Since 1999 AXIS Healthcare has been operating its healthcare advocacy and coordination program for people with disabilities in the state of Minnesota as a pilot program. By accepting clients on a voluntary basis, AXIS hoped to learn what is really needed to build a successful managed care provider for people with disabilities before they launched the business into the community on a larger scale. Now they believe they have learned what they need to know, and the federal government has agreed with them. On September 1, 2001 the federal Center for Medicare and Medicaid Services (formerly the Health Care Financing Administration) authorized AXIS to begin taking on paid clients for the first time. Some of the leading advocates in the disability community, who were skeptical of the program in its early days, now are major supporters of the AXIS project. This article will take a look at what AXIS Healthcare is doing and plans to do now that it is formally “in business.”
The initial founders of AXIS were Courage Center, the Sister Kenny Institute, and Becklund Home Health Care.
(Becklund is no longer involved.) Some of the initial founders were involved in managed care but, when sitting in on roundtable conferences at the Minnesota Department of Human Services, did not declare themselves as representatives of AXIS. It was at that time that rumors were beginning to spread through the disability community about this new program. Charlie Smith, long-time disability advocate and editor of Access Press, was very concerned about why people would keep their intentions quiet. The concern was that AXIS might be just another program taking a paternal approach toward people with disabilities, saying, in effect “We already know what’s best for you and you should be happy we are looking out for you.”
The organization claimed that they had not incorporated yet and they really didn’t know what AXIS was going to become, if anything. According to Chris Duff, Executive Director of AXIS Healthcare, “it was unfortunate for AXIS to have started with a bad reputation within the disability community. In hindsight, we should have known better and explained our intentions to key people in the disability community so that it didn’t look like we were doing anything underhanded.” AXIS did subsequently disclose all their intentions, and the rumors quieted.
Some of the other concerns surrounding AXIS had to do with the bad reputation that managed care organizations (MCOs) as a whole have had in the disability community. The problem with most MCOs is that they frequently lack expertise in health issues that are unique to the disability community. Other managed care programs have not had voluntary enrollment, so that limited the opportunity for an individual to find someone with the expertise needed for their particular situation. Around the United States, lack of input from the disability community has resulted in other Medicaid managed care programs providing poor service, resulting in disappointed consumers.
Because it was founded by Courage Center, Sister Kenny Institute, and Becklund Home Health Care, all of whom had long track records in working with the local disability community, AXIS Healthcare has been able to draw upon the expertise of people with disabilities to best use the system to create a workable program. Much of the staff have years of experience working with disability health issues. This continued input by all of these groups is what some specialists say will set AXIS apart from earlier MCO programs.
How AXIS Works
The way the plan is intended to work is that the staff of AXIS will be the advocates for each individual enrolled in the plan. The plan will be available to any person with a disability aged 18 to 65 who is enrolled in Medicare, Medicaid or Minnesota waivered services. AXIS staff will follow the individual through the often-confusing maze of the healthcare system, coordinating the medical needs of each enrollee, whether that means keeping track of doctors’ appointments, ordering a wheelchair, or dealing with the UCare, Medicaid, and Medicare bureaucracies.
The community-based services involved with AXIS will include: personal care attendant services, durable medical equipment, adult day-care, independent living skills, behavior management, respite care, and others. Integration of mental health and chemical health services will also be available. The potential of bundling services will minimize redundancy costs and shorten time expenditures for all by increased coordination. AXIS will keep your primary physician informed about what your neurologist or urologist is doing, and vice versa. Each volunteer enrollee will maintain his or her key providers so, as an AXIS client, you won’t be expected to change your key vendors. AXIS promises to work with almost all agencies with whom their clients already have relationships.
AXIS will offer a choice of primary care doctors from a small network of disability-experienced clinics. AXIS promises to coordinate the authorization between the provider and payee with no hassle to the AXIS client, hopefully making long waits for prior authorization a thing of the past. Contracts with AXIS are voluntary, so if the plan does not work out for a client, the client has the option of disenrolling and going back to his/her previous program.
Many people with disabilities have experienced the negative side of trying to navigate through the healthcare system in the United States. Most people with disabilities are very capable of choosing competent providers. The trouble lies in coordinating all the providers. A supplier of durable medical equipment has to have a prescription. In order for the durable medical equipment supplier to get a prescription they must go through the primary physician, and the primary physician has to speak to the physician that ordered the equipment. For this all to happen often takes two weeks and, in the meantime, the pressure sore that brought on the problem in the first place needs the dressing today. Avoiding this type of problem is where AXIS promises to excel.
AXIS Healthcare will coordinate this process and get the supplies to you when you need them. Chris Duff claims, “AXIS doesn’t provide healthcare services. It empowers people with disabilities to make choices about their healthcare services and helps cut through the red tape to coordinate the unique needs of each of AXIS’s consumers.”
The Robert Wood Johnson Foundation (affiliated with the Johnson & Johnson Corporation) has awarded AXIS a two-year grant to help support the project. Many people throughout the United States are watching this program, including our own state government’s Minnesota Disability Health Options (MNDHO) program. The experts say that, if all goes well, Minnesota could be the home of another groundbreaking program that will be copied throughout the country.