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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
2016 NANASP Conference 2
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
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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
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2016 NANASP Conference 6
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
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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
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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
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The Role of Nutrition Services Building the Bridge
HealthcareHCBS
Nutrition Services
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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
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Role of Nutrition Services
Other Nutrition Services
Nutrition Counseling
Nutrition Education
Nutrition Assessment
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Role of Nutrition Services
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
2016 NANASP Conference 17
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
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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
2016 NANASP Conference 20
More Than a Meal Pilot Study – Phase I: Compare Daily to Weekly Delivery
Feel safer, helped them to eat healthier, more social contacts
Loneliness
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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
2016 NANASP Conference 24
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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2016 NANASP Conference 25
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
203.575.4208llabonte@NewOppInc.org
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
Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311
Preparation
Considerations:
Accounting/Tracking
Staffing
Communications Plan
Contract Separation
Data Sharing – HIPAA
Billing Options: Capitated, Fee-for Service
Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311
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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
Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311
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
Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311
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
Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311
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
Meals on Wheels and Senior Outreach Services mowsos.org 925.937.8311
Resources are
Abundant
NRCNA
State Associations
Webinars
SCAN Foundation
Meetings
ASA
Funders
LTSS Partners
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Thank You!
Uche Akobundu | uche@mealsonwheelsamerica.orgLisa LaBonte | LLabonte@newoppinc.org
Elaine Clark | eclark@mowsos.org
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