lines of communication open, a long‑standing practice for them. Their business relationship began over eight years ago when they partnered on a transportation initiative that sparked a lasting collaboration. Moving the business relationship to anLLC was a reasonable next step.
INCOG is represented by two Board members in the LLC and Ability Resources by three. This split was made to avoid management deadlocks and provide for clear decision‑making for the LLC. Without a basic level of trust, this approach would not have been an option. Miller noted that if the AAA were to be consistently out-voted by the CIL, then both organizations would thoughtfully discuss their collaboration. With the Alliance built upon several years of prior collaboration, the AAA and CIL feel confident that most challenges can be resolved if identified and addressed. This is a practice they have followed over time and can and will continue in the new LLC.
Core Missions Maintained for Partner Organizations
The LLC, essential to reach wider constituencies and to secure new funding streams, still allows Ability Resources and INCOG to maintain their separate identities: “Our experience is an example of how the creation of a stand-alone entity utilizing selective elements of two complementary agencies can be accomplished without undermining the core mission of either agency,” Miller said.
Lawson and Miller recognize their organizations will have somewhat different cultures and different approaches to service delivery. Because of earlier collaborations, they believe the organizations can work together harmoniously. They do plan trainings and other team activities involving staffs of both organizations to foster a common, positive culture.
Reconciling Different Approaches to Services
CILs and AAAs have traditionally operated with different approaches. Sometimes incorrectly described as only a difference in organizational culture, the differences go beyond culture: consumer control (consumer direction) practiced by CILs is firmly rooted in an independent living philosophy which holds that an individual has authority in decision making about how services are provided, when and by whom they are provided. Consumer direction and independent living mean, “…being able to exercise the greatest degree of choice in where you live, with whom you live, how you live, where you work, with whom you work and how you use your time.”(See greater choice and control to individuals.)
CILs have for more than four decades established a model that de-medicalizes services. Disability rights organizer Stephanie Thomas wrote in the article A Disability Perspective on Home Health Care, “The traditional stance in our culture is that “normal” is the “Pepsi generation” version of youth and physical fitness, and anything diverting from this is an abnormality which should be corrected. In the disability community, this is sometimes referred to as the “medical model” for service provision.”
Those in the aging field have been seen by those in the independent living movement to operate from more traditional service approaches based on a “care” approach closer to a medical model in which others–not the individual–have greater authority over decision‑making. The person‑centered approach used widely in the developmental disabilities field has more recently been adopted by many aging organizations. Those working in CILs experience the approach as a positive and important advance, although their perception is that it has traditionally offered diminished authority or agency of the individual. Recently, the person-centered approach has come to be considered as a framework for consumer control or self-direction, as described in a news announcement from the Administration for Community Living: “While person-centered planning provides the basis for self-directed arrangements, self- direction allows the person to have much greater control over services and supports than would be possible under traditional arrangements. Consistent with the philosophy of independent living, self-direction embraces the values of freedom, authority, autonomy, and responsibility to allow the person to fully participate in community life with the necessary supports.” Person-Centered Planning and Self-Direction
Ability Resources and INCOG will address these differences (and perceived differences) with a multipronged strategy. Through training and dialogue, their staffs will be exposed to or review consumer direction and person-centered services, as well as discuss and understand commonalities and divergences. On an operational level, they will adopt common strategies that maximize individual control. If there are difficult decisions around individual decision‑making in which, for example, an individual wishes to adopt an approach that may be thought not to be the best strategy, the organizations will adhere to a structured and thoughtful approach that considers the individual’s authority and “right to fail” while maintaining funder requirements of ensuring safety and wellbeing.
Positioning for New Funding Opportunities
The changing funding environment for community‑based services was an important driver for the decision to form the strategic alliance of Ability Resources and INCOG. INCOG’s Clark Miller said, “In this time of stagnant government funding, both our networks needed to be better positioned to seek out new business opportunities. The process of developing an LLC challenged our mindset of being grant-funded entities, to one where we began to understand how new business opportunities can support our long-term sustainability.”