Surfing with the Board to Catch the Age Wave Steven E. Marcus, - - PowerPoint PPT Presentation

Chronic Disease Self Management Education Wellness/Risk Assessment and Chronic Care Management Falls Prevention Depression Counseling

Surfing with the Board to Catch the Age Wave

Steven E. Marcus, President and CEO Health Foundation of South Florida/Florida Heath Networks Carol Nohelia Montoya, Network Director Florida Health Networks

Health Foundation of South Florida

Not-for-profit grantmaking organization established in 1993, dedicated to health in South Florida.

• Our support fuels:

– Programs – Policies – Systems changes

Engaging a broad network of effective partnerships, including elected officials, government agencies, business leaders, other funders, and communities, while finding and integrating smart, lasting solutions to key health issues.

Why Healthy Aging?

• The population age 65 and older represents

14.5% of Americans.

• Florida has the highest percentage of older

adults in the United States with 25.7% of its population being 65 and older (US Census 2016 estimates)

– 51.7% have arthritis – 23% have diabetes – 21.5% had reported coronary heart disease, heart attack, or stroke

Florida Department of Health, 2016

Toward an age-friendly world…

Age-Friendly Communities

Housing Social Participation Respect and Social Inclusion Civic Participation and Employment Communication and Information Community Support & Health Services Outdoor Spaces and Buildings

Health Foundation of South Florida Response

• Healthy Aging Regional Collaboration (2008-

2016) supported learning collaborative and evidence-based program in the following areas:

– Fall prevention – Physical activity – Self-management education and support (Stanford menu of Chronic Disease Self Management Education Programs) – Depression

Healthy Aging Regional Collaborative

• Six year implementation, 29 agencies offered one or more of

the following evidence-based programs:

– EnhanceFitness (EF): physical fitness – Living Healthy (LHP): chronic disease self-management – Tomando Control de su Salud (TCS): chronic disease self- management – Diabetes Self-Management in English (DSMP-E): diabetes self- management – Diabetes Self-Management in Spanish (DSMP-S): diabetes self- management – A Matter of Balance (MOB): increase mobility through reduced fear of falling – Asunto de Equilibrio (ADE): increase mobility through reduced fear of falling – Healthy IDEAS (HI): depression case management – Walk With Ease (WWE): self-directed walking program

Reach in Six Years

Total number of workshop attendees from all programs

• ver all six years was 40,365 persons. On average 30%
• f participants participated in two or more programs

yearly.

Percent of Participants By Age Group

Healthy Aging Regional Collaborative Outcomes…

• Created a collaborative atmosphere among the

community-based agencies who have participated as members in HARC

• Member agencies show a commitment and dedication to

continue to offer the evidence-based programs chosen by HARC to older adults in South Florida Develop a system that would allow for the continued and long-term maintenance of evidence-based programs in South Florida by community-based agencies

Current

• Right now catching a

major wave is near! (additional story telling)

• Decision making two

major umbrellas external branding and marketing and internal

Decision Making Process to create a Statewide Network

• HFSF and Board commitment

to support and expand health and wellness services throughout the state

• Board decided to create a

separate FHN committee

• Obtaining and securing

additional funding

• Identify network partners
• Selecting evidence-based

programs Decision Making Team:

Board of Director CEO and President Finance Director Project Director

Florida Health Networks

• Created in 2014, upon success of HARC
• FHN through Falls Prevention and CDSME projects

has provided network partners the following services:

– Evidence-based program trainings – Statewide evidence-based licenses – Data management – Quality assurance – Technical assistance – Additional funding to expand the delivery of health and wellness programs

Provider Network

Each AAA/ADRC has a network that includes:

