1. Progress and Activities of Aging and Disability Resource Center Grantees ASA/NCOA, Chicago March 9, 2007 Lisa Alecxih, The Lewin Group lisa.alecxih@lewin.com, (703) 269-5742 www.adrc-tae.org

2. 1 One Stop Access One-Stop Access Home and Community Based Services Nursing Homes Disease Prevention Health Promotion Employment Services Nutrition Education Private Services Public Programs

3. 2 Awareness & Information  Public Education  Information on Options Assistance  Options Counseling  Benefits Counseling  Employment Options Counseling  Referral  Crisis Intervention  Planning for Future Needs Access  Eligibility Screening  Private Pay Services  Comprehensive Assessment  Programmatic Eligibility Determination  Medicaid Financial Eligibility Determination  One-Stop Access to all public programs CONSUMER ACCESS AWARENESS & INFORMATION ASSISTANCE Empowering Individuals ADRC Components

4. 3 ADRC Grantees MA

5. 4 Target Populations Served Target Population Percent of Pilot Sites Number of States Adults Aged 60 and Over 100%43 People with Physical Disabilities 94%38 People with MR/DD/ID 59%24 People with Mental Illness 53%16 All Disabilities 27%12

6. 5 What is Different About ADRCs? u Strong consumer orientation  Make it easier for consumers to get what they need u Not just information and referral  Follow through and tracking of consumers u Focus on appropriate setting for services & supports  Intervention in critical pathways  Options counseling  Conducts or facilitates eligibility for public programs

7. 6 What is Different about ADRCs? (cont.) u Combines aging and disability  Similar basic needs, but acknowledges difference u Requires multiple partnerships on all levels  Only practical way to do one stop shop concept u Effective use of technology  Web-based resource databases  Information exchange protocols and software across partners

8. 7 Two Dimensions of ADRC Model Type Organizational Structure Centralized Decentralized Consumer Access Physical Virtual

9. Distribution of Pilot Sites by Model Types Organizational StructureConsumer Access # of Pilot Sites % of Pilots CentralizedDecentralizedPhysicalVirtual √√ 4340% √√ 4037% √√ 1413% √√ 1110% 77%23%53%47%108100% 9 NOTE: Does not include Wisconsin’s original 9 ADRCs.

10. 9 Data Sources for Grantee Activities/Progress u Semi-annual Reporting u Quarterly AoA-CMS Grant Monitoring Calls u Technical Assistance Requests u 2003 Grantees’ Continuation Applications u Other Grantee Interactions

11. 10 Sources of ADRC Pilot Site Funding

12. 11 ADRC Contacts March 2004 - September 2006 Reporting Time Period No. of Pilot Sites Reporting Total No. of Contacts Total No. of Contacts Per Month Total No. of Contacts Per Month Per Site May 2004-March 2005 (11 months) 25154,72914,066562 April 2005-Sept. 2005 (6 months) 39274,54145,7561,173 October 2005- March 2006 (6 months) 50421,05970,1761,404 April 2006 – September 2006 (6 months) 58306,10151,017880

13. 12 Change in Contact Volume Over Time (17 Pilot Sites) Reporting Time Period Total No. of Contacts Per Month Per 1000 Residents May 2004-March 2005 (11 months) 1,5012.34 April 2005-Sept. 2005 (6 months) 1,6922.89 October 2005-March 2006 (6 months) 2,4263.99 April 2006 – September 2006 (6 months) 2,3213.92 2003-2004 Grantees (n=17 pilot sites)

14. 13 ADRC Consumer Satisfaction Percentage of Respondents Who Would Recommend the ADRC to Others Percentage of Grantees with this Level of Positive Responses 90-100%75% 80-90%13% 70-80%6% 60-70%6% “I feel the counselor will do everything she can for me.” “I like to get answers and this is where I know I can come for them.” “I got information I would not have otherwise known about.” 2003-2004 Grantees (n=22 pilot sites)

15. 14 Grantees Partnering with Different Organizations 2003-2004 Grantees (n=24) 24 5 5 12 6 24 9 7 10 24 9 9 04812162024 Other Transportation Services Task Force or Advisory Group Social Services Social Security Administration SHIP LTC Providers Medicaid Housing Services Employment Disability Services Adult Protective Services Aging Services Advocacy or Consumer Group 211

16. 15 Raising Visibility: Many Different Marketing and Outreach Strategies Used 2003-2004 Grantees (n=24 grantees) 10 13 12 24 19 15 16 18 19 8 24 04812162024 Other TV advertisements Radio advertisements Public service announcements Public forums and presentations Provider forums and presentations Press releases Newspaper advertisements Newsletters and direct mailings Health fairs Earned/unpaid media coverage Brochures and fliers

17. 16 Reaching Out to “Critical Pathways” 2003-2004 Grantees (n=24 grantee) 17 6 12 9 3 13 15 04812162024 Any Activity Other Critical Pathways Provider Association Physician's Office Emergency Room Nursing Home/Rehab Facility Hospital Discharge Planner

18. 17 Major Sources of Referral to ADRC 2003-2004 Grantees (n=24 grantees) Marketing Materials 17% Other 2% Friends/ Family 26% Critical Pathways 55%

19. 18 IT/MIS Enhancements 2003-2004 Grantees (n=24 grantees) 15 17 4 12 11 9 1 2 04812162024 Enhancing Existing I&R Websites Building New ADRC Websites Integrating Different IT Systems Enhancing Client Tracking Systems Using Specialized I&R Software Both Levels State Level Pilot Level

