Consolidating Data Sources to Improve Public Access to Benefits and Public Accountability

1. Consolidating Data Sources to Improve Public Access to Benefits and Public Accountability Tom Snedden Director Pharmaceutical Assistance Pennsylvania Department of Aging 717-787-7313 tsnedden@pa.gov September 19, 2013

2. Pennsylvania Department of Aging-- Mission • “Enhancing the quality of life of all older Pennsylvanians by empowering diverse communities, the family and the individual.”

3. Pennsylvania Department of Aging-- Priority Areas • Two main goals of Pennsylvania Department of Aging are prevention and protection.

4. Pennsylvania Department of Aging-- Priority Areas • Prevention • Prevention from instability in health and wellbeing through • assessment and service care coordination • nutrition programs • transportation • PACE and PACENET and pharmaceutical assistance • health and wellness programs: • PrimeTime Health, Healthy Steps, • Chronic Disease Self Management • Promote advocacy for consumers of long-term care • Encourage partnerships among communities and agencies

5. Pennsylvania Department of Aging-- Priority Areas • Protection • Ensure vulnerable Pennsylvanians are protected from abuse • Safeguard rights of residents in facilities • Continually monitor services provided

6. Pennsylvania Department of Aging-- Constituent Growth

7. Pennsylvania Department of Aging-- Constituent Growth

8. Pennsylvania’s Aging Population • In Pennsylvania, there are more than 300,000 residents who are over the age of 85 (2.4%); PA ranks 4th among states in percentage of population age 85. • Additionally, 22% of PA population is age 60 and over; PA ranks 4thin percentage of population age 65 and over. Source: US Census Bureau

9. Pennsylvania’s Aging Population • Pennsylvania’s age 60+ population is projected to increase by 1.045 million from 2010 to 2030 Source: US Census Bureau

10. County % of Population Age 60 Years and Over Rural counties (green) have highest percentages of population age 60+ (tan and brown). Source: US Census Bureau

11. The Aging Population u • Americans are living longer with more complex conditions and disabilities. • One in five Americans will be eligible for Medicare by 2030 • More than 20% of older adults have at least five chronic conditions • Heart disease • Diabetes • Arthritis • Osteoporosis • Dementia • This group of 20% accounts for 80% of all Medicare spending • http://www.americangeriatrics.org

12. The Aging Population u • Americans are living longer with more complex conditions and disabilities. • Older adults access healthcare more than younger adults and children • 26% of all physician office visits • 35% of all hospital stay • 34% of all prescriptions • 38% of emergency medical services and responses • 90% of all nursing home use • http://www.americangeriatrics.org

13. Pennsylvania Department of Aging-- Funding • The Pennsylvania Department of Aging funding sources do not include any general fund revenue.

14. The Aging Population and Access u • Older adults need access to benefits and resources to reach and maintain economic security and a healthful life.

15. ·                      Pennsylvania Department of Aging-- Current Service Delivery • Serves over 960,000 older adults annually • 52 Area Agencies on Aging, serving all 67 counties • Prescription medications for 350,000 older adults • In home and community services to over 520,000 older adults • 12.1 million meals served annually • Average person served by PDA is a woman age 78 who is widowed

16. PENNCARE and PACE • To address prevention and protection, PDA administers: • Home and Community Based Services • Pharmaceutical Assistance (PACE) • Health and Wellness Programs • Protective Services • Advocacy (Ombudsman)

17. Protective Services--Increasing

18. Pre-Admission Assessment--Increasing

19. Nursing Home Population--Decreasing Nursing Home Population Trend

20. Nursing Facility Bed Trends--Decreasing

21. Pennsylvania Department of Aging-- Direction • Ensure Pennsylvanians will age and live well and our communities are places to age and live well • Provide Pennsylvanians with access to care in the right setting, with the right intensity and at the right time • Bring the best of Pennsylvania to Pennsylvanians

22. Our Direction with Data Technology • Using technology in a person-centered approach to improve benefit access by identifying and contacting unenrolled eligible seniors • Using technology to overcome barriers to successful enrollment • Using technology to be accountable

23. Multiple Barriers to Benefit Access Lack of awareness Complicated applications Fear Stigma No transportation

24. Multiple Barriers to Benefit Access Estimated rates of unenrolled eligible individuals for government benefits are in the 30 to 90% range, depending on the program. Pathways to Success: Meeting the Challenge of Enrolling Medicare Beneficiaries with Limited Incomes, NCOA, 2005

25. The PACE Application Center • Department of Aging outreaches to eligible seniors using multiple, measurable databases. • Model developed by Benefits Data Trust(BDT) for outreach, • assistance, • enrollment, • evaluation.

