One challenge involves moving from an unmanaged fee-for-service system to managed care. Smoky CEO Brian Ingraham provided an account of this change and what it means to providers in July's "News You Can Use" newsletter.

Smoky's Selection and Retention Policy offers a fair, impartial and consistent process. One might say, "Of course Smoky thinks that, Smoky wrote the policy!" If you are a provider affected by recent decisions or purely an observer, you may disagree, question our authority or be fearful. My goal is not to ask you to agree with Smoky's decisions. It's about asking you to understand the direction we're taking in a more informed manner.

Smoky has been consistent in recent years in moving toward a comprehensive care center (CCC) model. One of our most important values is to serve the uninsured or underinsured. We do not have the luxury to NOT serve these individuals. Comprehensive care centers promote access to needed services for all people - not just individuals who receive Medicaid. Last year, Smoky served more than 17,000 people in 23 counties who were either uninsured or underinsured. The only way we can serve the thousands of people in need of care but not eligible for Medicaid is by creating a network model committed to serving the most people, regardless of funding source.   

Most providers are challenged in providing services to these individuals using current funding to cover expenses. I'm sure some of you serve the uninsured or underinsured based on your values, principles and moral compass. However, most providers cannot afford to take a loss and serve a large number of people with no payment source. The earlier, unmanaged system of care failed to hold providers accountable for providing services to those unable to pay. That system provided a false sense that these people were receiving care.

Smoky has been open and honest about our CCC model, the process for identifying comprehensive providers and what services they are required to provide. Under this model, many people who never received care are now offered services. The need for more services will increase as the number of individuals unable to pay for care and those living with mental health, intellectual or developmental disability or substance use challenges continue to grow. This is one reason we believe the CCC model is the best way to serve the most people.

This model is the "best thinking" to implement our values that all people are equal, and to maximize state funding for indigent care. If you have innovative ideas of how to serve more people without funding, I would love to hear from you.  

Note: Next month's focus will be more specific to challenges with the intellectual/developmental disability provider network.