A2-Ensuring the Future of Catholic Health Care - EngKrasnausky

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© 2014 by the Catholic Health Association of the United States© 2014 by the Catholic Health Association of the United States
Ensuring The Future of Catholic Healthcare Through Education &
Collaboration
© 2014 by the Catholic Health Association of the United States 2
Agenda
II. Environmental Context for Change
III. Catholic Providers Forum: Seeds of Collaboration
IV. Cardinal Health Partners IPA, LLC
V. Why an IPA?
VII. Questions & Comments
Overview of Presenting Organizations
© 2014 by the Catholic Health Association of the United States
Mission Statement
is committed to the tradition of Mother
Cabrini, to bring God’s love to the world
through personalized, compassionate and
justice and respect for all.
St. Frances Xavier Cabrini
• Foundress of the Missionary Sisters of the Sacred Heart of Jesus
“Bearers of God’s love.”
• Sponsors of Cabrini of Westchester
“We love caring for people.”
Corporate Members:
Service Area:
Westchester County
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Cabrini
Cabrini Immigrant Services
The Mission of ArchCare, the Continuing Care
Community of the Archdiocese of New York is
to foster and provide faith based holistic care
to frail and vulnerable people
unable to fully care for themselves.
Through shared commitments, ArchCare seeks
to improve the quality of the lives
of those individuals and their families.
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The ArchCare Ministry Offers A Broad Array Of Programs To Serve Diverse Needs
Environmental Context for Change
NYS Public Policy Direction: Care Management for All
Drivers of Policy Changes – Move toward managed care to create Accountability Budgetary predictability Minimize unnecessary utilization & reduce costs Optimize quality
Focus on high-cost, high-need Medicaid populations – dual eligibles
Mandatory enrollment in Managed Long Term Care Plans (MLTCPs) of individuals ≥ 21 years of age requiring > 120 days of community long term care.
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Mandatory enrollment of > 123,000 duals into MLTCPs which are risk arrangements capitated for Medicaid
> 80 % of beneficiaries were receiving long-term care services via fee-for-service (FFS) Medicaid
> 100 Long Term Home Health Care Programs (LTHHCPs) served 27,000 individuals
LTHHCPs opting to become an MLTCP would require Managing risk Utilization Management (UM)
experience Working capital for start-ups
and operational losses Risk reserves MCO IT
NYS decided to participate in the federal demonstration program to create integrated Medicare and Medicaid Plans, or Fully Integrated Duals Advantage (FIDA) plans.
NYS viewed MLTCPs as the foundation for transitioning into FIDAs.
Fee For
2012 2015
MLTCP FIDA
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Catholic Providers Forum: Seeds of Collaboration
Given the sweeping State & Federal policy changes Carmelite Sisters for the Aged and Infirm Cabrini Eldercare ArchCare
Met early in 2011 to identify ways to ensure a continuing Catholic presence in caring for the elderly & disabled.
Decided to bring together representatives from Catholic service providers and religious orders caring for their own aging members to 1. provide education on Federal and State health policy changes; 2. share information about the broad array of services of Catholic
providers; and 3. explore opportunities for collaboration that could assist
organizations to adapt to the changing healthcare landscape.
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The Founders invited Catholic service providers and religious orders to a symposium on June 14, 2011.
It was a groundbreaking gathering in that these groups had never been convened.
More than 80 representatives from 26 Catholic organizations attended the day-long symposium, and the response of participants was enthusiastic.
Given strong interest, subsequent gatherings have been convened each year.
As Timothy Cardinal Dolan stated at one Forum, “We may have been able to do it separately in the past, but right now we’ve got to be collaborative.”
Structure of the day-long Symposium:
The Keynote Address, Msgr. Charles J. Fahey cited two powerful bonds that brought us together: the swift health care policy changes and our fundamental identity with a rich Catholic historic legacy of serving those in need.
Silos of care evolved over the decades as a result of diverse government reimbursement streams.
“There could be and should be an especial advantage to interact with other institutions, programs and individuals with whom we share a common heritage, world vision and values.”
An in-depth overview of 1) federal policy trends, presented by Michael Rodgers (CHAUSA), and 2) NYS policy changes.
Attendees shared an overview of their organizations.
Sr. Peter Lillian DeMaria led the group discussion on opportunities to collaborate, barriers and solutions, next steps.
The Learning Collaborative was created based on a number of compelling factors: 1. Sweeping changes in healthcare. 2. Our shared Catholic identity, values and
commitment to serving those in need. 3. Desire to ensure a Catholic presence in the long
term care. 4. Strong interest in learning about healthcare
reform and its implications.
breadth of services and offerings --- as well as potential opportunities.
Open discussion of opportunities, barriers and solutions helped to open the door to possibilities.
