1. NEW CHALLENGES AND OPPORTUNITIES FOR NUTRITION PROGRAMS IN THIS CHANGING ENVIRONMENT Linda Netterville, MA, RD, LD Dietitian Consultant, DADS

2. SESSION OVERVIEW  The changing community and healthcare environment  Challenges  Opportunities  Building sustainability for the future

3. CHANGING ENVIRONMENT Factors Demographics Resources Business Healthcare

4. CHANGING DEMOGRAPHICS  More older people  More healthy older people  More frail older people  More minorities  More HCBS, less nursing home care

5. MOST OLDER TEXANS 60+ YEARS LIVE IN THE COMMUNITY  Community 4.01 M; 97.7%  Nursing Homes 95,640; 2.3% AGID Database

6. TEXAS PERCENT OF 6O+POPULATION

7. PROJECTED POPULATION 60+

8. TEXAS POPULATION OF 60+

9. PERCENT OF AMERICANS AGE 65 EXPECTED TO SURVIVE TO AGE 90

10. CHANGING LIFE EXPECTANCY Older Americans 2012: Key Indicators of Well-Being

11. CHANGING RESOURCES GOVERNMENT/PUBLIC FUNDING  Older Americans Act Title III (C1, C2, NSIP), V, VI  Other Federal Social services or community service block grants  State-Vary by State

12. EXPENDITURES PER MEAL-TEXAS BASED ON STATE PROGRAM REPORTS SUBMITTED TO ACL/AOA

13. % OF TITLE III IN TOTAL EXPENDITURES FOR MEALS

14. FEDERAL FUNDING SOURCES OAA Funding Medicare/Medicaid (Title III) (ACOs, MLTSS, Duals) $2.1 Billion $11.5 Billion

15. BUSINESS DEMANDS  Service needs  Quality Services  Appropriate services: cultural, religious, therapeutic  Choice  Diversity  HCBS Services

16. CHANGING BUSINESS PRACTICES  For Profits  Expanding into non-traditional markets  Offering competing services  Restaurants, groceries, fitness options  Non-Profits  Becoming more entrepreneurial  Developing community partnerships  Identifying other funding streams

17. TECHNOLOGY TO ASSIST  Data collection and sharing information with healthcare  Billing systems compatible with healthcare  Improved service and delivery models  Routing/scheduling  Telemedicine

18. THE CHANGING HEALTHCARE MARKET Patient Protection and Affordable Care Act of 2010  Triple Aim  Better care  Healthier people  Smarter spending

19. THE CHANGING HEALTHCARE MARKET DRIVEN BY CMS Medicare-Title XVIII of the Social Security Act, long term disabilities, end stage renal, 65 or older  Part A  Part B  Part C- (Medicare Advantage)  Part D-(Prescription) Medicaid -Title XIX of the Social Security Act, low income, children, elderly, blind or disabled (Jointly funded by the state)

20. THE CHANGING HEALTHCARE MARKET  Services must meet the needs  Customer- Payer (MCO, Insurance, Hospital)  Consumer-Beneficiary (client)  Focused on quality metrics and improved outcomes  Payers assume the risk  Want a clearly defined Return on Investment (ROI)  Opens the door to For-Profit entities

21. CHANGING CARE SYSTEMS  Medicaid LTSS- Managed Care  Long Term Services and Supports (LTSS)  Home and Community Based Services (HCBS)  Health Care/Care Transitions  Accountable Care Organizations  Bundled Payment Initiatives

22. LONG TERM SERVICES AND SUPPORTS (LTSS)  Target Audience  Older adults  People with disabilities  Include:  Residential care in facilities  Home and community-based (HCBS)  Support:  Managing chronic conditions  Accomplishing everyday tasks (IADL, ADL)

23. HOME AND COMMUNITY BASED SERVICES (HCBS)  Target Audience  Older adults  People with disabilities  Support Living in the Community  Funding Sources  Older Americans Act (OAA)  Medicaid  Social Services Block Grant (SSBG)  Education and Rehabilitation Funds  State General Funds  Local Funds

24. CARE TRANSITIONS  Coordination and continuity of health care based on a plan of care  Include:  Hospitals  Sub-acute And Post-acute Nursing Facilities  The Patient's Home,  Primary And Specialty Care Offices  Long-term Care Facilities

25. ACCOUNTABLE CARE ORGANIZATION (ACO)  Groups of doctors, hospitals, and other health care providers  Provided to Medicare beneficiaries.  Provide coordinated care and chronic disease management while lowering costs.

