Rizzo and Siegfried | 29-36




Positive Approaches Journal - Volume 2 Title

Volume 8 ► Issue 4 ► 2020



The Adult Community Autism Program: A Different Approach

Julie Rizzo & Kimberly Siegfried, Ph.D.


Abstract

Ten years ago, a group of individuals proposed a paradigm shift in human service delivery. Challenging the traditional model, the Adult Community Autism Program (ACAP) was developed as a comprehensive, person-centered, individualized, integrated, and cost-effective way to provide the care, supports, and services an individual needs to live a socially valued and healthy life. This article describes the advantages of this program to maximize resources through a capitated support model that provides physical, behavioral, and community-based services to adults with autism.

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Ten years ago, a group of individuals created an innovative approach to supporting adults with autism. In contrast to the traditional model of service-delivery, their vision was to support adults with autism within their communities, in natural settings, rather than segregated facilities. Determined to evolve the role from that of a provider of services to that of a facilitator and community organizer, their model incorporated several key aspects: person-centered services across the lifespan; efficient, accessible, sustainable, quality, and cost-effective services; and partnership among individuals, families, government, and providers. From this vision, the model for the Adult Community Autism Program (ACAP) emerged.

In 2009, Pennsylvania Department of Human Services (DHS) obtained approval for a Prepaid Inpatient Health Plan (PIHP) under the 1915(a) authority to create the Adult Community Autism Program (ACAP) in four Pennsylvania counties.1 ACAP was the first program in the nation to use a single home- and community-based services (HCBS) provider, Keystone Autism Services (KAS), to provide an integrated system of care as a managed care organization.1 ACAP was designed to provide physical, behavioral, and community-based services to adults with autism not limited to Medical Assistance service definitions. KAS, a subsidiary of Keystone Human Services, functions as a service provider as well as the managed care organization. All health services as well as behavioral, skill building, and community supports are coordinated and provided by ACAP. This model was designed to maximize continuity, flexibility, integration, and coordination of a wide range of services for participants, and thus maximizing resources. ACAP is guided by the following foundational principles:

- Every person living with an Autism Spectrum Disorder (ASD) can experience a meaningful and quality life
- Every person with ASD can grow and learn for the entirety of their life
- Services are comprehensive, highly individualized, flexible, and continuously adapted to the person’s needs and preferences
- Services are community based and make maximum use of the capacity of the family, friends, neighbors, and community at large
- Therapeutic strategies are evidence based and are carried out by a highly qualified clinical team
- The effectiveness of the program is continuously measured
- The program makes maximum use of innovation, creativity, and technology to support successful functioning

ACAP operates as a fully functioning Managed Care Organization (MCO) where KAS receives a capitation payment and takes risk for 200 individuals. ACAP Participants must disenroll from their HealthChoices Plan and enroll in the ACAP as their insurer. ACAP is responsible for clinical and administrative oversight of all services provided pursuant to an individual support/care plan. ACAP contracts with a provider network of physicians, as well as psychologists, therapists, counselors, and nutritionists. An administrative third-party organization (TPO) is responsible for processing billing and claims. ACAP manages and pays all health services, with exception of hospital, diagnostic, laboratory, and pharmacy services, which are covered by private insurance, Medicare or Medical Assistance.

ACAP has incorporated many strengths of the traditional MCO approach such as the capitation payment methodology matched with the responsibility for coordination of all care and services. ACAP has been able to bridge the traditional health services to the traditional waiver services and successfully coordinate and integrate the services. ACAP is not just a model for the young, healthy, and singly diagnosed adult with autism. The majority of individuals in ACAP have co-existing medical and/or mental health conditions. Supports for individuals served reflect careful consideration of the impact of comorbidities. As an MCO, ACAP has a responsibility to manage the health and wellness of its participants. Hiring clinically skilled staff has helped ACAP succeed in making progress with individuals. ACAP serves individuals with a broad range of support and supervision needs. Currently there are seven individuals living in a licensed residential setting with five of those individuals having significant medical needs. There are four individuals for which ACAP provides 24/7 support with limited natural supports, and there are nine individuals which are dependent on support shared by family and ACAP. The capitated model works with a mix of those independent individuals with those needing a higher level of care and support.

ACAP is able to maximize resources by having an adaptive, flexible, integrative team approach. With in-house supports coordination and a team led by a behavioral specialist, an individual’s supports and services can be changed quickly to meet the needs of the individual and/or family. ACAP also has the ability to identify non-traditional services that are deemed medically necessary to meet the needs of each individual. This provides flexibility to address important issues. For instance, gym memberships have been purchased for participants to address underlying medical issues including obesity, to provide a typical role for the individual, and to afford community inclusion and socialization in a typical setting. The internal supports coordination process permits efficient flexibility in service and supports authorization and delivery.

ACAP is structured to focus on outcome measures in addition to process measurements. The program is highly person-centered, clinically driven and integrated. The outcomes measured include improving the stability of participants, increasing community participation, independence, and meaningful engagement (employment, volunteering, and higher education), and improving access to medical services. With an individual’s team led by a behavioral specialist, services are driven by data-informed decisions based on progress the participant is making on their own person-centered goals, on an analysis of the annual assessments, on a review of medical needs, and on what the participant finds most important in their life.

Employment was an early goal identified for ACAP. The chance to serve in a valued role and earn money is very important for individuals. ACAP’s model allows for the focus towards integrated and competitive employment through skill building related to job searching, resume writing, interview skills, applying for jobs, volunteering, and/or higher education. Current data indicate this to be a highly successful service, with over 55% of ACAP individuals being competitively employed. Data are also gathered and assessed for the following quality indicators: volunteer work, number of hours participants work or are engaged in volunteer work, type of employment, and involvement in higher education.

Finally, the inclusion of health services, along with behavioral health and other support services in a truly integrated approach is an important part of the success of ACAP. Individuals and their families are spared the challenge of navigating multiple systems to meet their various medical and behavioral needs. ACAP successfully developed a network of healthcare providers so individuals can obtain access to the care they need. For these reasons, ACAP participants are largely successful with completing annual physical, dental, and gynecological exams. As ACAP evolves, so too does its impact on health with a focus on exercise, nutrition, and medication.

In conclusion, the ACAP structure and approach allows KAS to maximize resources for a truly comprehensive, person-centered, individualized, integrated, and cost-effective way to provide the care, supports, and services an individual needs to live a socially valued and healthy life.






References
  1. Pennsylvania Department of Human Services Medical Assistance Quality Strategy for Pennsylvania. Health Choices website http://www.healthchoices.pa.gov. Published April 20, 2017. Accessed January 29, 2020.
  2. IHI Triple Aim Initiative: Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs. Institute for Healthcare Improvement website www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx Accessed December 27, 2019.
  3. The Center for Consumer Information & Insurance Oversight: Medical Loss Ratio. Centers for Medicare and Medicaid Services website www.cms.gov Published July 24, 2018. Accessed December 27, 2019.

Biographies

Julie Rizzo is the Executive Director for Keystone Autism Services and provides program administration for the Adult Community Autism Program as both the managed care organization and provider services. 

Kimberly Siegfried, Ph.D. is the Clinical Director for Keystone Autism Services and provides clinical oversight as well as training and consultation with treatment teams to ensure efficacy of supports and services provided to participants. Dr. Siegfried collaborates with Julie Rizzo to align clinical and operational resources to optimize program outcomes.

Contact

Julie Rizzo, Executive Director

Keystone Autism Services

3700 Vartan Way

Harrisburg, PA 17110

(717) 220-1465