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AAA Collaborative Doing Business in the Managed Care Landscape

AAA Collaborative Doing Business in the Managed Care Landscape. October 28 th 2013. One Unique Example to Attract the MCOs: E astern V irginia C are T ransitions P artnership EVCTP A formal partnership of Area Agencies on Aging, Managed Care Organizations and Health Care Systems

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AAA Collaborative Doing Business in the Managed Care Landscape

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  1. AAA Collaborative Doing Business in the Managed Care Landscape October 28th 2013 One Unique Example to Attract the MCOs: Eastern Virginia Care Transitions Partnership EVCTP A formal partnership of Area Agencies on Aging, Managed Care Organizations and Health Care Systems Kathy Vesley-Massey, President/CEO, Bay Aging

  2. Eastern Virginia Care Transitions Partnership: GOALS FOR TODAY: Introduce Eastern Virginia Care Transitions Partnership - EVCTP Brief Overview of Organization and How We Operate Current Services and Results How We Can Partner to Enhance MCO’s Ability to Assist Clients to Live Healthily in the Community

  3. Eastern Virginia Care Transitions Partnership: A community partnership of health systems, area agencies on aging, independent physicians’ groups and other public and private health and human service providers. AREA AGENCIES ON AGING Bay Aging – Lead Community Based Organization Eastern Shore Area Agency on Aging and Community Action Agency, Inc. Peninsula Agency on Aging, Inc. Senior Services of Southeastern Virginia MANAGED CARE ORGANIZATIONS HEALTH SYSTEMS Bon Secours Mary Washington Healthcare Rappahannock General Hospital Riverside Health System Sentara Health Care

  4. 1 2 3 4 5 6 7 11 8 10 9

  5. BAY AGING: • Established in June 1978 as a 501(c)3 non-profit organization • Planning Districts 17 and 18 (in red circle) • Rural region • Ten counties: Essex, Gloucester, King & Queen, King William, Lancaster, Mathews, Middlesex, Northumberland, Richmond, Westmoreland • 2030 65+ population – 41,016 projected • Governed by a volunteer 15 member Board of Directors • Over 6,752 seniors received services/supports • All counties are designated as whole or partially Medically Underserved Areas by Health Resources and Service Administration • 166,243 public transportation rides provided independence for people to access jobs, health services, businesses, education and more • 195,471 hot, nutritious meals served to the frail and seniors • 116,751 hours of home care and 38,792 hours of respite care vs skilled nursing facilities

  6. Revised 5/1/13 EVCTP Director

  7. Eastern Shore Area Agency on Aging and Community Action Agency, Inc.: • Designated as an Area Agency on Aging and a Community Action Agency • Planning District 22 (in red circle) • Rural region • Two counties: Accomack and Northampton • 2030 65+ population – 13,284 or 30% projected • All counties are designated as whole or partially Medically Underserved Areas by Health Resources and Service Administration • 4,888 residents served in FY2012 • Over 49,000 hot, nutritious meals served to the frail and seniors • 10,000+ hours of personal care, respite care and comprehensive support services were provided for seniors and their caregivers vs skilled nursing facilities • 400 seniors regularly visit one of three senior centers where they receive health screenings and flu shots to participating in many recreational activities and socialization

  8. PENINSULA AGENCY ON AGING, INC.: • Established in 1974 as a 501(c)3 non-profit • Planning District 21 (in red circle) • Urban region • Jurisdictions of Newport News, Hampton, Williamsburg, James City County, York County and Poquoson • 2030 65+ population – 111,437 projected • Governed by a volunteer 12 member Board of Directors with Advisory Council input • Over 4,000 seniors were served in FY2012 • 176,009 hot nutritious meals served to the homebound frail and seniors • 17,422 hours of in-home care and 9,927 hours of respite care keep families together vs skilled nursing facilities • 845 seniors received care coordination services • Over 802 hours spent on disease prevention and medication management to 1,226 seniors

  9. Senior Services of Southeastern Virginia: • Established in 1968 as a 501(c)3 non-profit organization • Planning District 20 (in red circle) • Urban/rural region • Jurisdictions of Chesapeake, Franklin, Norfolk, Portsmouth, Suffolk, Virginia Beach, Isle of Wight, Southampton • 2030 65+ population – 252,063 projected • Governed by a volunteer 31 member Board of Directors • Over 12,000 seniors were served in FY2012 • 94,850 rides provided for citizens residing in the service region • 210,000 hot, nutritious meals served to seniors • 156,900 hours of respite, in-home care and other community based long term care services vs skilled nursing facilities

  10. Privacy, Confidentiality, Security: • Required of all EVCTP Members • All patient information protected and not divulged • All patient information securely stored at all times whether digital or physical • Any proprietary partner information considered confidential unless otherwise agreed to in writing

  11. Services Available through EVCTP:

  12. Care Transitions Using the Coleman Model • EVCTP AAAs use transitional coaching for reducing readmissions using the Coleman model – Four Pillars of Care Transitions • Coaches are professionally trained and certified through the Coleman Institute Developed by Eric A. Coleman, M.D., M.P.H. • A proven, evidence-based model of reducing hospital readmissions. • Medication Self-Managementwhere patient becomes knowledgeable about medications and has a medication management system. • Dynamic Patient-Centered Record so patient understands/uses a Personal Health Record to improve communication with primary care provider and specialist. • Follow-Uppatient schedules and completes follow-up visit with primary care provider/specialist. • Red Flagsalerts patient about indications that condition is getting worse and how they should respond.

