The Business Institute Vision: To improve the health and well-being - - PowerPoint PPT Presentation

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The Business Institute Vision: To improve the health and well-being - - PowerPoint PPT Presentation

Jan 10, 2024 408 likes •757 views

The Business Institute Vision: To improve the health and well-being of older adults and people with disabilities through improved and increased access to quality services and evidence-based programs. Mission: To build and strengthen partnerships

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The Business Institute

Vision: To improve the health and well-being of

  • lder adults and people with disabilities through

improved and increased access to quality services and evidence-based programs. Mission: To build and strengthen partnerships between aging and disability CBOs and the health care system.

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Business Institute Funders

  • The John A. Hartford Foundation
  • The Administration for Community

Living

  • The SCAN Foundation
  • The Gary and Mary West Foundation
  • The Colorado Health Foundation
  • The Buck Family Fund of the Marin

Community Foundation

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Business Institute Partners

  • National Association of Area Agencies on Aging
  • Independent Living Research Utilization/National

Center for Aging and Disability

  • American Society on Aging
  • Partners in Care Foundation
  • Elder Services of the Merrimack Valley/Healthy

Living Center of Excellence

  • National Council on Aging
  • Meals on Wheels America
  • Evidence-Based Leadership Council

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Goals & Activities

Build a national resource center Develop an assessment tool to determine the capacity of CBOs Provide training and technical assistance Conduct an outreach and educational campaign targeting the health care sector Systems Change Through Stakeholder Engagement

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www.aginganddisabilitybusinessinstitute.org

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Readiness Assessment Tool

Purpose: To guide organizations through the process of successfully preparing for, securing and maintaining partnerships with the health care sector.

  • Enable CBOs to assess their current readiness for engaging

the health care sector, identify strengths and gaps, and provide clear direction on progress and feedback

  • Serve as a framework of resources for navigating the process

successfully

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Readiness Assessment Modules

  • Change Readiness
  • Strategic Direction Readiness
  • Operational Readiness
  • Management Readiness
  • Leadership Readiness

Internal

  • External Market Readiness
  • Partnership Development

Readiness

External

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Training and Technical Assistance

 Monthly Webinar Series  Conferences  State & Regional Business Acumen Trainings  Case Studies  Learning Collaboratives  Targeted Technical Assistance  Consulting Services

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RFI Survey

To Take th the Puls lse of f CB CBO-Healt lth Ca Care Part rtnership ips

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Survey Methods

  • Partnered with Scripps Gerontology Center at

Miami University

  • Disseminated via email directly to 623 AAAs

and 313 CILs

  • Key national agencies shared the survey with
  • ther CBOs (THANK YOU!)
  • Survey was in the field for 5 weeks between

July and August of 2017 with a total of 593 respondents

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RFI Survey Results

Data source 2017 data: Kunkel, S.R., Straker, J.K., Kelly, E.M., & Lackmeyer, A.E. (2017). Community-based organizations and health care contracting: Research brief. Scripps Gerontology Center, Oxford, OH.

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Contracting Status by Agency Type

Yes No, pursuing No, not pursuing Total Area Agency on Aging (AAA) 144 (41.0%) 63 (17.9%) 144 (41.0%) 351 Center for Independent Living (CIL) 39 (32.8%) 15 (12.6%) 65 (54.6%) 119 Other CBO 41 (38.7%) 20 (18.9%) 45 (42.5%) 106

Data source 2017 data: Kunkel, S.R., Straker, J.K., Kelly, E.M., & Lackmeyer, A.E. (2017). Community-based organizations and health care contracting: Research brief. Scripps Gerontology Center, Oxford, OH.

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12.60% 13.90% 16.10% 19.10% 27.80% 35.00% 0.0% 10.0% 20.0% 30.0% 40.0% State Medicaid Commercial health insurance plan Medicare/Medicaid duals plan Veterans Administration Medical Center Hospital or hospital system Medicaid managed care organization

Most Common Health Care Partners for Organizations Contracting with Health Care Entities

Data source 2017 data: Kunkel, S.R., Straker, J.K., Kelly, E.M., & Lackmeyer, A.E. (2017). Community-based organizations and health care contracting: Research brief. Scripps Gerontology Center, Oxford, OH.

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19.70% 20.60% 20.60% 22.00% 26.00% 26.50% 29.10% 49.30% 0.0% 20.0% 40.0% 60.0% Evidence-based programs Transportation (medical or non-medical) Participant-directed care Person-centered planning Nutrition program Home care Care transitions/discharge planning Case management/care coordination/service coordination

Most Common Services Provided through Contracts by Organizations Contracting with Health Care Entities

Data source 2017 data: Kunkel, S.R., Straker, J.K., Kelly, E.M., & Lackmeyer, A.E. (2017). Community-based organizations and health care contracting: Research

  • brief. Scripps Gerontology Center, Oxford, OH.

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8.60% 17.30% 19.40% 22.30% 30.20% 0.00% 10.00% 20.00% 30.00% 40.00% Full-Time Equivalent (FTE) based contract Per participant Per service unit Per member per month (PM/PM) Fee for Service (FFS)

Most Common Payment Models of Respondents

Data source 2017 data: Kunkel, S.R., Straker, J.K., Kelly, E.M., & Lackmeyer, A.E. (2017). Request for information: Community-based organizations and health care contracting. Scripps Gerontology Center, Oxford, OH.

