Care Coordination Model: Meeting the Needs of the I/DD Population October 30, 2014

1. Care Coordination Model: Meeting the Needs of the I/DD Population October 30, 2014

2. AGENDA • Population Served • Background & Challenges • Model of Care • Strategic Priorities

3. POPULATION SERVED 3 • Average age – 52 years old • 62% with mild/moderate Intellectual Disability (ID) diagnosis; 38% with severe/profound ID • 34% with communication challenges; 23% with ambulation/mobility challenges • 43% are 50 – 64 years old; 18% are 65 years or older

4. POPULATION SERVED 4 • 100% of people have I/DD diagnosis. In addition: • 52% of this group is considered overweight (BMI > 25) • 41% of this group has secondary MI diagnosis • 26% of this group has heart disease • 3% of this group has asthma • 1% of this group has substance abuse issues

5. ENVIRONMENTAL CHALLENGES 5 • Few physicians willing to take on Medicaid patients with ID diagnosis. • Willing providers scattered across wide geographic location, making travel time a significant challenge. • Reliable, long term patient/doctor relationships almost impossible. • Quality of care and follow-up inconsistent at best.

6. MEDICAID WAIVER 6 • Medicaid Waiver offers minimal support for integrated, coordinated care approach • Partially funds nursing professional • Funds intervention, individual and group counseling behavioral services • Does not fund transportation, in-appointment staff support, specialized medical case management, capital costs associated with clinic operations • Residential service providers are required to coordinate care – effort is currently fragmented and inefficient

7. OUR RESPONSE • Create clinic-based medical homes co-located at existing day service sites • Specifically designed to meet needs of people with ID diagnosis • Reduces missed appointments • Improves follow-through with treatments, care and transitions • Facilitates access to specialty services • Reduces reliance on expensive skilled care • Maximizes cost savings AND improves outcomes

8. MODEL OVERVIEW: CLINIC SERVICES 8 • Medical homes/clinics dedicated to ID population – 3 clinics currently in operation • Clinic staffing consists of: • Medical Services Coordinator – Provides medical case management, 24 hour on-call support • Nursing professionals – 24 hour on-call support • Team of behavioral services professionals

9. MODEL OVERVIEW: CLINIC SERVICES 9 Clinic services include intensive medical case management: • Arranging services with providers • Coordinating transportation and support • Fully-supported health care visits • Keeping track of all client appointments • Scheduling follow-up appointments • Monitoring/coordinating following through on client treatments and medications • Supporting transitions

10. MODEL OVERVIEW: COMMUNITY PROVIDER NETWORK 10 • Operating agreements with wide variety of health care providers - providers are independent contractors billing for their own services • Access to an array of services provided on-site and off-site, including: • Primary care • Behavioral and Psychiatry services • Dietary • Gynecology • Neurology • Physical and Occupational therapy • Labs/Testing/Pharmacy • Dental Care

11. MODEL OVERVIEW: CARE DELIVERY PROFILE 11 • 7,142 medical encounters coordinated in FY 14 (as of 6/30/14) • percent of E.R. encounters = less than 1.9% of total (135 total E.R. encounters) • 13,332 behavioral services provided in FY 14 • Care delivered on-site at clinics: 87%; Care delivered offsite: 13% • Average duration of medical appointments: • Offsite – 2 hours, 10 minutes • Onsite – 15 minutes

12. MODEL OVERVIEW: CARE DELIVERY PROFILE 12 Key elements: • All individuals are linked to a primary care physician, care coordinator and pharmacy provider on day one • Care coordination services include 24 hour on call support for medical and behavioral concerns • Services include the training of support staff and family members on the medications and treatments individuals receive

13. OUTCOMES 13 Outcome: Individuals receive the care they’ve been scheduled to receive, without unnecessary delays. Performance Indicator: The percent of medical services delivered as scheduled is 99% or greater. Result:

14. OUTCOMES 14 Outcome: Individuals receive routine, preventative care through their primary care provider, rather than through the ER. Performance Indicator: The percent of care provided through the ER is 2% or less of total services delivered. Result:

15. OUTCOMES Service intensity declined from FY 2008 to FY 2014 due to effective coordination.

16. STRATEGIC PRIORITIES 16 • Maintain alignment between service providers and health homes • Preserve co-located clinical model for those we currently serve • Create new clinical capacity to serve 9,000 individuals with ID/DD in North Cook & Lake counties • Support capacity expansion through Keystone IT & Management platform

17. Care Coordination Model: Meeting the Needs of the I/DD Population Q & A