Aging and Disability Resource Centers: A National View

November 13, 2013

Lisa Alecxih, Senior Vice President

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Getting to the No Wrong Door System

“The vision is to have

Resource Centers in

every community

serving as highly

visible and trusted

places where people of

all ages and income

levels can turn for

information and options

counseling on their

long-term care options.”

-AoA/CMS 2003 ADRC

Program Announcement

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VD-HCBS launched

49 States awarded new ADRC grants (5 year plans)

2007

2008

2009

2010

2011

2012

10 CMS Hospital Discharge Planning grants to ADRC states

Affordable Care Act Money Follows the Person

CCTP and Balance Incentive Program launched

2003 12 states, 8 sites, 2% of pop.

24 states, 42 sites, 8% of pop.

43 states, 147 sites, 30% of pop.

47 states, 300 sites, 49% of pop.

51 states, 509 sites, 77% of pop.

ACL, CMS, VHA NWD System FOA

Milestones of ADRC Development

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Who Benefits From a NWD System?

People

• Informed decisions

• Person-centered approach

• Efficient use of own resources

• More seamless access to public programs

States

• Coherent, responsive system with consistency across populations

• Builds upon strengths of multiple organizations

• Leverages Federal funding

Public Payers

• Better deployment of both individual and public resources

• High return on investment

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Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica (September 2011) http://www.longtermscorecard.org/

Found that states with the highest level of performance

have enacted public policies designed to:

• Improve access to services and choices in their

delivery by directing state Medicaid programs to

serve more people in need and offer alternatives to

nursing homes that most consumers prefer.

• Establish a single point of system entry to help

people find needed information and more easily

access services.

• Improve support for family caregivers by offering

legal protections as well as other services to

address caregiver needs.

A State Scorecard on Long-Term Services and Supports for Older

Adults, People with Physical Disabilities, and Family Caregivers

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Veteran’s Directed Home and Community-based

Services (VD-HCBS) & Respite

• VD-HCBS equivalent to participant directed budget available in some

Medicaid HCBS programs

• 101 AAA/ADRCs working with 43 Veteran Administration Medical

Centers (VAMCs) have provided VD-HCBS to 1,559 Vets as of

August 2013

– San Diego and Palo Alto VAMC have been actively pursuing VD-HCBS

implementation with the support of ACL RO, SUA and local agencies

• VHA plans to add respite benefits under their new caregiver support

program through the same mechanism

• 8,785 Veterans received VA LTSS (in-home) in CA (FY2012)

– 3,342 Veterans receive VA LTSS on any given day in CA

• 2,187 Veterans on any given day were provided nursing home

services by VA in CA (FY2012)

– This level of care cost VA approximately $476M in FY2012

Building the “No Wrong Door” for All Populations

Karol Swartzlander California Health and Human Services Agency

November 13, 2013

Lessons Learned

Maintenance of state infrastructure (staff, technical

materials, training) essential

ADRC partnership development takes time

ADRCs are successful transition partners

ADRC partnership best practice - third party,

objective facilitation of strategic planning

ADRC partnerships that embody mutual respect and

focus on the consumer are the most successful

Local organizations need technical assistance to

engage with the formal health care system (managed

LTSS)

Disseminate New Technical Tools: ADRC business plan

template and guidance; ADRC financial model(s)

Formally designate ADRCs under new designation criteria

Encourage and support VA Medical Center/ADRC

collaboration

Monitor and collaborate with national ADRC

developments and state initiatives (e.g., Money Follows

the Person)

quality assurance and monitoring

long-term sustainability

Continue Options Counseling Training Program

California’s ADRC Program Focus 2013-2014

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Current Status

Today, 7 ADRCs serve 11 counties: Del Norte,

Nevada, Orange, Riverside, San Diego, San

Francisco, Butte, Glenn, Tehama, Colusa and

Plumas

ADRC under development in Alameda

All ADRCs to submit formal ADRC designation

applications by December 2013

Emerging partnerships: Los Angeles, Monterey

Bay (Monterey, Santa Cruz, San Benito) and

Santa Clara 10

Challenges

Lack of dedicated (and sufficient) ADRC funding

Start up funding necessary to develop new lines

of business (care transitions, VD HCBS, etc.)

Quality assurance and monitoring

Lack of standardized data to assess full impact

of the ADRC initiative

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The SCAN Foundation’s 3rd Annual LTSS Summit ADRC Business Plan Development November 13, 2013

Government Human Services Consulting

Project Goal: Establish a replicable business model for Aging and Disability Resource Connection (ADRC) partner organizations focused on the purchase of integrated long-term services and supports (LTSS) by managed care and other potential buyers.

