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Stakeholder Engagement in Program Design and Improvement

Purpose and Process of Stakeholder Engagement

The move from a fee-for-service to a managed care contracting arrangement for LTSS may be met with some reluctance from key stakeholders. For example, beneficiaries may doubt that they will be able to receive the care they need in a managed care environment, beneficiaries may have concerns about the possibility of having to change providers, or LTSS providers may be wary of the change in payments. In order to ease concerns, create transparency, and avail yourself of stakeholders’ expertise, it is essential to engage stakeholders early in the planning and transition processes. After the transition has occurred, it is important to continue involving stakeholders in order to address questions, get feedback and maintain stakeholder support. (Barth, 2007, Lind, Gore, Barnette, Somers, 2010).

When engaging stakeholders, some useful steps to keep in mind are:

  • Identifying key stakeholder groups. Beneficiaries and LTSS providers are extremely important stakeholders, but consider engaging others, including, but not limited to, individuals with disabilities, families and/or guardians, consumer advocates, aging and disability service providers (e.g., AAAs, Independent Living Centers), locally active consumer, health, and LTSS non-profit organizations, and prospective MLTSS contractors. Also note that not all stakeholders are external; there are many state agencies that also must come together to effectively implement MLTSS programs. For example, inclusion of state agencies responsible for older adults, persons with developmental disabilities or other LTSS populations; state licensure and insurance; purchasing; and Medicaid managed care are essential to a well-crafted approach.

  • Determining level of stakeholder involvement. Before involving stakeholders, consider how much involvement you want from them and at what specific points in your development process you will need stakeholder input. Familiarize yourself with your state’s procurement rules, and determine if stakeholder engagement must be suspended during certain phases to ensure a fair procurement process.

  • Setting expectations for involvement. Establish your expectations for stakeholder involvement early in the process. For example, develop clear “charge” statements laying out roles and responsibilities, establish rules for stakeholder meetings, inform stakeholders how input will be used, etc (Barth, 2007).

  • Establishing forums for input. Determine the most appropriate forum(s) for meeting with key stakeholders. It may be helpful to have more than one forum to make the sessions as accessible as possible to a wide range of stakeholders. Some examples of forums used by states setting up Medicaid managed care programs include town hall style meetings, focus groups, and committees (Barth, 2007). (click here for more information about establishing forums for input)

  • Educating stakeholders about MLTSS. To improve overall input and to make sure all stakeholders have a similar starting point for discussions, provide materials and have discussions about the basics of managed care and LTSS (Barth, 2007 and Lind & Gore, 2010).

  • Preparing, distributing, and formatting materials. Prepare and distribute documents well in advance of a meeting so stakeholders have an opportunity to review them before attending any of the forums. Also, ensure documents are available in appropriate formats for your beneficiary stakeholders, e.g., prepare documents in braille or large print or provide materials in an audio format for beneficiaries with visual impairments (Consumer Involvement Toolkit, 2010).


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