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

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 between aging and disability CBOs and the health care system. 2

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 3

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 4

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 5

www.aginganddisabilitybusinessinstitute.org 6

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 7

Readiness Assessment Modules • Change Readiness • Strategic Direction Readiness Internal • Operational Readiness • Management Readiness • Leadership Readiness • External Market Readiness External • Partnership Development Readiness 8

Training and Technical Assistance  Monthly Webinar Series  Conferences  State & Regional Business Acumen Trainings  Case Studies  Learning Collaboratives  Targeted Technical Assistance  Consulting Services 9

RFI Survey To Take th the Puls lse of f CB CBO-Healt lth Ca Care Part rtnership ips 10

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 other CBOs (THANK YOU!) • Survey was in the field for 5 weeks between July and August of 2017 with a total of 593 respondents 11

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. 12

Contracting Status by Agency Type No, No, not Yes Total pursuing pursuing Area Agency on Aging 144 63 (17.9%) 144 (41.0%) 351 (AAA) (41.0%) 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. 13

Most Common Health Care Partners for Organizations Contracting with Health Care Entities Medicaid managed care organization 35.00% Hospital or hospital system 27.80% Veterans Administration Medical Center 19.10% Medicare/Medicaid duals plan 16.10% Commercial health insurance plan 13.90% State Medicaid 12.60% 0.0% 10.0% 20.0% 30.0% 40.0% 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. 14

Most Common Services Provided through Contracts by Organizations Contracting with Health Care Entities Case management/care 49.30% coordination/service coordination Care transitions/discharge planning 29.10% Home care 26.50% Nutrition program 26.00% Person-centered planning 22.00% Participant-directed care 20.60% Transportation (medical or non-medical) 20.60% Evidence-based programs 19.70% 0.0% 20.0% 40.0% 60.0% 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. 15

Most Common Payment Models of Respondents Fee for Service (FFS) 30.20% Per member per month (PM/PM) 22.30% Per service unit 19.40% Per participant 17.30% Full-Time Equivalent (FTE) based 8.60% contract 0.00% 10.00% 20.00% 30.00% 40.00% 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. 16

CBO Networks CA Partners At Home Network FL Florida Health Network IL Illinois Community Health ME and Aging Collaborative WA VT IN Indiana Aging Alliance NH MA KS Kansas Association of Area MT ND MN Agencies on Aging NY OR RI MA Healthy Living Center ID WI MI SD CT of Excellence NJ WY PA MD Living Well Center of DE IA Excellence OH NE MO Kansas City Integrated IN IL WV NV VA MD Care Network, MO 1 UT Community Health Partners 1 NC CA CO KY KS MO NC NY Western New York Integrated Care Collaborative 1 TN SC NYC Department for the Aging 1 NY OK AR OH Direction Home AZ NM GA OR Oregon Wellness Network AL MS OK Oklahoma Aging & Disability Alliance 1 TX LA PA Aging Well, LLC & Comprehensive FL Care Connections (C3) TX Texas Healthy at Home VA Virginia Area Agencies on Aging – Caring for the Commonwealth (VAAACares) WA Conexus Health Resources 1 Networks in Development 1 Not a full statewide network

Interest in Contracting of Respondents without Contracts We have not thought about pursuing a 19.40% contract with a health care entity No, this is not something we plan to 17.50% pursue Yes, and we have actively pursued 8.20% contracts but have not been successful Yes, but we need more information or 39.90% guidance before pursuing Yes, but not at this time 14.90% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 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. 18

https://www.healthaffairs.org/do/10.1377/hblog20180130.620899/full / 19

RFI Survey https:/ ://mia iamio ioh.qualt ltric ics.c .com/S /SE/? /?SID=SV_9Mn4 bih ih45kQGo6x&Q_JFE=0 20

Changes to Medicare Advantage • Expanded supplementary benefits • 2019 Call Letter • CHRONIC Care Act • Updates to uniformity requirements • 2019 Call Letter • CHRONIC Care Act 21

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 22

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” 23

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 24

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 25

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 26