Ready, Willing and Able or Is It Willing, Able, and Ready

1. Ready, Willing and Ableor Is It Willing, Able, and Ready Beth Nelson Director, Medicaid Services ClearStone Solutions

2. Willing • The AAA interest is high - move to a different service delivery option or business model – the level of acceptance/embracing of actually doing it varies • You have the know how - spent years developing and perfecting service delivery • Models that work need people than know how to work them • AAA individually and collectively are assessing opportunity and making strategic decisions • AAA discovering that they may need to create a business development arm to meet their business need • Go from verbalizing to defining the business care • You are willing to invest in business development

3. Where AAA’s are discovering opportunity • Integrated Care/Integrated Care System Partnerships (ICSPs) • Integration of physical and behavioral health cultures. Integration of Medicare and Medicaid preventive and primary care, care coordination across primary, acute and long term care, long term care and/or behavioral care services • Health Care Homes/Community First Choice • Money Follows the Person • ACO – Accountable Care Organizations • Managed Medicaid • Dual Demonstrations • Medicare Advantage Plans

4. Services of interest • Demonstration/Supplemental Services • Transition Planning and Transition Coordination Services • Comprehensive Community Support Services – Waiver Network • Case Consultation and Collaboration • Medication reconciliation • Dementia screening • Night Supervision • Respite Services • Environmental Modifications • PERS • DME and Assistive Technology • Non-medical Transportation • Person Centered Plan –behavioral management strategies, 1:1 staffing in community through waiver

5. Creating your value proposition for the managed care entity • We specialize in or specialize working with: • Hard to reach populations • People with Low literacy levels • People with Low health care literacy levels • People with language barriers • Complex health care system (navigating the health care system, eligibility questions, etc.) • Connecting the dots • Navigation

6. Think about your value proposition

7. Find common ground and forge a bridge to cross The health plan has all the risk. They have to stay in control. They have to meet quality metrics and financial performance expectations.AAAs, on the other hand, think in terms of reducing fragmentation, enhancing access, promoting consistency, community infrastructure – hear the differences in approach.

8. Learning to speak Health Care System or Managed Care • AAA Language - • Pulse on the community • Strong advocates • Understand HCBS development • Understand HCBS provider networks • Understand LTC waivers • Embrace keeping people in the least restricted environment • Understand case management and care transitions • Trusted relationships with seniors • Relationships with stakeholder groups • Managed Care Language – • Market Segmentation • PMPM • Contract obligations with non-compliance ramifications- withholds • Quality measures • Health care affordability strategies that impact health plan Medical Loss Ratio • Value Adding Program Options • ROI – Return on Investment • Speed to Market Make your language transfer into what managed care needs

9. Able - When • You have high confidence that your state will support your efforts • Your Board and Advisory Councils are part of the development and execution plans • Your staff support the effort • Your agency has set up the ability to act in a more business or for-profit manner • You know what services will be targeted • Your business plan is developed

10. Ready • You have solidified the services you are going to provide/sell • Supporting policy and procedures • Developed your market plan which includes your key target markets • Priced them competitively • Added your value proposition • You’ve done your research and have selected your best target for outreach – including your short list • You are confident in your decisions • You have the capacity to respond to questions quickly

11. Time to move to true engagement

12. Contact Information Beth Nelson Director Medicaid Services, ClearStone Solutions (651) 662-6882 beth_b_nelson@clearstonesolutions.com