MERCER October 24, 2013 14

ADRC Model

Streamlined Access to

Public Programs

ADRC

Person- Centered Care

Transitions

Enhanced Information

and Referral/ Assistance

Options Counseling

Quality Assurance and

CI

Short-term Service

Coordination

MERCER October 24, 2013 15

ADRC Roles and Responsibilities

Building blocks for effectively working together

Vision

Organizational

Lead(s)

Key Function and Lead Org (as applicable)

Positions/Strategies for Carrying out Functions

Effective Strategies for

Coordination Across Organizations

All partners communicating, engaging in work toward mission, and identifying

resources and strategies to

build value and recognition –

within community and among

payers

MERCER October 24, 2013 16

Business Model

• Provides an overview on how the ADRC partnerships plan to operate, deliver value to customers, and how it will remain financially viable

• The sustainability model was developed in conjunction between Mercer and the ADRCs and will help determine the revenue needed to break even as a sustainable ADRC without subsidies from other programs

MERCER October 24, 2013 17

Business Model

• The key components that were asked during the business model development are:

– Who are the key partners of the ADRC?

– What are the key activities of the ADRC?

– What are the key resources of the ADRC?

– Who/what are the ADRC customer segments, how to enhance the customer services, and what are the channels to address customer needs?

– What value does the ADRC bring to customers/contractors?

MERCER October 24, 2013 18

Business Model

• Components of the business model that projects up to 5 years includes:

–Grants and Contributions

–Other Current

–Contracted Services

–Agency Staff

–General Administration

–Sellable Services

MERCER October 24, 2013 19

Opportunities Towards Sustainability Preliminary Recommendations

• Medicaid Administrative claiming

• Money Follows the Person demonstration opportunities

• Veterans Directed HCBS program

• Mental Health services

• Medicare Advantage program

• Private Pay

• Contracting with managed care organizations

MERCER October 24, 2013 20

Conclusion

• The fluidity and philosophy of the “no wrong door” system while providing tools to measure the financial viability of the partnerships, including – where possible – quantifying the value they bring to their communities as demonstrated by demand/funding priorities, etc.

• Bridges needed to maintain the objectivity

• Additional funding sources

• Dedicated champion

MERCER October 24, 2013 21 21

Questions? Contact Information Michele Walker, Senior Associate Michele.Walker@mercer.com www.mercer-government.mercer.com

ADRC of

Nevada

County

Vision All seniors and persons with

disabilities in Nevada County have independence and autonomy and

live full and healthy lives.

Mission Provide easy access to a broad array of services, a continuum of help in accessing services and

advocacy for individuals desiring long term support services and

information.

Core Partners:

FREED Center for Independent Living

Area 4 Agency on Aging

211 Nevada County

Extended Partners:

Nevada County Social Services

Gold Country LIFT

Alta Regional

Nevada County Transit Services

Domestic Violence & Sexual Assault Coalition

The Salvation Army

Falls Prevention Coalition

Hospice of the Foothills

Western Sierra Medical Clinic

Gold Country Community Services

Collaboration & Partnership

No Wrong

Door

Approach

Shared Values Prevention of Institutionalization

Honoring individual/consumer rights

Person-centered and consumer-directed approach

Participation on ADRC Advisory Committee Community Living Implementation

Council

Cross-training

Promotion of ADRC services and referrals

Warm Hand Offs

Core Partners -

FREED, A4AA/HelpLine &

211:

Enhanced Information and

Assistance

Person-Centered Options

Counseling

Short-Term Service

Coordination

FREED:

Transition Services

Care Transition

Intervention Program

California Community

Transitions (CCT)

MDS 3.0 Referrals

ADRC Service

Challenges Successes

Collaboration takes time

Sustainable Funding

Service consistency across organizations

No Wrong Door vs. Single Point of Entry

Increased collaboration

Transitions – CTI & CCT

MOUs with Extended Partners

Trained Options Counselors

211 ADRC Resource Guide

ADRC of Nevada County

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Alameda County ADRC

Tracy Murray

Assistant Director, Area Agency on Aging

In the Beginning…

Challenges

Changing political and funding landscape discourages program development of any kind

Escalated time frame of application inhibited extensive participation by extended partners

Governance and organizational structure of organizations hinders some activities

Lack of funding impedes full implementation

Successes

Opportunity to have meaningful dialogue between the AAA, CIL & CRIL

Support from our community members

Technical Assistance from the CHHS

Terrific Strategic Planning Session lead by Lindel Hatton

Agreement in principal to provide Core Services

Expanded collaborative opportunities

Contacts

Tracy Murray, Assistant Director

Area Agency on Aging

510 577-1966

Thomas Gregory, Program Manager

Center for Independent Living

510 841-4776

Sheri Burns, Executive Director

Community Resources for Independent Living

510 881-5743

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