Knowing Our MarketFlorida Neighborhood Networks

Helena, Anna, Maria, Sandra, Gabriel

Customer Groups(By customers, we are referring to individuals whom your network will serve – e.g.,

older adults, persons with developmental disabilities, caregivers.)

Possible customer groups our network can serve•Anyone with 2+ chronic conditions•Individuals 50 or older•Pilot – is individuals with 2 chronic conditions that is Medicare HMOs or Medicaid dual eligible– Need to demonstrate short term savings

2

Customer Groups(By customers, we are referring individuals whom your network you will serve – e.g.,

older adults, persons with developmental disabilities, caregivers.)

Defining characteristics of our potential customers – special health conditions (e.g., diabetes, multiple chronic conditions), social conditions (e.g., need for transportation, adult day health, etc.) •2+ chronic conditions and includes social conditions (adult day health, etc.); including dual eligibles (continue to explore based on provider contract)

– More duals in Dade than in Broward

•Plan to expand in the future

3

Customer Groups(By customers, we are referring individuals whom your network you will serve – e.g.,

older adults, persons with developmental disabilities, caregivers.)

Customers’ primary needs that we can meet• Intervention will provide accessible, age-friendly package of

patient activation, health information, self-management and other Ebps (physical activity, self-management, depression).

• Coordinated package of wellness programs offered in the neighborhood where people live.

• Demonstrated health improvement outcomes

4

Customer Groups(By customers, we are referring individuals whom your network you will serve – e.g.,

older adults, persons with developmental disabilities, caregivers.)

Measurable high value outcome(s) we produce for customers• Proven outcomes, reduce hospitalization and recidivism• Improve quality of life• Improved utilization of the health system (lower cost)

5

Customer Groups(By customers, we are referring individuals whom your network you will serve – e.g.,

older adults, persons with developmental disabilities, caregivers.)

Our next step(s) to further develop the customer profile and test need•5 years of developing customer profile, 7 years of delivering Ebps – low/no cost•30,000 older adults have been served with at least one program

– Age, gender, income, live alone, basic demographic– Where are these individuals now

•Now need to learn more about those who we will be paid for, e.g. link to clinical outcomes – need to develop with payer system new customer profile via pilot program

– Success will be how much money is saved

6

Contracting Organization (CO) We Will Pursue First/Next

(e.g., health plan, ACO, health system, etc.)Name/Type of CO• Several initial contacts:

Humana, Avmed, Florida Blue, Prestige health plans/ACOs, Sunshine

• Larger network needs to list all the potential buyers/plan that could become buyer (all MCOs that received LTSS or other Medicaid

Key CO person for contractingDepends on the pilot serving 600

people – defined in next 45 days

Their mission and major interest/need

• Provide population health to a defined populations

• Meet Hedis measures, improve health/lower cost

• Need strategic plan – do we wait for pilot and data or do we start develop with others

7

Contracting Organization (CO) We Will Pursue First/Next

(e.g., health plan, ACO, health system, etc.)

Our next step(s) to further engage the CO•Meetings schedules – beginning Dec 6 Avmed and Fl Blue/exploratory presentations

– Medical director and chief of operations of Medicare

8

Policy or regulatory conditions to address?

Are there any policy or regulatory conditions that your network will need to meet or change in order to secure a contract? If so, what are they?• No change to secure contract•Using Health Foundation as contracting mechanism so CBOs come under it

–If Medicare, just become Medicare billable organization for all partner (Not a problem with HMOs)

9

ChampionsWho can endorse our network and open doors for us? • Community champions for buyers – Max Rothman and Edith are

very helpful in opening doors because of community history and have champions on Boards

• Look at partners like YMCAs, Alliance, Board Members – who should be on the advisory board of the new entity

• 5 years we had advisory council for Health Foundation initiative now a new business in community – aging providers connecting to selling our services (review current roster for possible representatives)

• Representatives from MCOs - don’t limit to nonprofits, 3rd party individuals/organizations that have been part of collaborative

• Utilize commissioner champions

10

Competition and Forces We Need to Address

Our primary competitors are:• Private for profit entities that are being created for ‘profit’ ,

not community-focused• ILS – Independent Living Services • Hospitals (build vs. buy) Baptist Health creating wellness

centers - all have their own programs – hard to get referrals• Medicare Advantage plans have disease management (using

for PCMH• Have to show we are complimentary, can do it better and for

less money

11

Competition and Forces We Need to Address

Major sources of inertia we must overcome:• Network for 5 years we have been working on assumption of

how much $$ we have, then we plan and do• Now it is more risky – need strategists not operations people• In the past looked at staffing for operations – need to evolve• Don’t leave out delivery systems, other organizations that can

provide wide support and sites

12

Competition and Forces We Need to Address

Competitors’ Advantage• Worked with health system,

or are with the health system; they control the $$ and they have a captive audience

• They are exclusively at clinical settings, no control over social environment

• Clinical health – they say their clinics are in the community

Our advantage

• Access to individuals where they live, broader community experience, get into their homes, housing system, churches

• Worked over a broader spectrum of resources and understand community resources

• Population health• Dade county 154 sites; similar in

Broward

13

Insights

Our biggest insight(s) from this session on Knowing Our Market is/are… • Everyone is our competition•How are other communities identifying their competition•We need to work with our current assets to identify community champions• Find other place, limited funding• Need to focus on strategy over operation/implementation• Let them know our strengths and embedded in community – uniform approach

14

Action StepsThe action step(s) we will take in the next month to engage our market are:•Scheduled appointments with 3 of the 4 health plans and we will schedule Humana in January in Broward•Finalize review and contracting with Health IT – preliminary to use CHRASYS (GE) subsidiary – platform that will adapt – willing to charge per patient fee rather than user fee (no risk)•Articulate role of steering committee and send to network partners•Reach out to partners to id champions for new steering committee (who will open doors)•In 2014, Beyond pilot, need to use AHEC, Health Department Key West - These partners can serve every zip code Monroe

15

Parking Lot (Issues for later, additional questions for speakers)

• Want success stories from this acumen group to share to make our case

16