Aging & Health Resources Committee Meeting Dennis White, DHA, MSIT President & Chief Executive Officer
Alliant Health Solutions “ Led by clini nicians ns, driven b n by techno nology a and gui uided by po policy”. ”. Alliant Health Solutions is a non-profit organization driven to make health care better in the United States by improving quality of care, increasing the value of health care, and promoting prevention and treatment for chronic illnesses. Our family of companies provide professional services to state, federal and private partners, supporting effective administration of health care programs and health care improvement initiatives. Our ur H History: Alliant has a rich, stable history in working with public health care agencies that dates back to the early 1970’s. Alliant has been engaged by state Medicaid agencies to provide quality management and medical review services since 1971. We have supported Medicare since 1984 as a Peer Review Organization (PRO) and Quality Improvement Organization (QIO) now serving as the Quality Innovation Network (QIN-QIO) in Georgia and North Carolina. In 2011, the End Stage Renal Disease (ESRD) experts at Network 8 Inc. joined the Alliant family. This expanded Alliant’s quality improvement services to the ESRD community in Alabama, Mississippi and Tennessee. In 2015 the ESRD networks in Georgia, North Carolina, South Carolina and Texas also joined the Alliant family, forming the Alliant Quality Kidney Collaborative.
Alliant Health Solutions Missi sion: Make health care better for patients, purchasers, providers and payors ► Vision on: To be a leader in providing health care information and services to increase ► value, effectiveness and accessibility. We ma make h healthcare b better. – Cus Customers come first. We We ar are e clinical ally lead ead an and IT dat ata a driven en. – Values: Va ► Integrity – Worth of the Individual/Employee/Customer – Responsiveness – Teamwork – Communication – Commitment to Excellence – Our ur S Stories, Our ur Cul Culture: – http://www.allianthealth.org/news – http://www.allianthealth.org/content/careers –
Our Partnership… ► Alliant Quality supported ARC in their data needs and budgeting for the CCTP grant ► ARC and Alliant coached the six Atlanta area CCTP funded hospitals to reduce readmissions through increasing referrals ► ARC has served on several of Alliant’s and Georgia Hospital Association advisory boards as partners to reduce readmissions ► Alliant Quality provided a letter of support in April 2016 for application for the Administration for Community Living’s (ACL) Empowering Older Adults and Adults with Disabilities through Chronic Disease Self-Management Grant ► Alliant has included the AAA staff representatives in Georgia to assist in providing Diabetes Empowerment Education Program (DEEP) classes
Aging & Health Resources Committee Meeting Presented by: Adrienne Mims, MD MPH Vice President, Chief Medical Officer
Alliant Health Solutions ► Our Company ► Our Contract with the Centers for Medicare and Medicaid Services (CMS) ► Our Contract with Georgia Department of Community Health (Medicaid)
NC TN SC GA AL MS TX FL
Alliant Medicare Contract August 2014-July 2019
Learning and Action Network
Dy Dyin ing in g in Americ ica: Improving Quality and Honoring Individual Preferences Near the End of Life ► “The IOM committee believes a person-centered, family- oriented approach that honors individual preferences and promotes quality of life through the end of life should be a national priority.” ► SEPTEMBER 2014 http://www.iom.edu/Reports/2014/Dying-In- America-Improving-Quality-and-Honoring- Individual-Preferences- Near-the-End-of- Life.aspx
ONE NE con onversati tion on c can n make a all the he differ erence. e. 70% of people say they prefer to die at home yet 70% die in a hospital, ► nursing home, or long-term-care facility (Centers for Disease Control, 2005) 82% of people say it’s important to put their wishes in writing ; 23% have ► actually done it 80% of people say that if seriously ill, they would want to talk to their doctor ► about end-of-life care 7% report having had an end-of-life conversation with their doctor (Survey of Californians by the California HealthCare Foundation – 2012)
“Hope is not a plan” “…In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die in peace and in control of their situation and to spare their family anguish.” http://www.pbs.org/wgbh/frontline/film/being-mortal/
Advance Care Planning ► Patients want to participate in advance care planning. ► Most physicians are not initiating these discussions. ► It takes a system to identify and respect patients’ end-of-life treatment wishes. ► Advance directives can prevent unwanted hospital admissions and readmissions ► POLST programs can improve end- of-life quality metrics for patients and the system.
