Insights

Coding, Coverage, and Payment to Improve Inclusive Health

Individuals with intellectual and/or developmental disabilities (I/DD) face unique challenges in equitable access to high-quality health care and experience poorer health outcomes. These challenges are compounded by difficulties that clinicians face in providing care to this population, with barriers impacting clinician-to-patient time, time to prepare for visits, coverage and payment for services, infrastructure and accommodation limitations, and workforce and training gaps.

Special Olympics has promoted the concept of Inclusive Health, a set of principles designed to ensure that people with I/DD have access to, and can fully participate in, their own health care decisions. Special Olympics contracted with Leavitt Partners, Health Management Associates, and the Institute for Exceptional Care to better understand how coding mechanisms may reduce barriers to Inclusive Health.

This report reflects insights from a detailed coding analysis, literature review, and interviews with 22 experts on the elements needed to develop and implement Inclusive Health-driven care models and overcome barriers impacting care for individuals with I/DD. With insights from the interviews and analyses, the team developed potential policy options and solutions to accelerate and expand the adoption of Inclusive Health-driven care models. The four areas of potential solutions include:

  • Cover additional services needed to achieve care models consistent with principles of Inclusive Health.
  • Provide sufficient payments that account for the significant costs and the flexibility needed to implement Inclusive Health-driven care models.
  • Reduce administrative burdens for clinicians and staff who serve individuals with I/DD.
  • Increase training of clinicians and staff to enhance the workforce who can execute Inclusive Health-driven care models and increase education of payers to support provider and practice innovation.

For questions or comments on the report and its findings, please contact our expert below.

This report was resourced by Special Olympics. Special Olympics Health activities are supported by many sources, including a grant from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS). These contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or HHS. 

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