Strategies for Improving SHIP and SMP Partnerships

1. Strategies for Improving SHIP and SMP Partnerships Effective Models of SHIP/SMP Collaboration Barbara Dieker, Director, Office of Consumer Choice and Protection, Administration on Aging Susan Johnson, Program Manager, V.A. SMP Julie Schoen, Esq., Special Projects Director, California Health Advocates Carla Obiol, Director, N.C. SHIIP Doranna Anderson, Program Operations Manager/SHIIP, NCSMP Director

2. Session Overview • As a result of this session, participants will have a better understanding of: • The benefits of successful SHIP/SMP partnerships; • How collaboration with SMPs enhance SHIP program capacity; • Specific ways SHIPs can collaborate with the SMP program in their state; • How models for collaboration may differ based on organizational relationships • Joint CMS/AoA efforts underway to enhance SMP/SMP program effective interface

3. SMP Strategic Vision and Goal • VISION:Nationally recognized leader in prevention and identification of fraud and abuse in health care programs that affect the lives of elderly consumers. • GOAL:Protect the financial resources of elderly consumers and of Federal and state health care programs.

4. SMP Program Objectives for 2006 • Foster National and Statewide Program Coverage. • Improve beneficiary education and inquiry resolution for other areas of health care fraud. • Foster national program visibility and consistency. • Improve the efficiency of the SMP Program while increasing results for both operational and quality measures. • Target training and education to isolated and hard -to -reachpopulations.

5. SMP Program Overview • 12 local demonstration projects started in 1997 • Today: 57 projects--nationwide in 50 states, DC,& territories • Recruit and train retired professionals to assist seniors and caregivers in the prevention, detection and reporting of health care error, fraud, and abuse, with an emphasis on Medicare and Medicaid • Partner with aging services network, health professionals, law enforcement, and others to promote community awareness of health care errors, fraud and abuse

6. Empowering Seniors To Prevent Healthcare Fraud SMP Program since 1997: • Achieved national program coverage • 58,473 volunteers trained • Over 40,000 complaints handled • 1,828,827 people educated • Over $104M saved

7. SMP/SHIP Collaboration: AoA and CMS • CMS SHIP Leadership on SHIP/SMP Interface Work Group • Partner in design of SMP/SHIP interface survey • Bi-monthly SHIP/SMP/ADRC calls— updates on current activities • AoA a regular participant in: • SHIP Steering Committee calls • SHIP Partner Group calls • SHIP Resource Center consulted AoA on dual eligibles initiative

8. Model #1- SHIP and SMP Housed Separately Virginia SMP Virginia Association of Area Agencies on Aging Susan Johnson, Project Manager 24 East Cary Street, Suite 100 Richmond, Virginia 23219 804-644-5628 or www.vaaaa.org

9. Affiliation/Relationship • In Virginia, the Virginia Insurance Counseling Program Assistance Program (VICAP) or SHIP Program is housed within the Virginia Department for the Aging, Richmond, Virginia. • Virginia SMP is administered by the Virginia Association of Area Agencies on Aging, Richmond, Virginia. • Programs are housed in separate offices – not in the same building and / or location.

10. Location Benefits • Virginia Department for the Aging (VDA) in Virginia: • Works with 25 local Area Agencies on Aging to help older Virginians, their families and loved ones find the services and information that they need. • Foster the dignity, independence, and security of older Virginians by promoting partnerships with families and communities. • VDA is designed by the federal government as the agency to oversee all state programs using funds provided by the Older Americans Act and the Virginia General Assembly. Area Agencies contract with the Department to provide services for older Virginians, families, and communities in Virginia. • Virginia Association of Area Agencies on Aging (V4A) • V4A is a private, non-profit 501(c)(3) organization established in 1976, comprised of the 25 Area Agencies on Aging. Principle activities include advocacy, promotion, facilitation and improvement on behalf of its members to better serve and represent Virginians older residents, caregivers and local communities. Also houses the Office of the State Long-Term Care Ombudsman. • Benefits: • Both organizations are in the Virginia “Aging Network”. • Both share the Virginia AAA’s as partners. • Both share additional program partners as well.

