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

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

3. 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 srw

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

5. American Aging/Disabilities Demographics
‘There are roughly 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 srw

6. 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 srw

7. 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 srw

8. 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 srw

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

10. 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 srw

11. Common Needs for Healthcare Organizations
Hospitals
Providers
Health Plans
MOWA NRCNA srw

12. 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 srw

13. 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 srw

14. 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 srw

15. 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 srw

16. Bibliography Patient Protection and Affordable Care Act, www.hhs.gov
Centers for Medicare and Medicaid Services,
National Business Coalition on Health’s Value-based Purchasing Council, Value Based Purchasing: A Definition,
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
MOWA NRCNA srw

17. Thank you. Sharon R. Williams sharonr. williams@comcast
Thank you!!! Sharon R. Williams
MOWA NRCNA srw