26. The PACE Application Center • Key components of data-sourced outreach • Benefits specialists reach people “where they are” by tracking multiple attempts and formats • Allows for analysis of key metrics • Provides trained outreach staff with tools that emphasize respect, patience, and empathy • Support is refined, as needed, immediately

27. The PACE Application Center • Key components of data-sourced outreach • Customized databases manage eligible senior contacts and response information • Mail, telephone calls, and post cards coming from an identifiable, trusted source • Person-centered management system is two-way: • Outreach to seniors and • Seniors as incoming callers who ask for support

28. The PACE Application Center • Key components of data-sourced outreach • Person-centered management system securely stores documentation to fulfill verification requirements of benefit programs • System manages documentation follow-up tasks for benefits specialists • Benefits specialists submit documentation on behalf of senior applicants

29. The PACE Application Center • Elements of person-centered application management and documentation • Age • Residency • Household size • Household income and assets • Household expenses • Medical expenses • Medical coverage • Enrollment status in benefits programs

30. Overcoming the Barriers to Benefit Access • Increasing awareness—by contacting enrollees in other programs to identify eligible individuals • Reducing stigma—by training call center staff to educate targeted eligibles, one-on-one • Eliminating complicated application processing—by streamlining and supplementing the process with the use of current data

31. Overcoming the Barriers to Benefit Access • Removing fear—by providing application assistance together with information management • No transportation—Obviate the need for applicant travel

32. Overcoming the Barriers to Benefit Access • Increasing awareness—by identifying eligible seniors in benefit databases who are not enrolled in other public benefits for which they are eligible: • PACE and PACENET prescription coverage • Part D Extra Help program for Medicare prescription assistance • Property Tax and Rent Rebates • SNAP enrollment for nutritional assistance • LIHEAP heating assistance • PennDOT low-income registration

33. Identifying Unenrolled and Determining Eligibility—Data Sources

34. Identifying Unenrolled and Determining Eligibility

35. Identifying Unenrolled and Determining Eligibility • Outreach cover letter for PACE enrollment application mailing

36. The PACE Application Center • Results of Targeted, Coordinated Benefits Access • Higher response rates • Better quality responses • Reduced outreach costs • Reduced time with screening ineligible persons • Higher enrollments • Healthcare savings

37. The PACE Application Center Results of Targeted, Coordinated Benefits

38. The PACE Application Center Results of Targeted, Coordinated Benefits Access—PACE

39. The PACE Program—Access AVERAGE PACE BENEFICIARY • WIDOWED FEMALE, 78 YEARS OLD, • LIVING ALONE IN HER OWN HOME, • MANAGING 3-4 CHRONIC DISEASES, • USING 4 OR 5 MAINTENANCE DRUGS, • TO TREAT CARDIOVASCULAR DISEASE, ARTHRITIS, • DIABETES, OR GASTROINTESTINAL PROBLEMS.

40. The PACE Program—Access

41. The PACE Program—Accountability

42. The PACE Program—Accountability PROTECTING A VULNERABLE POPULATION Outreach Program to Seniors, a statewide direct outreach, outbound call activity, targets unenrolled eligibles to screen for enrollment into PACE, Medicare Part D, the Low-Income Subsidy, and Property Tax and Rent Rebate Program. Drug Utilization Review checks for harmful therapy before the pharmacist dispenses the drug by reviewing for interactions, duplicate therapies, and over- or under-utilization. For exceptional circumstances, a medical exception allows the prescriber to indicate the diagnosis and medical rationale to explain use of the drug. The Independent Drug Information Service brings non-commercial, evidence-based drug information directly into the physician office. Visits include data about comparative effectiveness, safety and costs. Improving the Health of Seniors with Mental Health Problems delivers counseling and care management to cardholders newly prescribed an antidepressant, anxiolytic, or antipsychotic. This patient-centered care program promotes patient involvement by providing timely assessment and access to mental health services. There is also a component for caregiver support.

43. The PACE Program—Accountability 2011 STUDY—THE PACE IMPACT ON MEDICAID • PACE supports many seniors prior to Medicaid enrollment. • Compared who “had” and “did not have” PACE in a 5-year period prior to long-term care or nursing waiver • PACE seniors remained in the community longer, with better health • PACE delayed entry into and lessened the utilization of these services • With early PACE drug coverage, PACE enrollees with later Medicaid enrollment had lower costs due to deferred services entry; savings estimated at $815.3 million annually.

44. The PACE Program—Accountability

45. The PACE Program—Accountability The Survey on Health and Well-Being assesses important aspects of providing a prescription benefit. The voluntary and confidential survey, now in its 13th year, measures health status, quality of life, attitudes, health related behavior, activity limitations, and satisfaction with the Program.

47. Questions?tsnedden@pa.gov THANK YOU

48. Information and data slides follow Budget performance measures PACE / PACENET Program PACE / PACENET Enrollment and Claims Dept. of Aging Organizational Chart State Plan on Aging Goals Benchmarking Reports

49. Budget Performance Measures

50. Budget Performance Measures