1. Special Delivery: Getting Care to Vulnerable Populations Renée Markus Hodin Community Catalyst Families USA Health Action 2009 January 29, 2009 Washington, DC The Role for Consumer Advocates

2. © Community Catalyst 2009 About Community Catalyst National nonprofit consumer advocacy organization Founded 1997 Working in 45 states Affordable, accessible quality care Consumer voice

3. © Community Catalyst 2009 The Integrated Care Project SNP Consumer Education Project Partnership with Commonwealth Care Alliance Our view of managed care

4. © Community Catalyst 20094 A Crisis in Value The United States is doing an especially rotten job of delivering chronic care, at spectacular cost. Susan Dentzer, Editor-in-Chief, Health Affairs Reform Chronic Illness Care? Yes, We Can January/February 2009

5. © Community Catalyst 2009 Vision for Systemic Delivery Reform Integrated acute and chronic care -- medical, mental health, community care, self-care and social supports -- promotes optimal health, function and independence Organized and coordinated delivery -- of all necessary medical and non-medical resources and services Flexible, person-focused approach to benefits and care -- not the typical insurance model Improved value – integrated care is high quality and cost- effective

6. © Community Catalyst 2009 Best Practices Specialized primary care networks Interdisciplinary team approach to care Comprehensive health assessment and reassessment 24/7 access Fully organized networks of alternatives to hospital and institutional care Meaningful patient and family involvement in care management Meaningful outcome measurements Single electronic medical record Member education Consumer voice in plan and governance

7. © Community Catalyst 2009 Consumer & Support Persons Primary Care Hospitals Residential Services Medical Specialists Mental Health Rehabilitation ? Home Care / PCA DME / Supplies …islands of care ? ? ? ? How Persons with Disabilities Experience the Health Care System

8. © Community Catalyst 2009 Member & Support Persons Primary Care Physician Coordinator Transportation Residential Settings Physician Specialists Mental Health Providers PCA Home Care Home Modification Housing w/ Services Cognitive Rehabilitation Independent Living Skills Rehabilitation Therapies DME Chore Services Supplies Behavior Services Family Counseling Adult Day Program Alternative Services Structured Day Program ? ? Acute Care Emergency Response System Home Delivered Meals Dental DisabilityCare A Health Care System that Works

9. © Community Catalyst 2009 Integrated Care Vehicles Special Needs Plans (SNPs) Medicaid Initiatives Medical Homes Chronic Care Model

10. © Community Catalyst 2009 Special Needs Plans (SNPs) Authorized by MMA in 2003 Target populations Duals Chronic illness Institutionalized 769 approved plans

11. © Community Catalyst 2009 SNPs: Promises and Pitfalls Promises Improve quality for vulnerable populations Contain Medicare and Medicaid costs Model for Medicaid- only enrollees Pitfalls Lax oversight Few special requirements Risk adjustment may not accurately reflect members level of need

12. © Community Catalyst 2009 MIPPA Requirements Care Management/Model of Care Disclosure of Information Quality Reporting Contracting

13. © Community Catalyst 2009 The Three-Legged Stool Committed and knowledgeable policymakers Mission-driven health plans with commitment to patient-driven care Informed and engaged consumer advocates

14. © Community Catalyst 2009 Consumer Advocate Roles Member feedback Governance Policy Advocacy Model of Care Advisory Committees

15. © Community Catalyst 2009 For More Information Renée Markus Hodin Project Director Community Catalyst 617.275.2810 hodin@communitycatalyst.org www.communitycatalyst.org