11. Partnership Efforts • No “formalized” partnership with an agreement or Memorandum of Understanding.

12. Benefits • Co-publish a Monthly Health Care Journal together –share outreach materials. • Combine some resources and efforts for outreach in Virginia, i.e. senior and health fairs and exhibits, community presentations, press releases, etc. – staffing and education. • Provide some volunteer training together in regions. (New!!) • Collaborative efforts utilize AAA staff and volunteers time more effectively. • Contributes to a more effective relationship and better informed Program Managers.

13. Successful Joint Initiatives • Programs “might share some volunteers” who choose to serve as volunteers for SMP and VICAP. Some volunteers do not want extensive training. Some volunteers will include SMP outreach objectives with their presentation-depending on the audience. • Tips – educate volunteers and AAA staff contacts about roles and reporting, so everybody is on the same page and this is a benefit and not confusing for the volunteer.

14. Keys to Success • In Virginia, this collaboration is helpful because both programs are in the “Aging Network” so we share partners and visions. • Desired outcomes for both agencies in both organizational and program goals. • Any functions related to AAA duties, volunteers, staff time, and training that help streamline the duties of the AAA staff and volunteers is positive. • Growth potential. Successful aspects of the collaboration will lead to more creative future partnerships within the two programs. • Knowledge – staff and volunteers more knowledgeable of the programs, issues and can provide community education.

15. Lessons Learned- Keys to Success • Clear communication among Managers and staff. • Clear communication to AAA Partners and staff that are involved in both programs. • Defined roles – more effective relationships among agencies, partners and communities. • Defined missions – this helps avoid confusion and prevents feelings of program duplication, etc. • Genuine beliefs of “Win-Win” partnership and what both programs can bring to the table.

16. Lessons Learned- Pitfalls to Avoid • Define Roles. • Make sure both programs understand reporting requirements. Want information and reporting to count!

17. Contact Information Susan Johnson, Project Manager Virginia SMP Virginia Association of Area Agencies on Aging 24 East Cary Street, Suite 100 Richmond, Virginia 23219 804-644-5628 or sjohnson@theV4A.org

18. Model #2: HICAP and SMP Julie Schoen, Esq. Special Projects Director CHA CA SMP

19. REGIONAL HICAP PROJECTS THROUGHOUT STATE OF CALIFORNIA State of CA’s HICAPs (SHIP)

20. The SMP/SHIP Connection • California Health Advocates (CHA) is the incorporated association of the HICAPs • CHA holds the SMP grant • Every HICAP recruits and trains their own volunteers. • To be an SMP volunteer they must have HICAP training • Trainings are coordinated through the CHA offices

21. Partnership Efforts • SMP adds a whole new dimension to HICAP services • SMP provides yearly training in a statewide conference and program specific training • Community Educations provide new topic areas to explore • Community Education produces case reports • All fraud/abuse allegations are channeled through the SMP office, California Department of Aging supports this effort through our statewide intake form • SMP is responsible for inputting these statewide cases into Smartfacts and doing all required reporting

22. Benefits • Cohesive trainings and shared materials in English, Spanish and Vietnamese • Fraud alert e-mail system that allows all programs to be updated throughout the state concerning current fraud/abuse trends • SMP is the clearinghouse for all allegations, saves HICAPs staff time and resources • SMP does all tracking • State and National recognition for successful reporting • Continuous resources for new information

23. Successful Joint Initiatives • Sharing volunteers enables each HICAP to provide quality control and individualized recognition. SMP could not monitor the activities of all 900+ volunteers statewide • SMP provides new volunteer opportunity outside the realm of traditional HICAP counseling • HICAP/SMP volunteers have a well rounded knowledge base of Medicare • Drawback: We do not know each volunteer personally and must rely on the program manager to relay our update information throughout the year.

