developing service packages for integrated care february 20, 2014 11:30 am – 12:30 pm est
TRANSCRIPT
Developing Service Packages for Integrated Care
February 20, 201411:30 am – 12:30 pm EST
www.mltssnetwork.org
Developing Service Packages
Offering Choices for Independent Lives
Lynn Kellogg, CEORegion IV Area Agency on Aging, MI
Aging Network’s Evolution to Medical Partnerships Simultaneous development on 2 levels…
Level 1: Product development with Health Plans/Funders
Integrated Care [IC] – product design associated with Michigan’s Integrated Care demonstration for persons with dual eligibility [Medicare & Medicaid]
Level 2: Product development w/ local hospitals, FQHCs, PCP groups
Interagency Care Teams [ICT]: product design associated with avoiding hospitalization readmissions, ACOs, PCMHs and other best practices.
Service Packages…Integrated Care [IC] –Level 1
Process: “Unbundling” Medicaid waiver, OAA and state initiatives and repackaging to conform to the Patient Benefit Plan [PBP] required of all health plans competing for a role in the proposed IC demonstration. Includes re-pricing, re-bundling, determination of ability to assume risk and scalability
Service examples: supports coordination, transition, assessment, vendor management, housing assistance, self-directed care, all HCBS, evidence-based training
Interagency Care Team [ICT] - Level 2
Process: Working w/ case management staff and PCPs from different entities serving the same individuals to achieve better outcomes
Service: Creation of ICT to link medical & HCBS providers; capability to shift lead across agencies; HIPAA communication tool
Networks…Integrated Care [IC] –Level 1
Who: Other AAAs serving IC demonstration region
Service Providers
Why: Need to present “single” package to health plan
Need vehicles for increased capacity
Interagency Care Team [ICT] - Level 2
Who: AAA, FQHC, Hospital, Health Dept.
Designed to expand to other entities on Community Roadmap
Why: AAA – transitions coaching; linkage to HCBS; ongoing CM
FQHC – PCP; care coordination
Hospital – Identification of all initial patients; coordination w/ hospitalists, other physician groups
Health Dept. – outcome analysis; data tracking
Tween Value Expectations…
Integrated Care [IC] –Level 1
•Cost-effective service network for HP
•Person-centered approach for consumers
•Structural partnership between aging network and medical systems
•Expanded development of HCBS system
•Expansion of consumer training/empowerment
Interagency Care Team [ICT] - Level 2
•Reduced hospitalizations
•Better health outcomes for targeted high risk patients/consumers
•Less duplication & fragmentation of effort
•Development of “bundled” payment model for scalability
•Recognition of merit of AAA product as valued for ACO, PCMH development
Tween Results/Commitments…
Integrated Care [IC] –Level 1
•Scalable service delivery
•Assumption of risk [under discussion]
•Commitment to refining system as needed; development of new AAA direct services
•Creation of legal partnerships w/ otherAAAs for efficient geographic response
Interagency Care Team [ICT] - Level 2
•Reduction of ED use & hospitalizations; cost reductions
•Better health outcomes for some diagnoses
•Consumer empowerment - patient survey
•Creation of replicable model
•Initial redirection of staff time making ICT a priority
Tween Advice/lessons learned…
Integrated Care [IC] –Level 1
•Must let go of pre-established terminology and processes
•Shift to a “business only” model
•Need to improve/scale up data tracking and analysis
•Must combine new pricing strategies with volume expectations for negotiations & sustainability
Interagency Care Team [ICT] - Level 2
•Need to build on relationships
•Approach from consumer perspective; recognize where work/goals intersect
•Use reality that major systems have great services but operate in functional isolation, often seeing the same person
•Creating a Community Roadmap of the range of services available to and used by consumers helped give perspective
Questions?
Developing Service Packagesthat appeal to healthcare entities of
various sizes, shapes and motivations
June Simmons, CEOPartners in Care Foundation
Presented to N4A, February 20th, 2014
Partners in CareWho We Are
Partners in Care is a transforming presence, an innovator and an advocate to shape the future of health care
We address social and environmental determinants of health to broaden the impact of medicine
We have a two-fold approach, creating and using evidence-based models for: provider/system practice change and enhanced patient self-management
Changing the shape of health care through new community partnerships and innovations
Partners in CareWho We Are
5% spend 50%
1% spend 21%
The Upstream Approach: What would happen if we were to spend more addressing
social & environmental causes of poor health?
The Upstream Approach: What would happen if we were to spend more addressing
social & environmental causes of poor health?
• 2011 RWJF survey of 1,000 primary care physicians– 85%: Social needs directly contribute to poor health– 4 out of 5 not confident can meet social needs,
hurting their ability to provide quality care– 1 in 7 prescriptions would be for social needs– Psychosocial issues treated as physical concerns
• This is the gap we fill…our value to patients and the healthcare system
Healthcare’s Blind Side
Why should CBOs be part of the healthcare system?
• To thrive, CBOs need to play a new role connecting the home with the healthcare system– Home provides unique perspective otherwise unavailable
to healthcare providers.
– Quality measures for health plans and providers relate to issues such as medication use and fall prevention – HEDIS, Medicare Advantage Star Ratings
– Meds are major factor in readmissions (72%)
– New focus on population health – identifying and proactively addressing health for high-risk patients
Healthcare + HCBS = Better Health, Lower Costs
• We address social determinants of health– Personal choices in everyday life– Isolation, Family structure/issues, caregiver needs– Environment – home safety, neighborhood– Economics – affordability, access
• Lower cost structure, high impact, evidence based• We help identify where interventions will have greatest
impact:– Population health management – prevention– Managing progression of chronic conditions & function– Medication management– Reducing admissions/readmissions & SNF– Late life care – palliative/hospice
Home Palliative Care End of
Life
Hot Spotters!
Post Acute and Long Term Supports and Services
Complex Chronic I llnesses w/ major
impairment
Chronic Condition(s) with Mild Functional &/ or Cognitive I mpairment
Chronic Condition with Mild Symptoms
Evidence Based Self- Management, Home
Assessment and HomeMeds
Well – No Chronic Conditions or Diagnosis without Symptoms
Targeted Patient Population Management withIncreasing Disease/Disability
HCBS in Active Population Management – ValuePropositions: Who Pays and Who Saves?
EOL
LTSS &CaregiverSupport
Care TransitionsHomeMeds/HomeSafety Assessment
EB Self-Management:CDSMP/DSMP; MOB; Healthy IDEAS; EnhanceFitness; PEARLS; Fit & Strong
Senior Center – meals, classes, exercise, socialization
ED/Hosp: Capitated Providers/PlansReadmission penalties: Hospitals
Chronic Disease Management:Duals Plans; MA SNP
Prevention: MA Plans; Capitated Med Groups
25% of all Medicare is Last Year of Life: Duals Plans; Medicare Advantage SNP; ACO/MSSP
Nursing Home Diversion for Duals Plans
Contact Us
June Simmons, CEOPartners in Care Foundation732 Mott St., Suite 150, San Fernando, CA 91340Main #: [email protected] www.HomeMeds.org
Questions?