5/26/2016 Delivery System Reform and Nutrition Providers: Finding - - PDF document

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Delivery System Reform and Nutrition Providers: Finding Your Niche and Adding Value

Marisa Scala-Foley Uche Akobundu June 2, 2016

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Medicare enrollees with chronic conditions and functional limitations represent over half of Medicare’s highest spenders

Source: H. Komisar & J. Feder, Transforming Care for Medicare Beneficiaries with Chronic Conditions and Long-Term Care Needs: Coordinating Care Across All Services, The SCAN Foundation, October 2011.

Top 5% of Medicare Spenders Top 20% of Medicare Spenders All Enrollees

High risk, high cost individuals= Those with chronic conditions AND functional needs

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Medicare beneficiaries with chronic conditions and functional limitations are more likely to use hospital inpatient and emergency department services

Source: H. Komisar & J. Feder, Transforming Care for Medicare Beneficiaries with Chronic Conditions and Long-Term Care Needs: Coordinating Care Across All Services, The SCAN Foundation, October 2011.

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Concerns about sustainability & systems changes

Source: Aging and Disability 2015 Information & Referral/Assistance National Survey, National Association of States United for Aging and Disabilities (NASUAD) in partnership with the National Council on Independent Living (NCIL)

Integrated Care Opportunities

Accountable Care Organizations (ACOs) Community- Based Care Transitions Program (CCTP) Duals Financial Alignment Initiative State Innovation Models (SIM) Medicaid Managed LTSS (MLTSS) Health Homes Bundled payments

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Managing chronic conditions Activating beneficiaries Diversion/ Avoiding long-term residential stays Preventing hospital (re)admissions ACL

Community- based aging & disability

• rganizations

State aging & disability agencies

• Nutrition programs (counseling & meal provision)
• Chronic disease self-management
• Diabetes self-management
• Education about Medicare preventive benefits
• Evidence-based care

transitions

• Person-centered

planning

• Chronic disease self-

management

• Information, referral &

assistance/system navigation

• Benefits outreach and

enrollment

• Employment related

supports

• Community/beneficiary/

caregiver engagement

• Transitions from nursing

facility to home/community

• Person-centered planning
• Assessment/pre-admission

review

• Information, referral &

assistance/system navigation

• Environmental modifications
• Caregiver support
• LTSS innovations
• Nutrition programs

(counseling & meal provision)

• Evidence-based care

transitions

• Care coordination
• Information, referral &

assistance/system navigation

• Medical transportation
• Evidence-based

medication reconciliation programs

• Evidence-based fall

prevention programs/home risk assessments

• Caregiver support
• Environmental

modifications

The critical role of community-based organizations

Why this is important for the aging & disability networks

• Shaping the future of the aging & disability networks
• Shaping the infrastructure for health care and long-term

services and supports in your state and community

We’ll Wait & See Let’s Do This!

Bottom-line: If we don’t do this, someone else will.

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Why else?

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2012: Grants to national partners to build the business capacity of aging and disability

• rganizations for MLTSS

2012 - Present: Engagement with public and private partners 2013-Present: Business Acumen Learning Collaboratives

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ACL & business acumen

ACL, in partnership with foundations, are providing aging & disability organizations with the tools they need to partner and contract with health care payers and providers in delivery system reform.

• Leverage existing ACL grants and contracts and public-

private partnerships to provide targeted technical assistance to build business capacity of community- based integrated care networks

• Aim of collaborative: Each network will have at least
• ne new contract with an integrated care entity by the

end of each collaborative.

• Secondary Aim: To establish networks through

which they can do business.

