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N4a’s 3 rd Annual Managed Care Conference

N4a’s 3 rd Annual Managed Care Conference. Finding Your Future Lines of Business (and Revenue). June Simmons, President and CEO Partners in Care Foundation. April 28 th , 2014. Targeted Patient Population Management with Increasing Disease/Disability.

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N4a’s 3 rd Annual Managed Care Conference

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  1. N4a’s 3rd Annual Managed Care Conference Finding Your Future Lines of Business (and Revenue) June Simmons, President and CEO Partners in Care Foundation April 28th, 2014

  2. Targeted Patient Population Management with Increasing Disease/Disability

  3. Creating Service Tiers – Risk/Targeting Criteria

  4. Translating CBO Services into Tiers for Health Plans

  5. HCBS in Active Population Management – Value Propositions: Who Pays and Who Saves? 25% of all Medicare is Last Year of Life: Duals Plans; Medicare Advantage SNP; ACO/MSSP EOL LTSS & Caregiver Support Nursing Home Diversion for Duals Plans Care Transitions HomeMeds/Home Safety Assessment ED/Hosp: Capitated Providers/Plans Readmission penalties: Hospitals EB Self-Management: CDSMP/DSMP; MOB; Healthy IDEAS; EnhanceFitness; PEARLS; Fit & Strong Chronic Disease Management: Duals Plans; MA SNP Prevention: MA Plans; Capitated Med Groups Senior Center – meals, classes, exercise, socialization

  6. Current Examples of Contracts

  7. Sample Metrics – the Value Proposition

  8. HomeMeds-Plus: Home Evaluation and Needs Assessment • What is it? • 2 hour home visit • HomeMeds comprehensive medication risk assessment • Home Safety and Fall Risk evaluation • Functional and Psychosocial assessment • PHQ 2/9 • Mini mental • ADL/IADL • Advance Directive education and assistance • Pharmacist follow-through on medication problems • Develop community service plan with member • Coordination of community resources • Collaboration with health plan case managers

  9. HomeMeds-Plus: Home Evaluation and Needs Assessment • Why do it? Expected Outcomes • Improve medication use in 30% of all of those visited at home • Fewer readmissions • In large medical group, 22% lower readmission rate than qualified patients who refused home visit • 40% lower than the group’s other patients at the same hospital • Lower ED use • 13% fewer ED visits compared to those who refused • ROI • 56% net return, compared to those who refused • $135,000 cost avoidance on $88,000 invested • 155% compared to the group’s other patients at same hospital • $224,000 cost avoidance on $88,000 investment

  10. Evidence-Based Self-Management • Who is it for? • Anyone with 2+ chronic diseases judged by Blue Shield CMs to be able to benefit • What is it? • 6-week series of peer-led classes, including: • Stanford suite of Chronic Disease Self-Management Programs • Online or in-person • Diabetes or Pain variants – or Spanish Tomando Control. • A Matter of Balance • Others such as Arthritis Foundation Walk with Ease, Savvy Caregiver, or UCLA Memory • Why do it? • Less pain/distress • Improved member satisfaction • Fewer falls • Lower utilization of high-cost services • Decreased caregiver burden/depression • More exercise/activity

  11. SoCal Network for an Integrated Community Care System One Call Does It All! Care & Service Coordination Evidence-based Self-Management Workshops Comprehensive Assessments Network Office LTSS: Meals, transportation, home mods, etc. HomeMeds/Med Reconciliation Caregiver Education & Support/Respite

  12. • Regional network covers Los Angeles, Ventura, Orange, San Diego & Kern Counties • Hospital-to-home coaching for optimal post-discharge recovery outcomes • Patient empowerment: PCP follow-up, meds management, ER avoidance education, healthy behaviors activation • Contracted with 40 hospitals • Served 1,000s of patients in first year • Projected results: 20% reduction in Medicare readmissions “My coach helped me make continuing health a priority – and having her support made me feel important despite my age.” Patient Lolita

  13. Advice/lessons learned • Broad, diverse product lines for the diverse needs of payers and providers • It takes a long time • Get contract minimum &/or startup funding • Clear roles on both sides • Keep building relationships – become part of the team • Continued marketing after starting • Metrics! Sell hope; then sell proof

  14. Contact Us June Simmons, CEO Partners in Care Foundation 732 Mott St., Suite 150, San Fernando, CA 91340 Main #: 818.837.3775 jsimmons@picf.org www.picf.org www.HomeMeds.org

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