As federal lawmakers head home to their constituents for a month-long August vacation, many disability community members are asking: what will be the impact of the new health care reform policies on people with disabilities and the all organizations that serve them? What could be the cumulative impacts of federal as well as state changes? At least one Minnesota organization, Axis Healthcare, isn’t waiting for answers before it retools to adapt to the known changes.

AXIS Healthcare is based in the Twin Cities. It was cofounded by Courage Center and Sister Kenny Institute in the late 1990s to bring knowledge of disability to managed care. Since then it has carved a niche in the local health care market as a care coordination expert for non-elderly adults with disabilities.

On its Web site, AXIS Healthcare describes itself as “an innovative model of disability care coordination because it puts you, the person with disabilities, at the center of everything rather than the insurance provider, health care provider, or equipment supplier.”

AXIS is a place “where disability care revolves around you,” according to the Web site. “That means you are at the center of making decisions about your care; you are at the center of all of our efforts and initiatives as an organization; and your independence, health and well being are the focus of our attention as we make recommendations and arrangements regarding your care.” But how that self-direction could be affected is unknown with the upcoming changes.

Perhaps best known for its role as care coordination contractor for UCare and for the Minnesota Disability Health Options (MnDHO) program, the state’s only fully integrated Medicaid/Medicare managed care program for people with disabilities. AXIS also serves as a care coordination contractor for Medica’s Special Needs Basic Care plan, AccessAbility.

But shifting political winds are bringing changes to the AXIS organization. Those changes were recently communicated to AXIS clients at a Member Advisory Committee meeting. AXIS Board chairperson, Karl Sandin of Allina and AXIS Board vice chairperson, Jan Malcolm of Courage Center also wrote a letter to organizations leaders in the disability community explaining the situation. “With healthcare reform looming at both the State and Federal levels, AXIS must refine our practice and demonstrate our value to position ourselves for alternative future scenarios.”

State legislative changes have both limited the growth of the MnDHO program by capping the availability of waivers and cut payments for the program’s services. The federal government’s inability to successfully match the payment for health services needed by Medicare clients served by AXIS with the costs of providing those services have created additional challenges

“In the short term, AXIS needs to greatly reduce our organizational cost structure,” Malcolm and Sandin stated. Personnel costs are at the top of the list.

Chris Duff, CEO will be leaving the organization, as his position was the first to be eliminated. Duff said, “As we look to the future for greatly reduced revenue, we need to make the cuts without significant impact on our staffs who works directly with the members, AXIS’s cuts will involve mostly administrative and managerial positions for minimal impact on our members,” Duff said. “in healthcare administration should be the first to take the hit!” Duff, who has been with AXIS since it began, will be missed which was stated at the Member Advisory Committee when Duff announced his departure to them. Additional options are also being explored to leverage the skills of owner organizations to create efficiencies in all areas, as well.

Nancy Larkin, COO at Courage Center and an AXIS board member said, “Both owner organizations are determined to preserve the relationships between client and their care coordinator. That is at the heart of what sets the AXIS model apart. If anyone served by AXIS has any concerns or questions, they should feel free to contact their care coordinator,” Larkin said, The current Member Advisory Committee will also continue to serve as a forum to raise and address any consumer or client issues.

The AXIS changes come at a time when national health care changes are also being seen. A key part of health reform packages at both the state and federal level is the concept of care coordination, recognizing that those with disabilities and chronic conditions often lack a comprehensive care plan and a lead coordinator to cut through the red tape and make it a reality.

The state Department of Human Services (DHS) began enrolling providers in its Primary Care Coordination program on Aug. 1. This will pay clinics a fee for successfully coordinating the care of those with multiple chronic conditions who are enrolled in the Medical Assistance programTypically the more complex the individual, the higher the payment will be.

DHS is also well on its way to developing rules and standards for its Health Care Home initiative, a cornerstone of the 2008 Health Reform Act. This program, too, will reward clinicians for better coordinating the medical needs of those on Medical Assistance. Eventually, health care homes will be included in the program offerings of all health plans in Minnesota.

At the national level, there are dozens of health care home pilot programs now underway for Medicare enrollees.

At a Minneapolis meeting of the National Council on Disability held July 22, Pam Parker of DHS made a plea for those at the national level to take a more “thoughtful and integrated approach” to health reform that recognizes the needs of many who are enrolled in both Medicare and Medical Assistance.

While much remains uncertain at the national level, AXIS leaders say the organization remains committed to those it now serves, and hopes to play a role in meeting the needs of those who now lack any help in coordinating their health services.