Healthcare Integration 101: Payers, Players and Opportunities NRCNA Pre-Conference Workshop Tuesday, August 30, 2016 12:45 p.m. – 4:00 p.m.

Sharon R. Williams, CEO Williams Jaxon Consulting, LLC NRCNA Pre Conference Workshop August 29, 2016

Agenda Understand the value proposition Senior Nutrition Programs bring. Learn about the drivers for healthcare organizations, Hospitals, ACOs, MCOs and providers. Benefit from peer-to-peer learnings via practice model presentations from successful Mini­ Grantees. Mini grantees will share their experiences and lessons learned. Get tips on positioning your services to sell to healthcare organizations (value proposition). MOWA NRCNA 8 2016 srw

Transformation ‘No social stability without individual stability’ Aldous Huxley, Brave New World MOWA NRCNA 8 2016 srw

American Aging/Disabilities Demographics ‘There are roughly 43-50 million people in the US who meet persons with disabilities criteria; by 2030 this number could increase to 75 million.’ --Lex Freidan, disabilities advocate, credited with contributing to the content of the ADA. MOWA NRCNA 8 2016 srw

U.S. Policy Catalysts In 1965, as Great Society landmark legislation such as Medicare and Medicaid transformed the national healthcare landscape; the passage of the Older Americans Act impacted the delivery, coordination and quality of socio-economic support services for older Americans and persons with disabilities. MOWA NRCNA 8 2016 srw

Implications of Integrated Care on Traditional Delivery Systems Full spectrum of intensive medical, behavioral, social-economic and other key determinants of quality of life Expanded ‘quality indicators’--Social Determinants of Health (SDOH) Community vs institutional settings Person centered planning, personal goal setting-including accommodations for natural support systems Primary Care Medical Homes (PCMH) Individualized care planning Blended funding/services New ‘providers’(that’s YOU!) with unique and fundamental training needs Managing coverage for ‘non clinical’ services, e.g., SDOH MOWA NRCNA 8 2016 srw

Affordable Care Act: Medicaid/Medicare Reforms Integrated Care System to reduce fractured care, payment and service structures Triple Aim Managed Long Term Care reform Dual Demonstrations Emphasis on quality/financial outcomes MOWA NRCNA 8 2016 srw

Triple Aim Population Health Per Capita Cost Redux Patient Experience (Quality Outcomes) MOWA NRCNA 8 2016 srw

Elements of Integrated Care Person centered accountable care/Strong consumer protections Multi-disciplinary care teams providing care management and coordination Comprehensive provider networks that meet the need of target population--clinical and SDOH Enhanced use of home & community based long term care services Robust data sharing and communication across all of the consumers’ providers of care Financial alignment that blends Medicare & Medicaid policies, standards & funding. Focus on consumer choice Great emphasis on cost effectiveness/other financial initiatives, e.g., risk sharing, Medical Loss Ratios (MLR) Quality outcomes vs process outcomes New opportunities/challenges for all entities in the healthcare continuum MOWA NRCNA 8 2016 srw

Common Needs for Healthcare Organizations Hospitals Providers Health Plans MOWA NRCNA 8 2016 srw

Common Needs for Healthcare Organizations Hospitals Contract Obligations Medicare payment rules Accreditation Patient Outreach/Satisfaction Cost Health Plans Network Adequacy Quality Outcomes Consumer Outreach/Satisfaction MOWA NRCNA 8 2016 srw

Common Needs for Healthcare Organizations Providers Primary Care Medical Home (PCMH) accreditation Patient Engagement/Satisfaction Quality/Performance Outcomes Cost Effectiveness ACOs Performance/Quality Outcomes Hospital/ER Utilization Reduction MOWA NRCNA 8 2016 srw

Nutrition Services Impact Integrated Care Initiatives Hard to reach Consumers Environmental Scan Assessment for other needed services Medication Reconciliation Satisfaction/Retention Community Needs Assessment data Consumer Engagement Increase Preventative Services Reduce Institutional Care Reduce Inpatient/ER Utilization Reduce Overall Cost of Care Supports population health management initiatives Performance Outcomes Nutrition Counseling Nutritious Support/Therapeutic Meals RD expertise for Integrated Care Teams Care Coordination MOWA NRCNA 8 2016 srw

Meet Them Where They Are… Understand the culture/business environment Know their unique issues, e.g., state regulations, contract terms, etc. (dynamic not static) Define your solutions to their needs in their terms Be prepared to design multiple value propositions for multiple audiences within an organization-finance, clinical/quality, etc. MOWA NRCNA 8 2016 srw

Bibliography Patient Protection and Affordable Care Act, www.hhs.gov Centers for Medicare and Medicaid Services, www.cms.gov National Business Coalition on Health’s Value-based Purchasing Council, Value Based Purchasing: A Definition, www.nbch.org/Value-based-Purchasing Centers for Health Care Strategies, Inc., Snapshots of Integrated Care Models to Serve Dually Eligible Beneficiaries, by Nancy Archibald and Alexandra Kruse, Technical Assistance Brief, December 2015 www.chcs.org MOWA NRCNA 8 2016 srw

Thank you. Sharon R. Williams sharonr. williams@comcast Thank you!!! Sharon R. Williams sharonr.williams@comcast.net 313 516 3326 MOWA NRCNA 8 2016 srw