1 Home Care Workers: Critical Members of the Health Care Team Corinne Eldridge Executive Director, CLTCEC State of Reform April 6, 2016

CMMI Project: Care Team Integration of the Home-based Workforce Health Care Innovation Award of $11.8M Train 6,000 IHSS Consumer- Provider Pairs over 3-Year Period Consumer directed Integrate provider into consumers’ care team Better care Reduce ER visits Reduce LOS in nursing homes Reduce hospitalization Improve health Achieve $25 million in savings $10.2m Medicaid; $14.7m Medicare Lower costs 2

The California model Consumer-directed care, over 500k consumers Over 450,000 IHSS providers Independent Providers The Home Care workforce is the 2 nd quickest growing workforce in the nation with predicted increase of 70% by IHSS workers are with consumers 4-24 hours a day; pivotal role as extension of consumer 3 California Model

Training and Integration Train provider on Core Competencies and Soft Skills 63 hours, Attendance Requirements, Skills Demonstration Prepare for Role on the Interdisciplinary Care Team Measuring Program Goals Integration Cost analysis: Utilization data from Health Plans (performed by UCSF) Focus Groups Consumer & Provider Surveys Quality of Life Indicators Workforce Satisfaction 4

Regions, Classes & Graduates 247 CMMI Classes 221 in Los Angeles County 15 in San Bernardino County 11 in Contra Costa County 5552 Provider Graduates 6390 Consumer Graduates 89% of students who attend 1 class complete graduation requirements 91 Classes in Spanish 82 Classes in English 38 Classes in Armenian 14 Classes in Korean 12 Classes in Mandarin 10 Classes in Cantonese 5

6 EDUCATION/TRAININGPERCENT (n=3,643) Less than high school42.8% High school graduate17.1% Some college or associate degree29.0% Bachelor's degree or higher11.1% TOTAL100% Worker Educational Background

7 INTEGRATION MEAN 5=Strongly agree 1=Strongly disagree IHSS providers should be part of healthcare teams (n=1,521) INTEGRATION: COMMUNICATION MEAN 5=Always 1=Never How often does your main IHSS provider communicate with anyone from your healthcare team about your health conditions (for example, asthma, diabetes, high blood pressure, etc.)? 3.87 (n=1,529) How often does your main IHSS provider communicate with anyone from your healthcare team about your well-being (for example, nutrition, exercise, social activities, etc.)? 3.77 (n=1,509) In future, how often do you want your main IHSS provider to communicate with your healthcare team 4.14 (n=1,438) Including IHSS Providers in Healthcare Team

Health Plan A: Summary Consistent trend within Plan A showing declining rates of utilization and reuse among members whose workers were trained. Demonstrated cost savings post training for both ER visits and inpatient hospital stays Differences are most notable by the second year after training 8 Evaluation: Health Plan A Summary

9 ABC Year 0: 12 Months before graduation Year 1: 12 Months after graduation Year 2: months after graduation 1# Trained Workers* #ER visits # ER Users Mean ER visits/Trained Workers* Mean visits/ER users % ER users among Trained Workers* Table 1: Emergency Room Visits Health Plan A Members with a Trained IHSS Provider *Trained Workers refers to health plan members whose worker graduated from the training Health Plan A

10 Table 2: Inpatient Hospital Stays Health Plan A Members with a Trained IHSS Provider ABC Year 0: 12 Months before graduation Year 1: 12 months after graduation Year 2: months after graduation 1# Trained Workers* #IP stays # IP Users Mean IP stays/Trained Workers* Mean IP stays/IP users % IP users among Trained Workers* *Trained Workers refers to health plan members whose worker graduated from the training Health Plan A

Health Plan A: Cost Savings* ER $2,310 per member savings in trained group compared to non-trained group INPATIENT $9600 per member savings in trained group compared to non-trained group *Based on standardized cost estimate from IHSS statewide data from 2008; $2100 per ER visit; $48,000 per hospital stay 11 Health Plan A Cost Savings *

Consumer directed nature intact Workforce is committed to training and is trainable Know your population and meet them where they are: language and place Integration: important to have deep collaboration with Health Plans Trained IHSS workers does improve the triple aim Providers better prepared & empowered in their role 12 Path Forward

Contact Information Corinne Eldridge Executive Director CLTCEC

“This publication was made possible by Grant Number 1C1CMS from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.” 14