Transcript Health Care Reform, Chronic Care Management, Care Transitions and the Future of Nursing Duke Carolina Visiting Professorship in Geriatric Nursing Duke University School of Nursing May 5,

Health Care Reform, Chronic
Care Management, Care
Transitions and the Future of
Nursing
Duke Carolina Visiting Professorship in Geriatric
Nursing
Duke University School of Nursing
May 5, 2010
William A. Dombi
National Association for Home Care & Hospice
[email protected]
Health Care Reform: What
Happened
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Health Insurance Reform
Expanded Coverage of the Uninsured
Medicare Spending Reductions
Health Care Cost Containment???
Health Care Delivery Reform???
Health Care Reform
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There is much more of health care cost
and care delivery reforms than mass
media has focused on
Great attention paid to:
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The “public option”
“death panels”
States rights
Health Care Reform
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Without public fanfare, the HCR legislation will revolutionize
significant parts of health care delivery
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Preventive care coverage expansion
Primary care supports
Accountable Care Organizations
Transitions in Care plans
Acute and post-acute care payment bundling
Long term care and chronic care management
Workforce supports
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All these reforms involve nurses as central players
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Health Care Reform
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Long Term Care and Chronic Care Management
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CLASS Act
Medicaid Home and Community Based Care
Expansions
Federal Coordinated Care Office
Special Needs Plans
Medical (Health) Homes
Independence at Home pilot
HHA-based chronic care management demonstration
CLASS Act: Long Term Care
Returns to the Agenda
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Community Living Assistance Services and Support
 Payments made to cover individuals with ADL
needs in home or nursing facility
Federal LTC insurance program
Premium withholding in wages
Opt-out of program authority
 Participation begins 2010
Eligibility based on ADL needs
Benefit payments begin in 2016
Preset daily payment to insured
Boon to Private Pay home care starting in 2016
Medicaid Provisions: HCBS
Expansion
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Major home care expansion/rebalancing
through federal money (FMAP)
Community Free Choice Option
Removal of barriers to HCBS services
Money Follows the Person Demo
extension
Spousal impoverishment protection
Chronic Care Management
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Federal Coordinated Care Office
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CMS based
Coordinate Medicare ad Medicaid dual eligible
patients
Develop coordination tools
Special Needs Plans
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Reauthorized through 2013
Refocus on enrollee characteristics
Chronic Care Management
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Medical (Health) Homes
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Grant programs and Medicaid supports
Interdisciplinary team approach
Required hospital referrals on Medicaid
patients
Retains Medicare demo and includes authority
for CMS Innovation Center creation of more
models
Independence at Home
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Pilot Program
Physician-centered interdisciplinary team
Focus on patients with:
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2 or more chronic illnesses
Recent hospital, SNF or HHA admission
Shared savings based payment
Coordinates care across all settings
Specialized physician qualifications
HHA-based Chonic Care
Management
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CMS Innovation Center based
demonstration
Nurse/care coach centered
Interdisciplinary team
Direct patient contact
Use of remote monitoring technologies
Shared savings reimbursement
Medicare/Medicaid Payment
Bundling
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Flexible authority for CMS
Many approaches to bndling available
Likely will include hospital, physician, and
post-acute care
A community care-based bundling model
possible
Community-Based Care
Transitions Program
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Medicare demonstration program
Competitively selected
Targets high readmission rates
Supports beyond routine discharge
planning
Expansions possible by HHS authority
Workforce Supports
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Primary Care physicians, NPs, Pas
Nurses
Direct care workers
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Home care aides
Workforce Supports
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Nurses
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Student loan program
Loan repayment supports
Public health recruitment and retention
programs
Nurse-managed health clinics
Advanced nursing education grants
Nurse education, practice, and retention
grants
Geriatric education and training career awards
Direct Care Workers
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Personal Care Workforce Advisory Panel
(CLASS Act)
Demo grants to establish competency
standards
Training and career ladder opportunities
REVOLUTION UNDERWAY
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Broad recognition that chronic illness is a major
factor in health care cost
Understanding that community-based care is an
effective way to address needs of chronic care
patients
Goals shifted to prevention and management,
away from crisis intervention
Identification that workforce supports needed to
staff the new care delivery models, with different
skills
Who Will Be Crucial To
Success
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Nurses, nurses, nurses……
Home care aides/personal care attendants
Primary care physicians
Committed/engaged patients and family
members
What Will Be Crucial To
Success
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New skills
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Technological supports
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Coaches
Educators
Coordinators
communicators
Remote monitoring
Interoperable EHR
Financial supports/incentives
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Medicare and Medicaid may need to lead
CONCLUSION
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EXCITING TIMES!
Opportunities, but no guarantees
Taking the initiative essential
Teamwork prevails over silos
Dreams coming true