Improving Preventive Healthcare Teach screening and Improved: management of • Aspirin Therapy Depression and risky • Blood Pressure Alcohol use Control • Cholesterol Establish linkages to Management behavioral health • Smoking referral network Screening & Cessation http://www.alliantquality.org/
Diabetes Empowerment Education Program (DEEP)
DEEP Curriculum ► 8 Modules over 6 sessions ( lasting 2.5 hours each) – Understanding the Human Body – Understanding Diabetes and Risk Factors – Monitoring Your Body – Get Up and Move: Diabetes and Exercise – Managing Diabetes through Nutrition; Food Labels – Diabetes Complications: Identification and Prevention – Learning about Medications – Coping with Diabetes: Mobilizing Family and Friends ► Closing meeting features graduation ceremony and award of DEEP Diplomas http://www.alliantquality.org/content/diabetes-classes
Contact Information Adrienne Mims, MD MPH Vice President, Chief Medical Officer 678-527-3492 Adrienne.Mims@AlliantQuality.org
Questions and Answers
Making Healthcare Better
SOURCE and CCSP Level of Care Determinations Presented by: Jennifer Purcell Deputy Director, Medical Review
Medical Management and Utilization Review Contract Georgia Department of Community Health (DCH): Medical Management Services All decisions are made independently Perform more than 500,000 reviews annually Utilization management (UM) Home and community-based waiver management Data analysis, focused studies and reporting in support of program activities Undocumented alien reviews Medical, dental and pharmacy consultations Centralized prior authorization portal for providers Utilization & Compliance Review
Current Medicaid Waiver Contracts ► NOW/COMP Waiver ► Katie Beckett Waiver ► GAPP Program (Georgia Pediatric Program) ► Source Waiver ► CCSP Waiver ► Independent Care Waiver Program
SOURCE Waiver Program ► Service Options Using Resources in Community Environment (SOURCE) is an enhanced primary case management program that serves frail elderly and disabled beneficiaries. ► SOURCE works to improve the health outcomes of persons with chronic health conditions, by linking primary medical care with home and community-based services through case management agencies.
CCSP Waiver Program ► The Community Care Services Program (CCSP) is a Medicaid waiver program that provides home and community-based services to assist individuals who are elderly and/or functionally impaired or have disabilities to achieve safe, self-reliant lives.
ALLIANT/GMCF’S Scope of Work for SOURCE and CCSP ► Initial Level of Care (LOC) admission determinations ► Second Level of Care (LOC) determinations ► Annual re-certifications Making Health Care Better
SOURCE Target Population ► Aged, blind, and disabled Georgian’s who are Medicaid eligible; ► Individuals who have acquired a cognitive loss that results in the need for assistance in the performance of the activities of daily living (ADLs) or instrumental activities of daily living (IADLs); ► Individuals must meet the definition for Intermediate Nursing Home Level of Care.
CCSP Target Population ► Qualify for the level of care provided in a nursing home; ► Have limitations that make it difficult to perform normal daily living activities and live independently; ► Have health needs that can be met in the community with services offered by the program.
SOURCE Reviews ► Alliant GMCF began SOURCE Level of Care determinations in 2012. ► Around 1,500 – 1,800 SOURCE Level of Care reviews are completed per month. ► 18,856 reviews were completed in 2016.
CCSP Reviews ► Alliant GMCF began CCSP Level of Care determinations in 2014. ► Around 700-800 CCSP Level of Care reviews are completed per month. ► 9,314 reviews were completed in 2016.
Conta ntact ct Inf nform ormati tion on Jennifer Purcell, RN, BSN Deputy Director, Medical Review 678-527-3626 Jennifer.Purcell@gmcf.org
Questions and Answers
Making Healthcare Better
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