24. Keys to Success • SMP relies upon the HICAP as its foundation. This model ensures outreach in all areas of CA. • SMP is allowed to focus wholly on our mission and then impart this knowledge to the HICAPs. The train the trainer model works very well. • No competition, we are all in this together. • Communication is key

25. Lessons Learned- Keys to Success • HICAP is ever evolving, new staff, new volunteers etc. Reaching out to all of the program managers is a full time position. • Keeping them informed of trends, • How to report • How to utilize SMP forms • How to request trainings, • How to utilize community education materials • Updating handbooks, brochures, translations etc. • Scheduling trainings and the conference

26. Lessons Learned- Pitfalls to Avoid • Never assume • After we provide the annual conference, we cannot assume that our job is done. • Communicate e-mail updates, fax flyers, give progress on cases • Renewal for the grant came up in 2005 and we had one of our one program managers ask if we would be applying for the grant-they still had not made the connection between SMP and our (at that time) SCAMS project.

27. Contact Information Julie Schoen, Director jschoen@cahealthadvocates.org Anne Gray, Coordinator agray@cahealthadvocates.org (714) 560-0309

28. Model 3: NCSMP and NC SHIIP Carla Obiol, Director, NC SHIIP Doranna Anderson, Operations Manager, NC SHIIP and Director, NCSMP Program

29. Affiliation/Relationship • NCSMP is housed in the NC SHIIP, NC Department of Insurance. • NC SHIIP is the SMP grantee. • NCSMP share the same location and office space as NC SHIIP. • NC SHIIP supports NCSMP with staff, office and counseling space, equipment and supplies.

30. Location Benefits • NC SHIIP is well established and respected program for over 20 years. • There are local and statewide partnerships and established relationships with other governmental agencies and organizations. • Staff possesses a strong Medicare knowledge base to determine if billing errors, fraud or abuse may have occurred. • CMS and NC SHIIP training sessions/information are provided to NCSMP specialists (volunteers). • We share a statewide toll-free consumer line, web site, beneficiary accessible counseling sites in all 100 counties, volunteers, and access to information.

31. Partnership Efforts • When possible NC SHIIP and NCSMP promote each other programs through printed materials, media outlets, presentations and outreach events. This has provided NCSMP access to various venues. • NC SHIIP staff and volunteers promote the NCSMP program and send referrals. • NCSMP has provided training to all NC SHIIP volunteers. • NCSMP has written contracts with seven AAA’s which receive AoA funds as a sub-grantee.

32. SHIPS & SMPs: Notable Results • Valued by the NC SHIIP, NCDOI • Build on established relationships and credibility of the NC SHIIP program • Enhancement of the work being done by NC SHIIP • Shared Medicare/Medicaid expertise • Share target audience and volunteers • Share resources (i.e., staff, volunteers, partnerships, office and counseling space, and equipment)

33. Benefits • Consumers with possible complex billing errors, fraud and abuse are referred to the NCSMP program. • NCSMP staff and specialists (volunteers) have opportunities to receive CMS trainings. • NC SHIIP shares their resources, promotes the program and refers speaking and outreach opportunities to NCSMP and vice versa. • NCSMP program gained credibility and acceptance with partners, organizations and beneficiaries because of being housed in NC SHIIP.

34. Successful Joint Initiatives • NCSMP specialists (volunteers) are also NC SHIIP volunteers. NCSMP specialists (volunteers) receive an NCSMP basic training (eight hours) and NC SHIIP basic training (24 hours). These training provided volunteers a solid Medicare knowledge base to be able to understand Medicare benefits and billing statements. • NCSMP specialists (volunteers) work primarily on SMP duties (presentations, outreach events and counseling.) NC SHIIP volunteers primarily work on SHIIP duties. • NCSMP specialists and NCSHIIP volunteers report activities on the CMS reporting forms. NCSMP uses a different color form for reporting. NCSMP data from these forms are then entered into Smartfacts. • NCSMP educational and training materials are shared with NC SHIIP staff, volunteers and partners.