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Feedback from Attendees:
What next steps do you see as result of today’s Symposium? “Continue to seek ways for Catholic Providers to
come together & provide healing ministry of Jesus. Working together.”
“Need to continue to meet & work together as Catholic Health Care.”
“Continuation of the discussion and commitment to collaborate.”
“Mutual support.”
What was most helpful to you today? “The people in the room.” “Learning about other organizations.” “The beginning of an open dialogue amongst
Catholic providers.”
Recent Survey Results
• 81% felt that their level of awareness of Catholic Services increased moderately or significantly since the inaugural June 2011 Catholic Providers Forum.
Level of collaborative activities with other Catholic providers that are moderate or significant increased between 2011 and 2014.
81%
47%
0%
20%
40%
60%
80%
100%
2011 2014
Since 2011, the Catholic Providers Forum has continued to hold gatherings and it has fostered a number of collaborative initiatives such as:
Working with religious communities to develop care arrangements for their elders to leverage their Medicaid & Medicare benefits without further erosion of community assets.
Avila Institute of Gerontology providing educational programs for providers.
Care coordination and service arrangements.
Creation of Cardinal Health Partners IPA, LLC.
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Cardinal Health Partners’ five Founding Members:
Cabrini of Westchester
Good Samaritan Regional Medical Center/ Bon Secours Charity Health System
Saint Joseph’s Hospital Nursing Home
Schervier Nursing Care Center/ Bon Secours New York Health System
What we had in common:
A heritage of Catholic sponsored value-based care
A total of 1200+ Medicaid chronic care clients who had long-standing relationships to the 5 provider organizations.
Hundreds of employees who cared for them, sometimes for years.
A Medicaid revenue stream to the 5 providers.
A new mandate which would eliminate # 1-5 above: enrollment of all clients into Managed Long Term Care Plans.
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What we had in common:
Goals and aspirations to Protect Patients from unscrupulous MLTCPs
Keep Catholic sponsored Patient care alive
Continue to provide work to our employees
And also …..
Our Choices:
» Incorporate as a Care Management entity
» Go out of business
Formed in December, 2012, Cardinal Health Partners is an Independent Practice Association (IPA) that:
•provides high quality care management expertise
•contracts with managed care organizations
•receives a per member / per month fee
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Vision
form an entity to:
provide each member’s LTHHCP clients continuity of care with the caregivers they know and trust
continue the mission of all the founding sponsors
sustain employment for hundreds of care givers who have been providing compassionate care to those who reside in the community for years.
The care management expertise of Cardinal
•derives from many years of case management in the LTHHC programs
•is supplemented by The Commission of Case Managers Certification (CCMC)
•is strengthened through the collaborative process
Care Management Services
Assists enrollees to access necessary covered services identified in the Care Plan
Also provides:
• referral and coordination of other services in support of the Care Plan irrespective of whether the needed services are covered under the capitation payment to the managed care program
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• Through contracts with the five provider organizations, Cardinal has access to a continuum of long term care services:
– Rehabilitation
MANAGERS
of Yonkers
System
Dominican Sisters Family Health Service
Cabrini of
Diane Law Clinical Director
Denise Kuhbier Clinical Director
Providers Programs and Services
SNF Acute Care LTHHC CHHAs LHCSAs Senior Housing Adult Day Care Social Day Care
Agewell NY
Service area:
Cardinal Health Partners provides its services throughout the five boroughs of New York City as well as in Westchester, Rockland, Putnam, Orange, Nassau and Suffolk Counties (NY State).
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Service area:
Why an IPA?
Why an IPA?
Ability to negotiate pm/pm rate with each MLTCP
Unified quality programs and metrics reporting
Future Risk Sharing
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Why an IPA? (cont’d)
Relatively Easy to Establish as a NFP or FP Entity
Volume Provides Negotiating Clout with HMOs and Other Managed Care Organizations (MCOs) that Need Access to Services
Many MCOs Prefer IPAs Single Contract One Tax ID Number Self Disciplining Internal Utilization Management, Quality
Management and Claims Review and Processing Members Can Opt In or Opt Out of a Contract
Serving Elders in Religious Communities
New Challenges
• Religious communities face difficulties in caring for their older and frail members due to declining human and financial resources.
• Rapid change in regulations affecting Medicare and Medicaid make it difficult to be fully informed of options.
• Accessing consultants, attorneys and private geriatric case managers can be expensive and confusing.
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New Solutions
Catholic Providers’ Forums welcome religious community members for education sessions about options and networking with Catholic providers representatives.
ArchCare provides special communal models of managed long term care and PACE to allow members to stay in their residences.
The Carmelite Sisters, through Avila
Institute provide consultation to religious
communities in need of a guide to available
options.
“cluster care” home care services in
community residences and a special nursing
home program for religious requiring long
term care.
Questions & Comments

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A2-Ensuring the Future of Catholic Health Care - EngKrasnausky