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

2. 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

3. 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?

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

14. 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.

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

16. 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%

18. Questions?