20. 19 Streamlining Access: Improving Consumer Ease of Access 1 1 3 5 5 13 14 3 10 4 4 1 5 8 9 04812162024 Fewer entities involved in the process Fewer interactions for the consumer Shorter time from intake to eligibility determination Online decision support tools Web-based resource database Electronic submission of application/ forms Online access to programmatic or financial application/ forms Before ADRCCompletedPlanned

21. 20 Streamlining Access: Improving Efficiency/Timeliness 1 7 2 1 1 14 2 9 9 7 9 20 1 1 1 8 1 04812162024 Integration of MIS/ sharing information across agencies/system-wide client tracking Presumptive eligibility or self-declaration of financial resources Co-location of eligibility staff (functional or financial) Reduced duplication/ pre-populating forms Integration of forms or universal assessment Shorter forms/ mostly functional but financial is possible Collect some financial information up front Before ADRCCompletedPlanned

22. 21 Expansion and Continuation

23. 22 Statewide Coverage StateStatewide Coverage Achieved Statewide Coverage Planned AlaskaX GuamX IowaX KentuckyX LouisianaX MinnesotaX New HampshireX New MexicoX Rhode IslandX VirginiaX

24. 23 ADRC Legislation and Funding u ADRC Legislation: Florida and Michigan u State Appropriations: 18 states contribute money to ADRC pilot sites budget  Maryland, Georgia, Indiana, and New Hampshire received significant state appropriations recently to continue and expand ADRC initiative. u Medicaid Federal Financial Participation for Administrative Functions: 22 states report pursuing FFP u Private Grants: 24 states report pursuing private grant funding

25. 24 2003 “Building Upon Success” Continuation Grants Expansion Plans StateCurrent ADRC Pilot Site CoveragePlanned ADRC Pilot Site Coverage Louisiana3 Pilot Sites Serving 35 Parishes64 Parishes (Statewide) Maryland2 Pilot Sites Serving 2 Counties6 Pilot Sites Serving 6 Counties Massachusetts2 Pilot Sites Serving 4 Counties5+ Pilot Sites Serving 10+ Counties MinnesotaStatewide Phone and Web-Based Services, 1 Pilot Serving 1 County Statewide Phone and Web-Based Services, 3 Pilots Serving 3 Counties Montana1 Pilot Site Serving 1 County2 Pilot Sites Serving 12 Counties and 2 Federal Indian Reservations New Hampshire10 Pilot Sites Serving 10 Counties (Statewide)

26. 25 2003 “Building Upon Success” Continuation Grants Expansion Plans (cont.) StateCurrent ADRC Pilot Site CoveragePlanned ADRC Pilot Site Coverage New Jersey2 Pilot Sites Serving 2 Counties7 Pilot Sites Serving 7 Counties Pennsylvania2 Pilot Sites Serving 2 Counties4+ Pilot Sites Serving Muli-County Regions Rhode IslandStatewide Telephone ServiceStatewide Telephone Service, 5 “Store-Front” Pilot Sites South Carolina3 Pilot Sites Serving 8 Counties4 Pilot Sites Serving 12 Counties West Virginia2 Pilot Sites Serving 2 Counties2 Pilot Sites Serving 7 Counties

27. 26 Other Areas of Focus for 2003 Grantees u Expanding disability target population u Strengthening partnerships between aging and disability services network u Adding on-line applications and other web-based tools u Developing new or enhancing existing intake/assessment tools u Enhancing “Planning for Future LTC Needs” services u Seeking state funding

28. 27 Lessons Learned

29. 28 Partnerships u Involve partners early in the planning process  Waiting until after opening or until you expand to a new target population may be too late u Identify champions in partnering organizations u Set clear and realistic expectations for partnership u Remain flexible in determining partner roles  What you have in mind may not fit with their goals  You need to identify what’s in it for them u Select pilot sites with strong existing partnerships with key agencies

30. 29 ADRC Services u Build on existing services and service networks  ADRC may not offer new services or add staff; it is more about re-aligning infrastructure and re-orienting staff u Allocate significant time and effort to streamlining eligibility determination  Develop protocols for sharing data with partners –Determine need for HIPAA compliance on information tradeoffs between entities u Treat options counseling as process, not as an event u Leverage experience from agencies that serve individuals who can pay privately

31. 30 Staffing u Appoint a dedicated project manager u Build on expertise of existing pilot level staff u Cross-train staff from partnering organizations u Expect and plan for considerable increase in call volume and increase in average length of calls

32. 31 Marketing and Outreach u See the ADRC through the consumer’s eyes  ADRC planners & staff see things differently than consumers u Decide how to ultimately sell the center to the public  ADRC name, Website name, Logo and tagline, Brochures  Communicate messages that are easy to understand, relevant and actionable –What do you want people to do? –What is in it for them? u Target outreach to the most likely consumers  Directly – word-of-mouth may be most effective  Through critical pathways -- hospital discharge planners, physicians, pharmacists  Mass media venues – radio, TV print

33. 32 IT/MIS u Allow adequate time and resource for determining IT/MIS needs and development  “It took much more time and money than we originally planned” u Establish a systematic process for determining business processes and user specifications u Involve end users (e.g. pilot site staff, consumers) in effort and in developing system specifications u Coordinate state and local IT development initiatives u Database maintenance is just as important as creation

34. 33 Sustainability u View ADRC as part of broader systems reform effort (not as a short-term grant) u Plan specifically for sustainability  Develop long term strategic plan  Institutionalize processes and staff training u Use evaluation to:  Demonstrate performance  Inform decision making and enable continuous quality improvement u Involve consumers and stakeholders in meaningful ways  If they play a key role in project design and implementation, they will be strong advocates