Addressing Service Gaps: A Meals on Wheels Plus … Conference LL...5/26/2016 1 2016 NANASP Conference 1 Addressing Service Gaps: A Meals on Wheels Plus Model Uche Akobundu, National

5/26/2016

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2016 NANASP Conference 1

Addressing Service Gaps: A Meals on Wheels Plus Model

Uche Akobundu, National Resource Center on Nutrition and Aging

Elaine Clark, Meals on Wheels and Senior Outreach Services

Lisa LaBonte, New Opportunities, Inc.

June 2, 2016


Session Overview

• The changing healthcare market

•Opportunities for nutrition services

• Impact of community nutrition services

• Tips to be competitive

•Perspectives and learnings from the field:• New Opportunities – Lisa Labonte• Meals on Wheels and Senior Outreach Services – Elaine Clark


The Changing Healthcare Market

Patient Protection and Affordable Care Act of 2010

•Triple Aimo Better careo Healthier peopleo Smarter spending

Better care

Healthier

People

Triple Aim

Smarter

Spending

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The Changing Healthcare Market•Managed Care (MCO) has completely commercialized

the delivery of Medicaid serviceso HCBS

o Long-Term Services and Supports

•Accountable Care Organizations (ACOs)

•Hospital/SNF payment reforms

•Bundled Payment Initiatives



The Changing Healthcare Market

• Services must meet the needs:o Customer – Payero Consumer – Beneficiary (client or patient)

• 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

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What the Healthcare Payer is Seeking

• Meet consumer needso Choice of meals, special or modified diets, flexibility in

deliveryo Other services – nutrition counseling, and evidence-

based programs• Access to the consumer• Coverage for the entire service area (1 contract)• Easy to submit referrals for services• Cost effectiveness• Meet quality metrics• Data provided to show improved outcomes


Changing Resources for Nutrition ProgramsGovernment and Public Funding

• Older Americans Act: Title III (C1, C2, NSIP), V, VI

• Other Federal o Social services or

community service block grants

• State Funding - Variance by State


Building Sustainable Resources for Nutrition Programs

• Expand existing funding

• Social entrepreneurship

• For-Pay options

•Contracts with Healthcare entities

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Role of Nutrition Services in Healthcare Market


The Role of Nutrition Services Building the Bridge

HealthcareHCBS

Nutrition Services


Something Magical Happens!

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Role of Nutrition Services

Value of Nutrition for Clients with Chronic Health Conditions

Heart disease

Hypertension

Diabetes

Osteoporosis

Kidney disease

Obesity



Other Nutrition Services

Nutrition Counseling

Nutrition Education

Nutrition Assessment



Value Add

Brand lift

Preventive services pre- and post-hospital admission

Wellness/Safety Check

Regular contact in the home

Trusted in the home

Client status (moved, hospital, nursing home)

Perform regular in-home assessments

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Advantages for Nutrition Programs

•Valued added services

• Service and delivery structure in place

• Trusted entity with long history of success

• Linked to other community-based services

•Ability to build community partnerships


More Than a Meal Pilot Study – Phase I: All Home-delivered Clients

Improvement in feelings of anxiety, self-rated health, isolation and loneliness

Decrease in hospitalizations and falls


More Than a Meal Pilot Study – Phase 1: Daily Home-delivered Clients

Improvement in feelings of anxiety, self-rated health, isolation and loneliness

Decrease in falls and worry about staying in the home

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More Than a Meal Pilot Study – Phase I: Daily Home-delivered Meal Clients Living Alone

Improvements in feelings of isolation and loneliness

Decreased worry about being able to remain in the home


More Than a Meal Pilot Study – Phase I: Compare Daily to Weekly Delivery

Feel safer, helped them to eat healthier, more social contacts

Loneliness


More Than a Meal Research: Next Steps

More Than a Meal Phase 2-Examine healthcare utilization and outcomes using Medicare Claims

More Than a Phase Meal 3-Broaden understanding of what happens during the meal delivery and the interaction between meal delivery drivers and clients.

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How to Compete?

Know:• The value and impact of your services• Health Reform activity in your community

o Medicare Advantage Planso Medicaid Managed Care initiativeso ACOso Bundled Payment Initiatives

• Your Competition • Your Partners• Your Champions

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How To 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


How To 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

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Learning as a Network

Lisa LaBonteNOI Senior Nutrition Director

NANASP ConferenceLas Vegas, NV

June 2, 2016

NOI Senior Nutrition ServicesServes 21-Towns [2 urban cities, 2 rural towns surrounded by 17 suburban towns] in CT

• Central Naugatuck Valley Region Beacon Falls, Bethlehem, Cheshire, Middlebury, Naugatuck, Oakville, Prospect, Roxbury, Southbury, Thomaston, Waterbury, Watertown, Wolcott, Woodbury

• Housatonic Valley Region Bethel, Bridgewater, Brookfield, Danbury, New Fairfield, New Milford, Newtown, Redding, Ridgefield, Sherman

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NOI Senior Nutrition Services

Provided 1,893 seniors with 524,224 home delivered meals in Fiscal Year 2014/2015

Offers an array of Therapeutic Diets [Low cholesterol, low sodium, low residue, low lactose, diabetic, renal, liquid supplements(Ensure) as well as chopped and ground mechanical]

Other services include: Animeals Pet Food Program, Emergency Response System, Companion Program, Nutrition Counseling and Education, Money Management

Incentives for Nutrition Programs in CT Current Medicaid Waiver Rate: $8.85/meal

Current Title III Rate: $8.26/2-meal unit with limits on service levels

Actual Cost: $9.50

ENPs can contract with health-care entities and negotiate a price that meets the true costs without limitations

Build volume, generate revenue and provide some relief to Title IIIC

If we don’t do it, someone else will

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Health Reform Activity in CT

Progress/PotentialIn CT, the initiation of Bundled Payment systems with the Hospitals and Orthopedic Physicians and the formation of ACOs have been the driving fore of our focus on partnering with healthcare.