26. OPPORTUNITY KNOCKS!

27. OPPORTUNITIES-WHO ARE CURRENTLY BEING SERVED- TEXAS Current PopulationPercent 60+- TX 4,105,225 Nutrition Program Served Total (2012) 134,760 3.3% Congregate Served 71,318 1.7% Home-Delivered Served 63,442 1.5% http://www.agid.acl.govhttp://www.agid.acl.gov -State Program Reports- 2012

28. OPPORTUNITIES TO BUILD SUSTAINABLE RESOURCES  Social Entrepreneurship  For Pay options  Healthcare entities

29. SOCIAL ENTREPRENEURSHIP  Catering Contracts  Expansion of Nutrition Services  Nutrition Counseling  Grocery Shopping  Other Program Opportunities  USDA Child Nutrition Programs

30. FOR PAY OPTIONS  Relook at “for pay” options  Other services  Tiered services  Expanded services

31. THE ROLE OF NUTRITION SERVICES Something Magical Happens!

32. CLIENTS VALUE THE PRODUCT Home DeliveredCongregate Able to eat healthier foods 83%78% Meal enabled living at home 92%60% AoA Survey of OAA Participants, December, 2011, http://www.agidnet.orghttp://www.agidnet.org

33. ROLE OF NUTRITION SERVICES Value of Nutrition to Chronic Health Conditions  Heart disease  Hypertension  Diabetes  Osteoporosis  Kidney disease  Obesity

34. ROLE OF NUTRITION SERVICES Other Nutrition Services  Nutrition Counseling  Nutrition Education  Nutrition Assessment

35. ROLE OF NUTRITION SERVICES Value Add  Wellness/Safety Check  Regular contact in the home  Trusted in the home  Client status (moved, hospital, nursing home)  Perform Regular In-home Assessments

36. KEY FINDINGS-MORE THAN A MEAL STUDY  Those receiving home-delivered meals:  Improvements  Anxiety  Self-rated health  Isolation  Loneliness  Reduced rates of:  Hospitalizations  Falls

37. KEY FINDINGS-MORE THAN A MEAL STUDY Those receiving daily meal delivery:  Improvement in mental health (anxiety)  Improvement in self-rated health  Reductions in the rate of falls  Improvement in feelings of isolation and loneliness  Decreases in worry about being able to remain in home

38. KEY FINDINGS-MORE THAN A MEAL STUDY Those receiving daily delivered compared to weekly:  Feel safer  Helped them to eat healthier food  More social contacts  Less loneliness

39. KEY FINDINGS-MORE THAN A MEAL STUDY Those receiving daily delivered and lived alone:  Decrease worry about being able to remain in the home  Improvements in feelings of isolation and loneliness

40. OPPORTUNITIES FOR NUTRITION PROGRAMS  Valued added service  Service and delivery structure in place  Trusted entity with long history of success  Linked to other community-based service  Community partnerships

41. WHAT CAN YOU DO? Know:  Health Reform activity in your community  Medicare Advantage Plans  Medicaid Managed Care initiatives  ACOs  Bundled Payment Initiatives  Competition  Partners  Champions 41

42. WHAT ARE HEALTH ENTITIES SEEKING  Meet consumer needs  Choice of meals, special or modified diets, flexibility)  Access to the consumer  Coverage for the entire service area (1 contract)  Easy to submit referrals for services  Meet quality metrics  Data provided to show improved outcomes

43. HOW CAN YOU COMPETE?  Organizational culture change (staff qualifications, characteristics, inter-organizational operations)  Strategic business plan  Development and structure of community-based networks  Service packages (identifying, pricing and packaging services)  Marketing and sales strategies

44. HOW CAN YOU COMPETE? Communication and negotiation techniques  Addressing program capacity challenges (developing, increasing, and managing the capacity of the program to deliver services)  Continuous quality improvement (setting standards, defining and measuring outcomes, monitoring)  Risk management (identifying, accepting, and managing)  Information technology (IT) system

45. ASSURE THE CAPACITY OF YOUR ORGANIZATION TO DELIVER  Services  Methods of production/delivery - Meals  Methods of development/delivery  Steps necessary to provide to provide the product (meal, nutrition education, etc.) and services  Capacity, expertise, human resources

46. PILOT PROJECT  Pilot through the National Resource Center on Nutrition and Aging and MOWAT Understand the changing landscaper Identify the opportunities for the Nutrition Program Help to develop the skills needed to: Develop support services Negotiate Contracts Billing Reporting

47. PILOT PROJECT- 5 PROGRAMS

48. FINAL WORDS  Know Your Market  Know Your Competition  Study Your Customer  Organize, Plan, and Execute

49. THE ROLE OF NUTRITION SERVICES BUILDING THE BRIDGE Healthcare HCBS Nutrition Services

50. WE HAVE TO GET IT RIGHT!

51. DISCUSSION  What is the vision for your nutrition program?  What are the tools and resources that you need to position your program now and into the future?

52. RESOURCES: WWW.NUTRITIONANDAGING.ORG  Recorded NRCNA Webinars—Positioning Your HCBS Program in the Healthcare Market Webinar Series  Part 1: Overview of Health Reform Initiatives - How this Affects Your Organization and Terminology 101  Part 2: Market Analysis - Determine Health Reform Initiatives in Your Market Area  Part 3: Network Collaboration - The Need for Collaboration  Part 4: Developing a Strategy and a Business Model for Your Organization  Part 5: Positioning Your HCBS Program in the Healthcare Market

53. RESOURCES: More That a Meal Study http://www.mealsonwheelsamerica.org/theissue/fac ts-resources/more-than-a-meal The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: (January 2012) http://www.medicaid.gov/medicaid-chip-program- information/by-topics/delivery- systems/downloads/mltssp_white_paper_combined. pdf