Systems Integration Grants Commonalities and Unique Elements System Integration Kick-Off Meeting November 7-8, 2011

System Integration Goal Objective 1: Coordinate the integration of a statewide set of programs that includes a Single Entry Point/No Wrong Door (SEP/NWD) access for individuals. Information, Referral and Access Options Counseling and Assistance Streamlined Eligibility Determinations for Public Programs and Assistance in Applying for these Programs Person-Centered Care Transitions Across Multiple Settings Objective 2: Ensure access to a comprehensive, sustainable set of high quality services relevant to the population residing in the state’s service area. Comprehensive set of services Robust quality assurance system Sustainable service system

Ohio New York Minnesota Georgia Shannon Skowronski Kathleen Votava Caroline Ryan/Joseph Lugo Barry Klitsberg/Kathleen Otte Eric Weakly Kathleen Votava Michelle Boutaugh Ron Taylor System Integration Teams Overall Point: Joseph Lugo Team Lead Dementia Components: Jane Tilly

July 2011 Submitting Proposals September Revised Programs/Budget Negotiations October NOA {3 Year Project Period} November Kick-Off Meeting January 2012 Operational Plans Due (3 Months) April Operational Plans Due (6 Months) Planning Phase Implementation Phase

Ohio New York Minnesota Georgia 3 Months 6 Months 3 Months 6 Months Proposed Planning Phase

Ohio New York Minnesota Georgia Care Transitions Interventions Statewide Coverage Community Supports Navigator Program 50% of State Population Build upon existing models 100% NH/50% Hospital (Target Population) TBD {Coleman/Naylor} 100% NH/50% Hospital Proposed Care Transition Models* *Applicants will establish measurable targets for achieving maximum population coverage for each year of the cooperative agreement period (e.g. 25%, 50%, 75%).

Most Commonly Proposed Areas of Performance Measurement

 African Proverb To go fast….. To go far….. To do both….. go alone go together go to the Aging Network

Partnerships Common Partners Medicaid, SUAs, ADRCs, AAAs, CILs, Alzheimer’s Associations, health care providers, minority services associations and organizations, consumers Examples of Unique Partners State Commission on Minority Health Latin American Association Center for Pan Asian Community Services SAGE (Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders) Wisdom Steps Health Preventive Program for Native Elders Governor's Office and Lieutenant Governor’s Office State Coordinating Council for Services Related to Alzheimer's Disease and Related Dementias Senior Services Property Tax Levy Staff AARP Workforce Development Office Private Health Plans

Unique Areas of Activity/Emphasis: Georgia Web-based technology plays a fundamental role in achieving overall project goals, in particular streamlining access and eligibility determination “technology when you want it, people when you don’t” Achieving "high touch"" with Medicaid“ Focus on broader array of and greater access to services that are evidence- based or evidence-informed, requiring all AAAs to offer in their Title III D and E programs by year 3 Using Baldrige criteria for quality improvement and the Measurement Analysis Plan (MAP) for all AAAs, including capacity of consumers to provide feedback on satisfaction via the web-based system Sustainability using internships, program contributions, and creative uses of CMS and Medicaid waivers

Unique Areas of Activity/Emphasis: Minnesota Focus on increasing coverage of evidence-based programs and CT by health plans Use of health care homes as foundation for systems change and integration Strong relationship with Governor office and Lt. Governor and building upon existing gubernatorial initiatives like Senior One Stop Use of Living Well at Home (LWAH) framework and Rapid Screen© as focal point for risk management and support planning across services—in particular options counseling, care transitions and identification of persons with dementia Focus on disability and enhancing DLL with new tools that support employment, health, and self-sufficiency Developing a 3-tier dementia training statewide Emphasis on sustainability using private pay models/cost-sharing, and building capacity of AAAs and local networks to enter into risk agreements in light of healthcare reform Incorporating Self-Directed Services across all programs in AAAs

Unique Areas of Activity/Emphasis: New York Development of dementia screening tool as part of NY Connects I&A screening tool Make care transitions available statewide, with emphasis on serving persons with dementia All staff at NY Connects will be trained to be dementia-capable and increase knowledge about self-directed services Building options counseling statewide including new protocols and dementia- capable emphasis partnering with their Alzheimer’s Association chapters Use of Multiple Chronic Conditions (MCC) framework to integrate programs and services Embedding care transitions into Electronic Medical Records Expanding use and capacity of their resource directory to include care transitions

Unique Areas of Activity/Emphasis: Ohio Focus on linking universal assessment with Electronic Health Records Enhancing Ohio Benefit Bank to include new tools, benefits and resources Focusing Part B on partnership with VAMCs using evidence-based program (Partners in Dementia Care or PDC) in two regions: Cleveland and Akron Standardization of consumer satisfaction tools statewide Expectation that all AAAs will offer Care Transitions Intervention Exploration of alternative reimbursement streams for services, with goal of 3 new funding streams identified by year 3 Train ADRNs and AAAs to become more disability, dementia, and person- centered capable

Commonly Anticipated Challenges Funding to sustain programs — in particular to expand care transition activities and programs Population trends — changes in diversity, sheer numbers, interests, and system capacity to meet these changes IT/MIS — continued fragmentation, silo’d by program and service Building capacity to become “dementia-capable” across all programs and services requires enormous energy, time, training, and follow up

ADRC 5-Yr Statewide Plans Funding Sources Reviewed existing and potential/planned funding sources identified by 14 states in their 5-Yr Statewide ADRC plans Alaska, Arizona, Colorado, Kentucky, Minnesota, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, South Dakota, Vermont, West Virginia, Wyoming Distinguished between current funding sources and possible or planned funding sources identified Most commonly cited funding sources: State Funds, ADRC Grant SHIP MIPPA

Number of States Relying on Different Types of AoA Funding

Number of States Relying on Different Types of CMS /Medicaid Funding

Number of States Relying on Other Sources of Funding

Other Potential Funding Sources Balancing Incentive Payment Program (ACA 10202) Department of Labor Disability Navigator Funding Health Plan Exchanges Federally Qualified Health Center