Barriers CT doesn’t have Medicaid Managed Care Initiatives

Medicare Advantage Plans have been difficult to access

CompetitionMom’s Meals has attempted to do business on a large scale in CT. There are some hospitals who are capable of providing the meal service themselves.

Services included in our Agency Business Plan

Home Delivered Meals: Double or Single Meals, Therapeutic Diets and Liquid Supplements

Nutrition Counseling and Education by a Registered Dietician

Comprehensive Nutrition Assessment

Emergency Response System

Companion Services

Money Management Services

Daily check on patients well-being and feedback providing “red flags” when needed

Pet food for patient’s pet

Services that require Community Partners

Fall Prevention and Safety Check

Comprehensive Nutrition Assessment

Case Management Services

Data Collection and reporting to health care entities

Registered Nurse and social work services

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Efforts Focused on “Getting On the Radar”

Connecticut Hospital Association [CHA]

Leading Age CT

CT Association of Nutrition & Services Providers [CANASP]

Medicaid Waiver Access Agency

Area Agencies on Aging

CT Community Clinic Advisory Council

Local Hospitals [4]

Discharge Planners

Community Nurses

Community Action Agencies

Legislators

CatMatt Software Solutions

Champions

Meals On Wheels America

National Resource Center on Nutrition & Aging

Hospital Foundations

Benefits of Participation in the Building the Business Capacity of Nutrition Programs

Education

Support

Collaboration

Motivation

Tools

Funding

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How To Compete

Communicate

Collaborate

Standardize

Centralize

Communication Speak with anyone you come in contact with about the

healthcare initiative. Sometimes the person you would least expect could make the most significant connection for you.

Keep your legislator informed. They will support initiatives that divert from state supported initiatives and may have connections.

Determine the needs of the healthcare provider and decide which community partnerships are needed to meet those needs.

Addressing Program Capacity Challenges

Use your agency’s resources; restructure if necessary to meet the needs of the healthcare world and expand your capacity.

Know your limitations in advance and partner where needed. Avoid saying “no” to a healthcare provider’s request – it could lead to losing the business.

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Continuous Quality Improvement

Quarterly Driver’s Training includes an RN who provides specific training involving monitoring of client changes and reporting.

Market and provide RD planned menus, including therapeutic diets.

Develop good methods of data collection that will be useful to the healthcare provider in determining the impact of the service on the readmission rate.

Information Technology [IT] System

Develop and provide one standardized easy method for healthcare providers to make referrals.

Centralize the referral process to one database that directs the referral to the appropriate ENP provider.

Develop an identifying factor on route lists so Drivers know which deliveries are healthcare related.

Contact Info:Lisa LaBonte

Director of Senior Nutrition Services

New Opportunities, Inc.232 North Elm StreetWaterbury, CT 06702

[email protected]

www.NewOppInc.org

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Preparation and

Contract NegotiationsKey Learnings

Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311

Preparation

Pre-Prep:

Board Support

Service Offerings

Costs

Partners

Competitors

Needs/Wins/Motives

Value Proposition

Timing – 2+ years


Preparation

Considerations:

Accounting/Tracking

Staffing

Communications Plan

Contract Separation

Data Sharing – HIPAA

Billing Options: Capitated, Fee-for Service


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Subcontractor Position

Little Room for Negotiation

Look For:

Exclusivity

Duration

Requirements

Billing

Benefits:

Quick Turnaround

Model Contract

Established Procedures

Established

Expectations


Direct Contractor – Hospital

You Control Negotiations

Determine:

Service Offering

Patients

Duration

Outcomes

Billing – Fee for Service

or Capitated

Negatives:

Long Negotiation

Period

Not a Priority


Contact Titles

Where Do You Start?

C.E.O

Discharge Planner

Director of Coordinated Care

Marketing Sales Support (Insurance)

Coordination of Care Services Director

Senior Services Supervisor

Physician Leader

Clinical Consulting Manager for the Continuum

VP Government Affairs


V.P Care Coordination and Integration

Director, Community Health Improvement

Retired Cardiologist

Director Health Resource Management

General Manager

Director of Public Health

Project Manager

Director of Case Management

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Key Learnings

Know that You Don’t Know What You Don’t Know

Key Learnings

Health Care is Messed Up

Politics is Everywhere

Your Priority is not Their

Priority

Multiply by X

You Will Be Surprised


Resources are

Abundant

NRCNA

State Associations

Webinars

SCAN Foundation

Meetings

ASA

Funders

LTSS Partners


Thank You!

Uche Akobundu | [email protected] LaBonte | [email protected]

Elaine Clark | [email protected]

mailto:[email protected]



Documents

Addressing Service Gaps: A Meals on Wheels Plus … Conference LL...5/26/2016 1 2016 NANASP Conference 1 Addressing Service Gaps: A Meals on Wheels Plus Model Uche Akobundu, National