Chronic Disease Self Management Falls Prevention Education Wellness/Risk Depression Assessment and Counseling Chronic Care Management 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… Housing Outdoor Spaces Social and Buildings Participation Age-Friendly Communities Community Respect and Support & Social Inclusion Health Services Civic Communication Participation and Information and Employment
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 over all six years was 40,365 persons. On average 30% of 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 • Decision making two major wave is near! major umbrellas (additional story external branding telling) 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 Decision Making Team: Board of Director • Identify network partners CEO and President Finance Director • Selecting evidence-based Project Director programs
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 Additional Resources Board Members • Financial • HFSF Board • Data Management System • FHN Committee • Billing Network Partners Healthcare Providers • Statewide Delivery • Referral Organizations • Sustainability • Readiness/Needs
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 • Contracting with a Network Specialty Care Company • FHN Committee is created • Successes of FHN in securing ACL grants and other Foundations program • In 2014, HFSF awards FHN grants a $300,000 grant • In 2017, Board approved line of credit increase to • May 2015 HFSF approved a $1.2 million for FHN $425,000 line of credit
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 Recently signed an champion surfer: agreement – Better slicker faster surf – Develop the relationship to board to surf out the health create an administrative plan waves services agreement – fill the service gap – Specialty care company – Relationship with (SCC) that had a long designated SCCs standing relationship with representatives some of the biggest – Included data, training, Medicare advantage plans help develop contract, and could be a value added training of their own staff partner to increase our credibility.
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 Community Self- delivery of the programs to Involvement Management community based Knowledge organizations Exchange • Marketing and Branding Outreach • Hedis, Star Rating, and CAHPS benefits for Health Plans • Proving concept and providing local data and/or ROI
Resources • Financial – HFSF continuous backing and support – Grants – Contracts • Data Management System • Billing
Financial FHN funding: - Grants - Health Foundation Line of Credit - HFSF In-Kind Support Grants HFSF Line of Credit HFSF In-Kind Support • 2014: – ACL Falls Prevention Services Provided by HFSF staff: Line of credit covers annual Grant $400,000 – President and CEO – HFSF $300,000 expenses (office rent, staff – CFO – salary, telephone, office VP of Communications • 2015: ACL CDSME Grant utilities, etc.) $900,000 • CMS consultant (Tim McNeil) – 2015: $425,000 has provided guidance on • 2017: – billing codes for specific 2016: $1.2 million programs and through ACL – ACL CDSME Grant CDSME grant. $757, 590 – Humana Foundation $118,500 – Weinberg Foundation $272,870
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.
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