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ACL Business Acumen Learning Collaboratives

• Networks/leads:

– Partners at Home/Partners in Care Foundation (CA) – San Francisco Department of Aging and Adult Services (CA) – Florida Health Networks (FL) – Healthy Aging Center of Excellence/Elder Services of the Merrimack Valley/Hebrew SeniorLife (MA) – The Senior Alliance and the Detroit Area Agency on Aging (MI) – Minnesota Metro Aging and Business Network (MN) – AAAs of Erie and Niagara counties (NY) – Pennsylvania Partners in Care, LLC/PA Association of AAAs, Inc. & PA Centers for Independent Living (PA) – Texas Healthy at Home/North Central Texas Council of Governments (TX)

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2013-2014 Business Acumen Learning Collaborative

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2015-2016 Business Acumen Learning Collaborative

• Networks/leads:

— County of San Diego, Health and Human Services Agency Aging & Independence Services (CA) — Alameda County Aging, Disability, and Resource Connection (CA) — Indiana Association of Area Agencies on Aging, Inc., and the Indiana Aging Alliance, LLC (IN) — Greater North Shore Link/Aging and Disability Resource Consortium of the Greater North Shore, Inc. (MA) — Gateway Wellness Network/St. Louis Metropolitan Integrated Health Collaborative (MO) — Center on Aging and Community Living (NH) — Oklahoma Aging and Disability Alliance, LLC/INCOG Area Agency on Aging and Ability Resources, Inc. (OK) — The Arc Tennessee (TN) — Vermont Association of Area Agencies on Aging (v4a) and the Vermont Community- Based Collaborative (VT) — Conexus Health Resources/Aging and Long Term Care of Eastern Washington (WA) — Wisconsin Institute for Healthy Aging (WI)

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Success on our aim: Where we are now (Contracts)

20 networks 24 signed contracts 7 more under negotiation

Services under contract

Populations served Payers

• Care transitions
• In-home

assessment

• Medication

reconciliation

• Care

coordination

• Evidence-based

programs (EBP)

• EBP targets
• Dual eligibles
• Other high risk

populations

• Duals plans
• ACOs
• Medicaid health

plans

• Physician group,
• State healthcare

exchange

• Culture is critical – balancing margin

and mission

• Networks need to match their

strengths with a payer’s needs

• Flexibility is key…but so is selectivity
• Relationships (and champions) are

critical to the process

• Policy shifts offer new opportunities

(and challenges)

• Still issues needing more work:

Continuous quality improvement, generating and managing volume, network infrastructure information technology, outcomes data, & more

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What we’ve learned

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Moving forward

• Two new ACL Funding Opportunity Announcements related to

business acumen (available at http://www.acl.gov/Funding_Opportunities/Announcements/ Index.aspx)

• Business Acumen for Disability Organizations

– Develop baseline knowledge about the content and infrastructure needs of community-based disability – organizations through surveys and feasibility studies; – Provide broad-based training and technical assistance for the disability networks; and – Utilize a learning collaborative model to provide targeted technical assistance to 10 to 15 state networks of CBOs serving persons with disabilities of all ages that seek to build their business capacity to contract with integrated care entities.

Moving forward (continued)

• Learning Collaboratives for Advanced Business Acumen Skills

– Organize and conduct 3-5 topically-based action learning collaboratives to address “next generation” issues such as continuous quality improvement, infrastructure and technology, generating and maintaining volume, data pooling, and more; and to provide targeted technical assistance to networks of community-based aging and disability organizations. – Create knowledge and capture insights through these collaboratives to incorporate into future curriculum for national dissemination.

• Eligible applicants (for both grants): Domestic, public or private

non-profit entities including state and local governments, Indian tribal governments and organizations (American Indian/Alaskan Native/Native American), faith-based organizations, and community-based organizations.

– Consideration will be given to national public and private non-profit agencies and organizations including faith- and community-based

• rganizations (FBOs and CBOs), and national Indian tribal organizations.