35. Keys to Success • Our target audience is the same - serving Medicare/Medicaid beneficiaries. It is important to have a solid knowledge base of Medicare program and products knowledge. (Ex: CMS trainings, SHIIP quarterly follow-up meetings, fraud alerts) • Both programs educate the beneficiaries so they make the best informed choice to meet their particular needs. (Ex: counseling, Web site, toll-free line, presentations, outreach events, health expense sheet, and health care journal) • Both programs share resources and their strengthens which provide the ability to increase statewide coverage. (Ex: Medicare Part D Expo, local counseling sites, underserved populations)

36. Lessons Learned- Keys to Success • We share the same basic goal to educate Medicare/Medicaid beneficiaries, professionals and caregivers to understand program benefits which will enable them to identify potential billing errors, fraud and abuse. (i.e., scam jams, presentations, outreach events, educational materials) • We are able to identify trends in a more timely manner for possible fraud and abuse (i.e., door-to-door solicitation) or high-pressure sales practices (i.e., Medicare Advantage) to develop educational messaging for the public. • We were able to build our program identity at a faster pace.

37. Why Doesn’t It Work Sometimes? • Poses a challenge as to how to count events and volunteer hours when activities are being conducted jointly by NC SHIIP and NCSMP or program crossover. • NC SHIIP work is a higher priority than NCSMP. • There are several avenues to receive beneficiaries complaints. Depending on the nature of complaint NCSMP staff may or may not receive an appropriate referral. • NC SHIIP staff usually receives the majority of simple and complex billing issues. Possible reports of fraud and abuse are referred to NCSMP staff. Sometimes NC SHIIP staff demonstrates a lack of clarity as to where to direct a complaint. Should it be sent to NC SHIIP or NCSMP.

38. Lessons Learned- Pitfalls to Avoid • Important to have at least one person to work 100% on NCSMP. NC SHIIP staff who have a percentage of time devoted to NCSMP have a challenge with balancing work priorities between NCSMP and NC SHIIP. • What constitutes an inquiry becoming an NCSMP complaint? There is a need to work within the established NC SHIIP protocol for processing inquiries and complaints. Currently NCSMP receives fraud and abuse complaints and some complex billing errors. NC SHIIP receives inquiries and most billing errors. NC SHIIP will include NCSMP in any potential fraud and abuse complaint. • How to record incorporated NCSMP program activities with NC SHIIP program activities without duplicating data to both CMS and AoA. (We have not resolved.)

39. Contact Information Carla Obiol, NC SHIIP Director cobiol@ncdoi.net or 1-800-443-9354 Doranna Anderson, NCSMP Director danders@ncdoi.net or 1-800-443-9354

40. [Conclusion] Summary of Partnership Concepts

41. Examples of Joint SHIP/SMP Activities • Cross train SHIP and SMP volunteers and staff • SMP refers all general inquiries about enrollment, eligibility, etc. to SHIP as part of presentation and SHIP refers complaints re: alleged fraud to SMP • Sharing outreach materials • Joint newsletters • SHIP staff on SMP Advisory Board • Joint or cross-posting of info on websites

42. Benefits of Partnerships • Enhanced effectiveness: better outcomes, greater innovation • Enhanced efficiency: eliminate redundancy, coordination of resources • Resource gains • Increase capacity • Increased visibility and legitimacy

43. Getting started: Planning • Identify your mission • Identify gaps • Brainstorm list of potential partners • Evaluate list and target priority groups

44. Getting it Done • Research your target • Identify opportunities to make connections (people and places) • Pick up the phone • Formalize the relationship- MOU, mission statement, goals, etc. • Identify specific measurable outcomes

45. Keeping it Alive • Plan for sustainability • Care and feeding: acknowledgement, attention, etc. • Track your outcomes • Recognize rewards and successes • Build on the momentum

46. Keys to Making Partnerships Work • Communicate! • Working with organizations that both benefit from the partnership • Keep it interesting- motivation • Tie your efforts to outcomes • Make it a priority