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Networks in Development

1 Not a full statewide network

CBO Networks

CA Partners At Home Network FL Florida Health Network IL Illinois Community Health and Aging Collaborative IN Indiana Aging Alliance KS Kansas Association of Area Agencies on Aging MA Healthy Living Center

  • f Excellence

MD Living Well Center of Excellence MO Kansas City Integrated Care Network, MO1 NC Community Health Partners1 NY Western New York Integrated Care Collaborative1 NY NYC Department for the Aging1 OH Direction Home OR Oregon Wellness Network OK Oklahoma Aging & Disability Alliance1 PA Aging Well, LLC & Comprehensive Care Connections (C3) TX Texas Healthy at Home VA Virginia Area Agencies on Aging – Caring for the Commonwealth (VAAACares) WA Conexus Health Resources1

WA OR CA MT ID NV AZ UT WY CO NM TX OK KS NE SD ND MN IA MO AR LA MS AL GA FL SC TN NC IL WI MI OH IN KY WV VA PA NY ME VT NH NJ DE MD MA CT RI

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14.90% 39.90% 8.20% 17.50% 19.40% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% Yes, but not at this time Yes, but we need more information or guidance before pursuing Yes, and we have actively pursued contracts but have not been successful No, this is not something we plan to pursue We have not thought about pursuing a contract with a health care entity

Interest in Contracting of Respondents without Contracts

Data source 2017 data: Kunkel, S.R., Straker, J.K., Kelly, E.M., & Lackmeyer, A.E. (2017). Request for information: Community-based organizations and health care contracting. Scripps Gerontology Center, Oxford, OH.

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https://www.healthaffairs.org/do/10.1377/hblog20180130.620899/full/

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RFI Survey

https:/ ://mia iamio ioh.qualt ltric ics.c .com/S /SE/? /?SID=SV_9Mn4 bih ih45kQGo6x&Q_JFE=0

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Changes to Medicare Advantage

  • Expanded supplementary benefits
  • 2019 Call Letter
  • CHRONIC Care Act
  • Updates to uniformity requirements
  • 2019 Call Letter
  • CHRONIC Care Act

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CHRONIC Care Act

  • Beginning in 2020
  • Expands supplemental benefits to allow benefits that
  • “with respect to a chronically ill enrollee, have a reasonable

expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.”

  • The Secretary may waive uniformity requirement for

supplemental benefits to chronically ill enrollees

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2019 Call Letter

  • For 2019 plan year
  • Reinterprets uniformity rule to allow

targeting of benefits to individuals that are similarly situated –with specific medical criteria

  • Reinterprets primarily health-related

supplemental benefit standard

  • Will allow benefits that “diagnose,

prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization”

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Additional Guidance Released April 27

  • Uniformity for those similarly situated as defined by clinical

conditions/categories such as diabetes, COPD, other conditions that can be “objectively defined” by ICD-10 codes

  • Targeted benefits must be “medically related to each health status or

disease state”

  • Clarified that benefits could not be for “solely or primarily used for

cosmetic, comfort, general use, or social determinant” purposes

  • Examples of types of services that could be covered are
  • Adult Day Services
  • In-Home Support Services
  • Support for Caregivers of Enrollees
  • Home and Bathroom Safety Devices and Modifications
  • Transportation

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Implications for CBOs

  • Expansion of supplemental benefits and allowing

targeting of benefits makes contracting with CBOs to provide supplemental benefits easier

  • Prior to these changes, MA plans were required to

make benefits available to all, which could be cost prohibitive

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What to Expect this year

  • Plan bids for 2019 are due in June, so most plans

will have their bids already developed

  • Plans will probably be conservative on

supplemental benefits this year

  • Good time to engage with MA plans on 2020 bids

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How to Get Started

  • Conduct a market

analysis

  • MA Plans
  • Special Needs Plans
  • Providers / Health

Systems serving MA plan/SNP members

  • MLTSS / D-SNP

requirements

  • Medicaid Managed

Care Plans

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What are the Plan’s Pain Points?

  • Performance on

HEDIS measures and Star Ratings

https://www.ncoa.org/resources/webinar- medicare-star-rating-system-webinar/

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  • Frame program in terms of how it will address the plan’s

pain points.

  • “My program reduces unnecessary hospitalizations.”
  • Share satisfaction statistics from your program surveys

to demonstrate the high level of consumer satisfaction for those enrolled in evidence-based programs or other applicable services.

Define Your Value Proposition

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Know Your Competitors/Collaborators

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Business Institute Resources on Medicare Advantage

  • Policy Spotlight: New

Federal Law and Rules Open Door for Integrated Care in Medicare Advantage

  • May 30 Webinar: The

CHRONIC Care Act: New Opportunities to Advance Complex Care through Community- Clinical Partnerships

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Questions?

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Sandy Markwood Chief Executive Officer National Association of Area Agencies

  • n Aging (n4a)

smarkwood@n4a.org Mary Kaschak Deputy Director, Aging and Disability Business Institute n4a mkaschak@n4a.org Karen Homer Research Associate, Aging and Disability Business Institute n4a khomer@n4a.org Paul Cantrell Consultant n4a pcantrell@n4a.org Davis Baird Senior Program Associate, Aging and Disability Business Institute n4a dbaird@n4a.org Elizabeth Blair Senior Research Associate, Aging and Disability Business Institute n4a eblair@n4a.org