Moving forward (continued)

• Recent grant from John A. Hartford Foundation to n4a,

American Society on Aging, Independent Living Research Utilization & Partners in Care Foundation -- Building the Capacity of the Aging and Disability Networks to Ensure the Delivery of Quality Integrated Care

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In the end it’s all about…

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Deliv Delivery ry System Reform and Nutrit rition Pr Provid iders: :

Find indin ing You

• ur Niche and

nd Addi dding ng Valu lue

Uche Akobundu June 2, 2016

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Learni rning as a Netw etwork

• rk:

: Role le of the he Natio iona nal Resource ce Center r

• n

n Nutri utritio tion n and nd Aging

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Nat National Res esource Cen enter r on n Nu Nutritio ion and nd Agin ging

 Funded under a cooperative agreement with the Administration for Community Living/Administration on Aging  Awarded September 2011 and 2014 to Meals On Wheels America Goals:

• To enhance the skills, knowledge, business acumen and sustainability

strategies of the nutrition and aging network.

• To increase the availability of information on programs and practices

showing promise of successful integration of the nutrition network in the HCBS services network.

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Nat ation

• nal Res

esource Cen enter r on n Nutritio ion and nd Agin ging

How?

• Online Resources www.nutritionandaging.org
• Professional development (webinars, live training sessions

and presentations at national conferences)

• SUA support (List serve and webinars)
• Single State Learning Collaborative
• Three consecutive 12-month Learning Collaboratives

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Lear earnin ing Tog

• gether:

r: Sing ngle State e Net etwor

• rk

Pilot with Five Texas Nutrition Programs 2014 Steps Nutrition Programs need to take

• Time to ramp up and prepare – GAP analysis and SWOT analysis,

determine who the payers are

• Do an environmental scan and market research – Which service

packages to provide and what technology is needed?

• Price the service packages
• Create a business plan
• Articulate the value proposition and the ROI the services will have

for the payer

• Build relationships with payers

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Lear earnin ing Tog

• gether:

r: Sing ngle State e Net etwor

• rk

Key Project Learnings  Securing adequate coverage for service area network  Engagement of a coalition of the willing  Aligning services with the needs of payors  Development of competitive organizational and network structures

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Bus usin iness Acum umen n Lea earn rning Coll

• llabo

borative – 201 015 Fun unded

 Last August, eight (8) Senior Nutrition Programs selected for a 12 month project period  Programs ranged in size, organizational structure, service area/type, clientele served, and organizational capacity.

• Davidson County Senior Services, Lexington, NC
• Senior Connections, The Capital Area Agency on Aging, Richmond, VA
• Catholic Charities of the Diocese of St. Cloud, St. Cloud, MN
• Christian Senior Services, San Antonio, TX
• New Opportunities, Inc., Waterbury, CT
• Meals on Wheels and Senior Outreach Services, Walnut Creek, CA
• LifeCare Alliance, Columbus, OH
• Greater Spokane County Meals On Wheels, Spokane, WA

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Senior Nutrition Program Targeted Learning Collaborative

• Duration – one year
• Engagement in monthly targeted webinars and in-person training

meetings

• Benefit from monthly Technical Assistance “Clinic Calls” calls
• Access to a living glossary of healthcare terms, acronyms, terms and

definitions

• Access to training opportunities from across the Aging Network

Lear earnin ing from

• m Tog
• gether:

r: Scali aling Ou Our r Lear earning ngs

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• Grantees receive targeted training via webinars, and in-person

training meetings – varied topics that may include:  Strategic business planning  Organizational culture change  Development and structure of community-based networks  Service packages (identifying, pricing and packaging services)  Marketing and sales strategies  Communication and negotiation techniques  Addressing program capacity challenges  Continuous quality improvement  Risk management  Information technology (IT) and integration challenges

Learni rning from

• m Toget

ether er: : Tra rain inin ing Opportu pportuniti ities

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Learni rning from

• m Toget

ether er: : Tra rain inin ing Opportu pportuniti ities

Assistance with business plan development;

Access to subject matter experts, including people who have led successful business development efforts for community-based networks, including nutrition providers; Peer-to-peer learning through regular calls, emails, online forums and in-person meetings; Broad-based learning through webinars and written materials from national experts.

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Lear earnin ing Coll

• llab

aborativ ive Del eliv iverables es

• Develop a Business Plan
• Formally meet with decision makers of targeted healthcare entities –

Community hospital, Hospital system, MCO, ACO, Insurers, etc.

