A Managed Care Plan and Area Agency on Aging Partnership: An Ohio Experience

1. A Managed Care Plan and Area Agency on Aging Partnership: • An Ohio Experience • CareSource and Akron Canton AAA Gary L. Cook, MA, MBA Chief Operating Officer Direction Home Akron/Canton Area Agency on Aging

2. CareSource • Non-profit, mission driven • Ohio’s first mandatory Medicaid MCP in 1989 • One of largest Medicaid HMOs U.S. • > 1 million members • Medicaid and Medicare Special Needs Plan • HCBS Waivers • Duals demonstration • Multiple States • URAC and NCQA accreditation • Headquarters Based in Dayton, Ohio with regional offices in Cleveland, Columbus, and Louisville, KY. • The CareSource Heartbeat: Making a difference in the lives of underserved people by improving their health care

3. MyCare Ohio History & Timeline • In 2011, the Ohio Office of Health Transformation (OHT) announced a plan for restructuring Ohio’s current healthcare delivery mechanisms. This plan included a demonstration for a fully Integrated Care Delivery System (ICDS) designed to improve the quality of care for dual (Medicare and Medicaid) eligible individuals in Ohio while reducing costs. • In 2012, ODJFS proposed the development of an Ohio ICDS demonstration for dual eligibles to CMS. • An RFP was subsequently issued. Nine managed care plans (MCPs) responded. • Plans were scored based on their experience with Medicare, Medicaid, and LTSS populations. • Current timeline for ICDS implementation is May 1st, 2014.

4. MyCare Ohio Regions

5. CareSource-AAA HCBS and MyCare Ohio Regions • NE (Cleveland) • EC (Akron/Canton) • NEC (Youngstown) • Total= 57k+ dual eligible

6. MyCare Ohio Population • Dual (MCR/MCD) eligible participants: • Community Well (non-Nursing Facility Level of Care) • NF LOC • Community Waiver: • 5 HCBS Waivers • PASSPORT • Choices • Assisted Living • Ohio Home Care • Transitions II “Carve Out” • Institutional, facility based- SNF/ECF

7. New Benchmarks inCare Coordination • All members must have a face to face visit, most within 75 days. • Assessment and visit requirements • Intensive 15 days / monthly visit for life of demo • High 30 days / monthly visit for 6 months • Medium 60 days / visit 1st 2 months, then quarterly • Low 75 days / visit 1st 4 months, then biannually • Monitor 75 days / visit 1st 6 months, then annually • Initial and ongoing (event based) assessments, as well as annual reassessment.

8. LTSS- Keys to integration: Services and Authorizations • Initial and ongoing continuity of services (e.g. LTCF and waiver). • Capturing, authorizing, monitoring, and assuring the quality of service delivery. • Systems (Integrated Assessments and CP) • Protocols (Ensuring appropriate CM and UM) • Oversee unique program options (e.g. Consumer Direction) • Ensuring effective utilization • Ohio- 1st year rate and service level guarantees for HCBS waiver and behavioral health services • Managing a full-continuum risk environment

9. Goals of Improved Integration • Beneficiary gets comprehensive care (acute & LTC) • Providers deal with one payer. • Physician, hospital, medications, mental health, and community support services are all connected so they make sense to the member. • Ideally this means… • Better outcomes and quality of life for beneficiaries • Fewer worries for providers • Reduced total cost of care; reduced waste, duplication, and omissions • Savings for Government and ROI for the health plan.

10. Ohio Medicaid Waivers • PASSPORT and Assisted Living • Helping Medicaid-eligible older adults who require nursing home level of care, but can be maintained in a home or community-based setting. • This provides a substantial savings to the state over the cost of nursing home care, as well as being a more preferred care setting by the member. • The AAA’s PASSPORT and Assisted Living Waivers are much larger than the OHC Waiver (38,000 vs. 12,000 statewide).

11. Medicaid Waivers (Con’t) • Ohio Home Care Waiver – • Helping Medicaid-eligible individuals who require nursing home level of care, who are under that age of 60. • Means the AAA provides HCBS to all ages- pediatric to geriatric and strategically feeds into the Duals Project (MyCare Ohio).

12. Additional AAA Program • Community-based Care Transitions Program (CCTP) • This newly expanded program is targeted towards reducing re-admission rates across 10 hospital systems in our region. • Provides new opportunity for collaboration.

13. LTSS Care Management Care Management is NOT a commodity A commodity is product that is differentiated primarily by PRICE. AAA CM provides value-added. • AAA CM outcomes are enhanced by personal relationships with members. • AAA CM is face-to-face. We see all members in their homes at least quarterly (more if hospitalizations, ED visits, NF visits, or other incidents occur). • AAA CM brings the entire range of services in the community (beyond waiver services) to the LTSS care plan of the member.

14. LTSS Care Management Care Management is NOT a commodity • LongTerm care management is different than other CM because a member has DAILY needs that must be ensured, regardless of known or unforeseen changes in circumstance on the part of the member, the caregiver, or the provider. For example: • Members must have meals every day. • Members must dress every day. • Members must toilet and attend to personal hygiene needs every day.

15. LTSS Care Management Care Management is NOT a commodity. • In order to ensure these needs are met, the AAA CM must integrate the role of the informal support system (family, neighbors, etc.) into the overall care plan. • They must actually see and acquaint themselves with the Member’s living environment, and match services to the specific barriers (or advantages) that their environment creates. • The AAA CM becomes a trusted friend and problem solver for the member.

16. LTSS Care Management • AAA Non-Medical interventions can improve medical outcomes • Reduce hospital admissions and avoidable readmissions. • Reduce length of stay. • Reduce emergency department (ED) visits.

17. AAA strengths • Operational synergy between ICDS and OHC Waivers. • Brand Reputation: 98%+ overall care management client satisfaction (Ohio Department of Aging). • Strong legislative support (e.g., ICDS). • NEOCAAA AAA’s (Akron, Cleveland , and Youngstown, have established working relationship). • AAA’s have the right people, right processes (never had a catastrophic client incident). • AAA’s are a preferred employer in our respective regions (staff up relatively quickly).

18. AAA strengths (Cont.) • Demonstrate value added through cost-effective services provide by the established AAA infrastructure. • Buy or build decisions for ancillary services should be more cost-effective to BUY from AAA’s.

19. John F. Kennedy When written in Chinese the word “crisis” is composed of two characters. One represents danger, and the other represents opportunity.

20. Questions?