1. Looking to Medical Partnerships for Sustainability: A Tale of Two Villages
Maureen Grannan, RN, MS Executive Director
Newton at Home
Andy Gaines
Executive Director
Ashby Village

2. Introduction Maureen Grannan, RN, MS
Executive Director, Newton at Home
Sharing a novel model of care in conjunction with our local community hospital
Andy Gaines
Executive Director, Ashby Village
Sharing our decision making process in assessing the suitability of a similar model for Ashby Village

3. Background Newton, MA Village launched 2011 Currently 180 members
4 staff; Maureen Grannan ; Julie ‘Volunteer Co- ordinator’ ; Barbara ‘Member services co- ordinator’; Hannah ‘Member services coordinator’ .
$660 fee individual; (n.b. currently offering a $295 for a six month trial)
Maureen’s background: Maureen’s background is in nursing. Predominantly oncology. She worked with Newton Wellesley Hospital 14 years.

4. Development of the program
Description of hospital
Relationship with hospital
Changes to Medicare Funding: The government’s penalties are based on the frequency that Medicare heart failure, heart attack and pneumonia patients were readmitted within 30 days as compared with a calculated "average hospital".
Benefits to Newton at Home

5. Details of the program
Village sold set of 10 short term memberships (30 days) for the hospital to provide to patients on discharge.
The short term memberships were priced at $180 each ($1800 total)
At the end of 30 days either the hospital can choose to extend the membership for another short period, or the patient can choose to join the village independently
The village trained 8 volunteers with medical background to provide personalised support to the patients, i.e. phone call check ins and ensure village services as needed were being provided.
Maureen would give a telephone call update to the hospital social worker on how patient was doing

6. Training Program Developed
Training was approximately 1.5 hrs.
Divided the group into two teams with a captain of each team
The hope was that a one-on-one relationship would develop and in practice this is what seemed to happen
Protocol for volunteers was to make a phone call every day in the first few days and then after that on a regular basis determined based on the member’s needs, but at least every week.

7. Successes
Patient’s happy, volunteers happy, hospital happy. Overall did not feel like a ‘drain’ on village resources. Feels like a good connection to grow.
Ten patients have been referred as (as at Feb 2014)
No re-hospitalizations
Six of the ten referred patients have signed up as annual membership
Mostly patients from the cardiac ward, one gentleman recovering from pneumonia
No formal review criteria or formal program evaluation process at this stage

8. Key successes for patients
The program helps more fully identify patient needs which may be missed
The program ensures timely assistance, particularly in the first few days
The program reduces social isolation which can contribute to re-admission

9. Future Growth Opportunities
Potential for expanding the program

10. Ashby Village Berkeley, CA
Covers Berkeley, Emeryville, Albany, North Oakland
Established in 2010
Currently 308 members
3 full time staff
Executive Director: Andy Gaines
Program Manager Andrea Mok
Operations / Volunteer Coordinator Pat Carvalho
Fees are $750 per annum for an individual / $1200 for a household

11. Steps undertaken 1. Clarifying goals: financial and timing
2. Research and idea generation
3. Assess internal resources
4. Assess local opportunities and competition
5. Consider whether there are other options that are more efficient

12. Impetus For Consideration of Medical Partnerships
Increasing needs of members
Forthcoming end of Archstone Foundation funding and pursuit of earned income opportunities
Medicare 30-day Readmission
Social Care interest by Kaiser Permanente
Proposal of MSW/MPH Cal Intern
> Request for funding from V2V Sustainability Grant successful!

13. Goals – Financial and timing
Discussion internally about what level of financial investment was appropriate from the reserve fund (this involved a level of future financial forecasting + gut feeling)
The level of risk and time commitment
How long we were willing to wait for a “return on investment”
Would the village consider providing services to non- members ?
DETERMINATION : Comfortable with approx $20,000 investment, but given financial pressures would like to see strong cash flow return within 2 years

14. Research and Idea Generation
Discussions with Newton at Home and Capitol Hill Village
Investigation of grant opportunities in this space
Exploration of alternative earned income opportunities
“Idea Basket”

15. Assessment of Internal Resources
Fairly stretched staff of 3
No qualified medical staff
Social Service Committee and MedPal operating well but
100% volunteer
Active volunteers to do house calls dropping
High needs ‘crisis’ members stretching resources and creating renewed need to assess village policy
Medical partnership would require addition of paid staff time

16. Assess local opportunities
Health Survey
50% of Ashby Village members were also KP members
Developing relationship with Kaiser Permanente (“KP”)
Invited to attend National Conference
Innovations team meetings
However:
At a local level the process for change seemed very slow
Medical model resistance to entering non-traditional roles such as transport
Need for ability to scale to address sizable, diverse population

17. Competition Medical home service providers
Roughly $24-25 per hour. These service providers, while more expensive, are easily deployed to any discharged patient.
Influx of entities seeking to address the 30 day readmission market opportunity

18. Conclusions No immediate opening with KP
Investment requirements for new staff quite high (even at part time level)
Limited financial return in the first few years of such a program
Decision to develop ‘Connections’ program as part of the Member Support Team
Decision to put resources into individual donor, foundation and corporate partnership activities.

19. Final Thoughts From Ashby Village and Newton at Home
We would like to thank Sophia Johnson Ashby Village volunteer and consultant on this project, for leading the research initiative and for producing this PowerPoint.

20. Q&A

21. Maureen Grannan, RN, MS Executive Director
Newton at Home
Andy Gaines
Executive Director
Ashby Village