• Contract with or develop a formal partnership with at least one

healthcare entity by August 31, 2017

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Lear earnin ing from

• m Tog
• gether:

r: Gr Gran antee Deli eliverable les

 Participate actively in all learning collaborative activities  Send at least one staff member to attend two (2) in-person meetings  Submit ongoing reporting  Share lessons learned and provide mentorship to other nutrition programs

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OK OK – Wh Where Are Are We e Hea eaded From Here?

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201 016 Gr Gran ant Op Oppo portuni nity www.Nut utri rition

• nand

ndAgin ing.org

Building the Business Capacity of Senior Nutrition Programs Mini- Grant Initiative  Number of Awards: 8  Amount of Each Award: $10,000  Application deadline: 5:00 pm EDT, June 3, 2016  Successful Applicants Notified of Award: July 6, 2016  Anticipated Project Start Date August 15, 2016  Grant Project Ends: August 31, 2017

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Lear earnin ing Coll

• llab

aborativ ive 201 016 & 201 017

Next two Learning Collaboratives

• Incorporate lessons learned from first one
• Engage all senior nutrition program participants as a

community of practice / mentors

• Leverage the learnings to Aging Nutrition Network

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Ultimate e Vi Vision: n:

Nu Nutrition Program ams

Par art of

• f Integrat

rated d Healt althcare re Deliv ivery ry Network rks

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We have to get get it righ ight!

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Res esou

• urces: www.N

.Nutri rition

• nandA

dAgin ing.org

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Res esources: Targeted d Documen ent Colle llectio ions

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Res esou

• urces: www.N

.Nutri rition

• nandA

dAgin ing.org

Recorded NRCNA Webinars

• Positioning Your HCBS Program in the Healthcare Market – 101

Webinar Series

• Part 1: Overview of Health Reform Initiatives - How this Affects

Your Organization and Terminology 101

• Part 2: Market Analysis - Determine Health Reform Initiatives in

Your Market Area

• Part 3: Network Collaboration - The Need for Collaboration
• Part 4: Developing a Strategy and a Business Model for Your

Organization

• Part 5: An Assessment of the Capacity of Your HCBS Organization

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Mor

• re Resources:

Recorded NRCNA Webinars (continued)

• Bridging the Divide: Opportunities for CBOs to Integrate Services into

the Emerging Healthcare Market

• Part 1: Key Drivers for Healthcare Organizations when Partnering with CBOs
• Part 2: Keeping Up with Health Care Organizations: Understanding the Value

Proposition as Integrated Care Progresses

• Part 3: Understanding the Variety of Perspectives Among Healthcare

Organization Decision Makers-How You Can Effectively Pitch to Them

• Part 4: Pricing for Success: Ways to Think about Valuing your Interventions
• HCBS Providers Use Quality Improvement to Demonstrate Impact

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Even en Mor

• re Res

esour urces: :

More Than a Meal Study http://www.mealsonwheelsamerica.org/theissue/facts-resources/more-than-a- meal NASUAD STATE Medicaid Integration Tracker http://www.nasuad.org/initiatives/tracking-state-activity/state-medicaid- integration-tracker The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: (January 2012) http://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery- systems/downloads/mltssp_white_paper_combined.pdf

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Fina inal l Wor

• rds
• Know Your Value
• Know Your Market
• Know Your Competition
• Study Your Customer
• Learn the Language
• Organize and Execute

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Con

• ntact Us: You
• ur NRCNA Team

eam

 Linda Netterville, Vice President, Project Management and Impact  Linda@mealsonwheelsamerica.org  Magda Hageman-Apol, Vice President, Education and Training  Magda@mealsonwheelsamerica.org  Uche Akobundu, Director, Project Management and Impact  Uche@mealsonwheelsamerica.org

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Th Than ank You

• u!

Uche Akobundu uche@mealsonwheelsamerica.org