Driving outcomes for Managed Care: Building Long Term Care Networks to Focus on Quality and Value Based Contracts

What are Today’s Pressure Points? The changing consumer Expectations vs. limited resources vs. family role The changing provider Competition driving change The role of government Safety net vs. regulator vs. funder The changing reimbursement/regulatory environment

Challenges for Providers in New Care and Payment Models Assessing the current service delivery model and how it fits with the value-based systems of ACOs, Bundled Payments, PCMH, etc. What outcomes are being achieved? Where are the areas for improvement? What is the core business and what can be done through partnerships?

Ohio Aging Services Network – OASN Networks Established Ohio Aging Services Network – OASN Established – July 2013 Over 60 LeadingAge Ohio Members representing 120 facilities throughout Ohio Over 20 different payor contracts – 4 P4P

Indiana Health Services Network – IHSN Networks Established Indiana Health Services Network – IHSN Established - August 2016 33 LeadingAge Indiana members representing 45 facilities throughout Indiana Four payor contracts – Two in negotiation

Iowa Aging Services Network – IASN Networks Established Iowa Aging Services Network – IASN Established – March 2017 33 LeadingAge Iowa members throughout Iowa Two payor contracts – Three in negotiation

Illinois Aging Services Network – ILASN Networks Established Illinois Aging Services Network – ILASN Established – October 2017 65 LeadingAge Illinois members throughout the state Seven payor contracts – Three in negotiation

The Benefits of a Network Greater visibility and attention by government, Medicare Advantage and commercial payors. We are their priority. Access to state government – Medicaid. Ability to identify key quality measures, collect data on those measures, aggregate information and present it in a meaningful way to payors and partners.

The Value of Networks Survey of members after three years showed three consistent values of OASN by the members: Access to payors they could never get to previously. Increase in reimbursement with payors already under contract with (one payor $25/bed day increase). Increase in revenue. One member share that due to getting a payor contract they had never been able to get yielded over $100,000 in new revenue. Reduced administrative burden. Contract negotiation, contract management, claims issues, credentialing, etc.

Network Development Separate LLC – each member of the network is an equal partner of the network. The network develops the parameters as to membership. Committees: Finance, Contracting, Quality and Membership Requirements for data collection of quality measures. Dues structure can be based on a variety of factors; unduplicated client numbers, size and type of services, net patient revenue etc.

Preparing for Managed Care Know your costs Know your quality Assess your current service delivery model and make changes to operate in a managed care environment. Find and know who are your partners. Be willing to educate payors on what you do and they value you bring to them.

It’s All About Data Collecting and analyzing data will be imperative for providers. Presenting that data in a meaningful format for your partners whether they be hospitals or payors shows your value to them. Readmissions and Length of Stay – the low hanging fruit.

Payors will Change Too… Quality verses Efficiency Paying for outcomes Providers must take advantage of opportunities to engage with payors to determine what those outcomes are and how they will be paid. Don’t assume payors know your business, be ready and willing to educate them how you deliver services and the outcomes you are trying to achieve.

Managed Care Spectrum Low Risk High Risk Pay for Performance Bundled Payment Shared Savings Downside Risk Capitation Managed Care Spectrum Low Risk High Risk

In 2015, Iowa was 14%. National Average remained the same from 2015-16, although #s did grow. In 2016, Iowa was 17%. National average was 31%. National growth rate was 5%, Iowa was 21% In 2017, Iowa was 18%. National Average was 33%. National growth rate was 8%, Iowa was 6%

Questions?