• Senior Centers
• Elder Housing
• Nutrition Sites
• Parks
• Community

Centers

• YMCA
• Adult Day Care
• Public Libraries
• Centers for

Independent Living

Resources/Challenges

Internal Operations

• Staff
• Administrative

Board Members

• HFSF Board
• FHN Committee

Network Partners

• Statewide Delivery

Organizations

• Readiness/Needs

Healthcare Providers

• Referral
• Sustainability

Additional Resources

• Financial
• Data Management System
• Billing

The Undertow

• Finance
• Operation
• Board
• Network Partners
• Healthcare Providers

Internal Operations

• Brief Staff History
• Defining staff roles based on needs and

administrative changes

• Establishing Fiscal/Financial roles and

responsibilities between FHN and HFSF staff

• Contract Monitoring (HFSF/FHN)
• Integration of FHN into Board Meetings

Getting on and off the Board

Continuous Education of Board Members on Statewide Network

• FHN Committee is created
• In 2014, HFSF awards FHN

a $300,000 grant

• May 2015 HFSF approved a

$425,000 line of credit

• Contracting with a

Specialty Care Company

• Successes of FHN in

securing ACL grants and

• ther Foundations program

grants

• In 2017, Board approved

line of credit increase to $1.2 million for FHN

Surfing through the Waves

• Early stages of FHN we thought we were about to catch some big

waves

• HARC outcomes and that the programs were already acknowledged by

major Universities for having evidence based outcomes.

• We were wrong!
• Needed to gain trust and respect
• Demonstrate a reduction in claims, current cost saving benefits, and

health metrics for the Health Plans to use our services

• Value of our services related to HEDIS, Star ratings, MIPS, CAHPS

measures

Surfing through the Waves

What we needed to become a champion surfer:

– Better slicker faster surf board to surf out the health plan waves – Specialty care company (SCC) that had a long standing relationship with some of the biggest Medicare advantage plans and could be a value added partner to increase our credibility.

• Recently signed an

agreement

– Develop the relationship to create an administrative services agreement – fill the service gap – Relationship with designated SCCs representatives – Included data, training, help develop contract, training of their own staff

Challenges

• Network Partners:

– Large number of partners, diverse, accustomed to working independently, governed by different priorities

• Healthcare Providers

– Cultural issues: for profit vs non for profit cultures – Community vs clinical interventions: trust issues

Network Partners

• Uneven Network Partner’s

readiness

• Uneven availability of

Human and Financial Resources

• Uneven Organizational

Capacity

• Recruitment of

leaders/coaches

• Program Trainings
• Quality Improvement

Processes

• Billing and Data Services

Healthcare Providers

• Engaging multi-sectorial

healthcare providers

• Securing contracts with

healthcare providers

• Education on Evidence-Based

programs

• Benefits of outsourcing the

delivery of the programs to community based

• rganizations
• Marketing and Branding
• Hedis, Star Rating, and CAHPS

benefits for Health Plans

• Proving concept and providing

local data and/or ROI

Outreach Knowledge Exchange Community Involvement Self- Management

Resources

• Financial

– HFSF continuous backing and support – Grants – Contracts

• Data Management System
• Billing

Financial

Grants

• 2014:

– ACL Falls Prevention Grant $400,000 – HFSF $300,000

• 2015: ACL CDSME Grant

$900,000

• 2017:

– ACL CDSME Grant $757, 590 – Humana Foundation $118,500 – Weinberg Foundation $272,870

HFSF In-Kind Support

Services Provided by HFSF staff:

– President and CEO – CFO – VP of Communications

• CMS consultant (Tim McNeil)

has provided guidance on billing codes for specific programs and through ACL CDSME grant.

FHN funding:

• Grants
• Health Foundation Line of Credit
• HFSF In-Kind Support

HFSF Line of Credit

Line of credit covers annual expenses (office rent, staff salary, telephone, office utilities, etc.) – 2015: $425,000 – 2016: $1.2 million

Data Management System

Operations staff responsible for data analysis and for managing multiple data bases for different uses:

– Centralized Database created for programs – HIPAA compliant system with capacity to provide reporting to healthcare partners – System able to provide data for ROI and for billing

Billing Services

FHN requires the capacity to provide billing services to partners. Board decided not to

pursue own Medicare number instead FHN:

• March 2015: FHN signed a contract with Comprehensive

Care Alliance to provide billing service to statewide

• network. CCA would receive a percentage of the total

amount billed by FHN.

• January 2018: FHN signed a contract with Provider

Network Solutions to provide administrative services including billing.

Why FHN Works?....

• Existing Relationship of Network Partners with

sustainability partners and/or healthcare providers

• Network partners experience in providing health and

wellness services to older adults

• Success of evidence-based programs
• Ability to work with health plans/ healthcare

partners and provide behavior change programs

Questions?

Contact Information

Carol Montoya

• Tel. 305-952-4266
• Email. cnmontoya@flhealthnetworks.org