Tailo ilored ed Me Meals ls Pilo ilot Progr gram Adrian Nunez - PowerPoint PPT Presentation

California’s Me Medi di-Ca Cal l Me Medi dically lly Tailo ilored ed Me Meals ls Pilo ilot Progr gram Adrian Nunez Director, Health Care Initiatives

Who We Wh e Are Project Open Hand is a nonprofit that provides nutritious meals to seniors and critically ill neighbors in San Francisco and Alameda County Founded, San Francisco, 1985, at a time when the city found itself at ground zero of a frightening and devastating epidemic called AIDS Retired food services worker named Ruth Brinker felt something needed to be done, and she began preparing meals with love from her kitchen and delivered them to seven neighbors with AIDS who were far too ill to cook for themselves

Today’s Overview • How the Medi-Cal Medically Tailored Pilot Program came to be • How we continue to stay present • Our future plans

What We Know – The Issues Image sources: FIMC Fact Sheet. www.fimcoalition.org

What We Know – The Solutions Image sources: FIMC Fact Sheet. www.fimcoalition.org

History Octob tober er 2016 16 June 2017 17 April ril 201 018 Senator McGuire Before 201 016 SB 97 budget bill embarked on a The Medi-Cal was approved by FIMC was forming crusade to get funding Medically Tailored the legislature and and research on secured in the budget Meals Pilot Program signed by Governor MTM was being for a statewide pilot started enrollment Jerry Brown conducted program Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 June 2016 16 April ril 201 017 March h 2018 18 California FIMC Assemblymember David Octob tober er 2018 18 CalFIMC Website began to from Chiu sponsored the Launches promoting Today National FIMC budget ask in the state Pilot Program momentum assembly subcommittee

Med edi-Cal Cal Med edicall ically y Tailor ilored ed Mea eals ls Pi Pilot lot Pr Program gram Three-year, $6 m million llion pilo lot t to evaluate the impact of a medically • tailored meal intervention on the health outcomes and health care costs of seriously ill Medi-Cal patients. The study will be conducted in seve ven n countie ties in California – • Alameda, Los Angeles, Marin, San Diego, San Francisco, Santa Clara, and Sonoma – by six organ anization izations. The Ca Califor liforni nia a Depar artment tment of Health alth Ca Care e Services ces (DHCS) has • oversight over the program.

Pilot Program Agencies

The Program The Medi-Cal MTM Pilot Program is a medical nutrition intervention for high utilizing Medi-Cal beneficiaries with a diagnosis of congestive heart failure (CHF). The intervention is 12 weeks in duration. Who: Discharged from a hospital, SNF, or ED, Medi-Cal patients who were • admitted due to CHF and have a history of being a high utilizer of health care services and/or likely at risk for readmission within 30 days. Inter terven ention tion Goal: l: Reduce hospital and emergency department 30-day and • 90-day readmissions. Cost: No cost to patient. Must be on Medi-Cal. •

The Intervention Medical ally Tail ilored d Meals s (MTM) • 12 weeks of complete nutrition, home delivery Medical al Nutrit ition ion Therapy py (MNT) • Four Medical Nutrition Therapy sessions, 2 in-person Informa rmation ion & Referral ral Services ces • Integration of other social determinants of health

Medically Tailored Meals Medicall ically y Tail ilored ed Meals ls are meals that designated by Registered Dietitians as an appropriate • part of a treatment plan for an individual with a defined health condition or combination of health conditions. For this program, agency dietitians design meals for by for persons with Congestive Heart Failure guided by the following evidence-based guidelines of the Academy of Nutrition and Dietetics. Nutrit itio ion conte tent nt shall adhere to the heart healthy guidelines of the Therapeutic Lifestyle Change • (TLC) Diet and with the Evidence-based Nutrition Practice Guidelines from the Academy of Nutrition and Dietetics Evidence Analysis Library. The Dietar tary Appr proache ches to to Sto top p Hyper ertens tensio ion (DASH) H) Diet meal l pattern ern shall be used to ensure • nutrition completeness of the overall meal plan, unless medical needs require otherwise. Registered dietitians also coll llaborat orate e with kitchen en staff or subcontracted meal preparers to ensure • meals adhere to nutrition guidelines and all other meal guidelines noted in this section.

Medical Nutrition Therapy (MNT) Each client receives clear, , detaile iled d evidenc ence-based sed plan n of care to ensure achievement of • guideline determined medical therapy goals, effective management of co-morbid conditions, follow-up with healthcare team as appropriate. The MNT process is upda dated d with each of the three (3) subsequent visits after the first. • MNT follows the Nutritio trition n Care e Proces cess s for Medica ical l Nutr tritio ition Therapy rapy and incorporate the • program-prepared nutrition education topic and materials. The process utilizes the Academy of Nutrition & Dietetics Heart Failure Toolkit and adopt evidence-based practices into their MNT as needed.

Information & Referral Services Make a good faith effort to contact clients that are not t respon onsiv sive to to request sts s for MNT • sessions and/or missing agreed upon meal deliveries to prevent disenrollment due to missed meals. Through the delivery process, ident ntif ify and d report t conc ncerns rns to appropriate staff for follow- • up, which may include change of address, change of condition, self-neglect, and abuse. Through RD, make a good faith effort to cont ntact ct medical ical provider ider(s) s) when a high risk for • readmission is identified, and if appropriate. Provide information and referral services to clients experie ienc ncing ing challenge llenges s preve vent nting ing • ongo going ing partic ticipatio tion in the intervention.

Payment Model • Currently fee for service / units of service – Loaded rate – MTM / MNT / Case Management • Considering collecting data to evaluate alternative payment models – CPT Codes and rates for MNT and/or MTM

The Value of a Coalition • Shared values and aligned medically tailored meals interventions • Cohort in counties that have the majority of Californians

Looking Forward • Collective discussions with health plans • Standardization of intervention through accreditation • Integration of social determinants of health services through Archstone Foundation grant

Website & Twitter https://www.openhand.org/ @ProjectOpenHand  follow us! https://calfimc.org/medical-pilot/ @CalFIMC  follow us!