nikki kmicinski, executive director western new york ...€¦ · 2014-2015: aaa leaders in erie...

Nikki Kmicinski, Executive Director Western New York Integrated Care Collaborative ACUU Conference, Albany, NY June 11, 2019

2014-2015: AAA Leaders in Erie & Niagara Counties: Business Acumen Learning Collaborative through ACL

2016: Non-profit, Incorporated, 501(c)3 2017 – 2020: 30 month grant from Health Foundation of

Western and Central NY 10/2017: 1 full-time staff: Director 12 network members 6 contracts with health payers to provide community

based programs & services to their members: Chronic Care Mgmt, Healthy IDEAS, DSMP, CDSMP

2019- 2022: Sub-Grantee with NYSOFA for 3-year ACL Grant to bring Sustainability to CDSME.

Convening Organization for our Network

Administrative role

Contracting and negotiations with health plans and payers

Billing and Invoicing

Credentialing

Medicare Supplier/Provider

Technical Support

Referral Processing

Training

Network Collaborations

Medicare Reimbursement Learning Collaborative

NCOA May 2018 - April 2019 10 cohorts from: NY, PA,

OR, TX, KY, NE, CT, DE, OR, NM

Health Information Technology Learning

Collaborative

n4a’s Aging & Disability Business Institute

November 2018 – October 2019

10 cohorts from: IL, WA, IN, Washington DC, MD, MI, OR, AZ, WA, NY

Purpose:

achieve integrated, sustainable service systems for Chronic Disease Self-Management Education (CDSME) programs

obtaining payment for CDSME services through the following distinct Medicare benefit: Chronic Care Management (CCM)

Application WNYICC’s Team Acceptance into LC Mentors Schedule Learning Modes Main Topics Homework Outcomes

Successes Learned about Chronic Care Management and

Medicare Supplemental Benefits Learned “how to speak” with Insurance Plans to

market Community-Based Programs

Hedis Measures, Cost Factors, Opportunities

Met colleagues from across country who are now resources and friends

Developed WNYICC Network Model

0 to 6 Contracts with health plans

Medicare Advantage CCM benefit: broad range of services offered

supervision of a physician, physician assistant, or nurse practitioner

individuals with 2+ chronic conditions follow their medical care plan, practice preventive health care, & more effectively manage their health.

AAA/CBO’s use case managers or community

health workers to provide monthly in-home health coaching.

CCM Benefit and CDSME Programs: Minimal time for a CDSME program can be billed under

the CCM benefit.

Many activities ancillary to CDSME can be offered under the CCM benefit:

▪ engaging individuals

▪ enrolling them in classes

▪ arranging transportation

▪ providing counseling & support throughout the program and afterward to improve health outcomes.

Challenges Time Scheduling Team Technology for documentation, communication,

record storing, reporting and billing Culture Change for Network partners (AAA/CBO)

New concepts

New business model

Goals:

grow the technology and business skill set of participants

encourage participants to share their knowledge and experiences with others that are just starting to develop these partnerships.

Mentors Schedule Learning Modes Main Topics Homework Outcomes

Topics To Date:

Vetting IT Vendors

Important features of IT platforms

Contracting

HIPAA Policies / Consent Management

Health Plan Presentations

Apply Team Participate Do the Homework Say Yes! Reach Out Share

Thank you!

Nikki Kmicinski, Executive Director Western New York Integrated Care Collaborative Nkmicinski@wnyicc.org 716-887-2749