Transcript Slide 1
Developing Service Packages for Integrated Care February 20, 2014 11:30 am – 12:30 pm EST www.mltssnetwork.org Developing Service Packages Lynn Kellogg, CEO Region IV Area Agency on Aging, MI Offering Choices for Independent Lives 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, evidencebased 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: Why: Other AAAs serving IC demonstration region Service Providers Need to present “single” package to health plan Need vehicles for increased capacity Interagency Care Team [ICT] - Level 2 Who: Why: AAA, FQHC, Hospital, Health Dept. Designed to expand to other entities on Community Roadmap 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 Value Expectations… Tween 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 Results/Commitments… Tween 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 Advice/lessons learned… Tween 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 Packages that appeal to healthcare entities of various sizes, shapes and motivations June Simmons, CEO Partners in Care Foundation Presented to N4A, February 20th, 2014 Partners in Care Partners in Are Care Who We Who 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 1% spend 21% 5% spend 50% The Upstream Approach: What would happen if we were to spend more addressing social & environmental causes of poor health? Healthcare’s Blind Side • 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 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 Targeted Patient Population Management with Increasing Disease/Disability Home Palliative Care Post Acute and Long Term Supports and Services End of Life Hot Spotters! Complex Chronic Illnesses w/ major impairment Chronic Condition(s) with Mild Functional &/or Cognitive Impairment Chronic Condition with Mild Symptoms Well – No Chronic Conditions or Diagnosis without Symptoms Evidence Based SelfManagement, Home Assessment and HomeMeds HCBS in Active Population Management – Value Propositions: Who Pays and Who Saves? EOL 25% of all Medicare is Last Year of Life: Duals Plans; Medicare Advantage SNP; ACO/MSSP LTSS & Caregiver Support Nursing Home Diversion for Duals Plans Care Transitions HomeMeds/Home Safety Assessment EB Self-Management: CDSMP/DSMP; MOB; Healthy IDEAS; EnhanceFitness; PEARLS; Fit & Strong Senior Center – meals, classes, exercise, socialization ED/Hosp: Capitated Providers/Plans Readmission penalties: Hospitals Chronic Disease Management: Duals Plans; MA SNP Prevention: MA Plans; Capitated Med Groups Contact Us June Simmons, CEO Partners in Care Foundation 732 Mott St., Suite 150, San Fernando, CA 91340 Main #: 818.837.3775 [email protected] www.picf.org www.HomeMeds.org Questions?