  13. RESULTS COUNT! In-Home Pilot Project: • 2011 – Partnered with hospitals to improve hospital to home patient outcomes • Goal - Reduce hospital readmissions for Dual Eligible (Medicare/Medicaid) people 60 years and over and nursing home eligible • Included enhanced services to improve quality of life – transportation, Meals on Wheels, chore services and other supports, advanced care planning supports • Outcomes - • 265 patients referred • 2 readmissions within 30 days of discharge 98.6% averted Veterans Directed Home and Community Based Services – 37 of 38 people avertedAdult Day Health Services (day care) – 72 of 73 people avertedProvide Financial Management System to process payroll for client-directed (employer) services

  14. EVCTP Capacity for Partnering With MCO’s: • Care Coordination Assessment • Staff skilled in analysis and reporting for Uniform Assessment Instrument and other risk assessments. Easy to expand capacity for new assessors. • Know clientele, geography and community service systems. • Care Coordination - Implementation • Staff plan, implement, follow up and (re)evaluate client needs for a wide array of home and community based services. • Secure IT tracking, reporting, billing, etc. systems in place. • Care Coordination Assistant – Back Office • Perform all aspects of review and evaluation of service needs.

  15. EVCTP AAA Capacity for Partnering With MCO’s: Last year alone we had a combined demonstrated capacity - • FISCAL INTEGRITY: • Four UNQUALIFIED independent third party audits – provided copies • Annual budget total of $34 million • Average administrative overhead of 14% • STAFFING CAPACITY: • 600 employees and $12.6 million payroll • 200 employees working within Case Management/Assessment Staffing • Nurses, Social Workers, Intake Specialists, Consumer-Directed Options Counselors, Certified Coaches, and Administrative Staff performing back office functions • Covers 6,300 square miles – AAAs and ADRCs/NWDs • EVCTP is a one-stop-shop for MCO referral, data management and billing • National Provider Identifiers and Atypical Provider Identifiers available for all • …continued on next slide…

  16. EVCTP AAA Capacity for Partnering With MCO’s: • EXPERIENCE: • 155 years of service working with other public and private providers • 41 years of billing, reporting and maintaining quality records for the State Medicaid Agency and more recently CMS • Secure IT referral, reporting and billing systems for State Medicaid and CMS processes 1,300 clients annually • SERVICES – FY2012: • Performed 1,500 intakes/Uniform Assessment Instrument • Provided direct service to 170 Adult Day Health Services clients; unlimited capacity • Directly performed 403,000 hours of personal care and 40,200 hours of respite care; have unlimited capacity for direct and referred services • Provided 300,000 trips: 98,500 medically related; no waiting lists for Logistcare • Home modification and repair provided directly to 1,000 families; know all subcontractors • Provided a myriad of other services (see annual reports)

  17. EVCTP Area Agencies on Aging (AAAs): EXPERIENCED! WELL RESPECTED! EXCELLENT REPUTATION! GET RESULTS!

  18. Eastern Virginia Care Transitions Partnership EVCTP PRESENTED BY: KATHY VESLEY-MASSEY, PRESIDENT/CEO Bay Aging P.O. Box 610 5306 Old Virginia Street Urbanna, Virginia 23175 804.758.2386 kvesley@bayaging.org www.bayaging.org

  19. AAA Care Management Strategy October 28, 2013

  20. VA AAA Dual Demonstration LTSS Strategy – Phase 1Readiness Review through Go Live Tidewater/Central Coverage Area Commonwealth Care Coordination • Natural Study Groups • Group 1 Tidewater • 10 counties in Central • belong to Tidewater • AAA’s • Group 2 Central – control • group Current Process Next Steps • Developing contracting with • Tidewater • Building implementation • plan • Completing Readiness Review • Deploying/Training Humana CM • in Richmond area

  21. VA AAA Pilot Strategy

  22. VA AAA Dual Demonstration LTSS Strategy – Phase 2Readiness Review through Go Live Coverage Area Commonwealth Care Coordination NOVA/Roanoke/Charlottesville • Determine moving forward based on Tidewater experience • Develop NOVA Contract • Develop JABA Contract • Build implementation plan • Complete Readiness Review • Training CM and deploy • GO LIVE

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