community-based high risk care management sandee ferguson area agency on aging, 10b
DESCRIPTION
Environmental Scan Other countries, such as United Kingdom and Australia, have literature for high risk in community care. Literature is primarily disease management (Acute Care or Insurance based) and does not include integration with community Care Managers. A NEW APPROACH TO COMMUNITY- BASED CARE MANAGEMENTTRANSCRIPT
Community-Based High RiskCommunity-Based High RiskCare ManagementCare Management
Sandee FergusonArea Agency on Aging, 10B
Nature of ProblemNature of Problem• In order to improve care while enhancing overall
efficiency, we must invest in development of new techniques and infrastructure in the changing long term care landscape.
• Investment needs to be made in new and more sophisticated methods of integrated medical care management in the home, instead of service management.
• By maintaining an older Ohioan at home rather than in the NF, we save the state $32,049 annually per member making the high risk care management initiative a vital investment and good policy.
Environmental ScanEnvironmental ScanOther countries, such as United Kingdom
and Australia, have literature for high risk in community care.
Literature is primarily disease management (Acute Care or Insurance based) and does not include integration with community Care Managers.
A NEW APPROACH TO COMMUNITY-BASED CARE MANAGEMENT
ApproachApproachThe project will be an effort to introduce
medical integration with protocol application:
INTERVENE
AVERTTHE
DECLINE
RECOGNIZE
• 4 County Region• Frail, chronic illnesses, 60+ adult• NF Level of Care• Receives Home and Community-based Waiver
High Risk Screening Tool Logit Model:Based on univariate analysis, a total of 30
predictors were identified
Target PopulationTarget Population
Process and Outcome MeasuresProcess and Outcome Measures• Member data (assessment and ongoing)-
protocol and risk measurement/ stratification• ↑ length of stay on program• ↓disenrollments to NF• ↓ hospitalizations• ↓ emergency Dept. visits• ↑ member satisfaction• Transition to community from NF and remain in
community = SUCCESS
Project TimelineProject TimelineYear 1Risk Stratification Methodology and application
process for HRCMDevelopment of Care Plan Protocols & PoliciesDevelopment of SoftwareEvaluationYear 2HRCM Manual and information packageExpand to HRCM ConsultationIntroduced and Integrated Statewide by State
Policy and Standards
Implementing the Program In AAA 10BImplementing the Program In AAA 10BOur Strategic Vision: High Risk Care Management
is in alignment with our vision and mission.
12 AAAs in Ohio: Opportunity
Key Stakeholders: 3500+ members, Care Managers, Hospitals, Physicians, Provider Network
Engaging is Involving!
Perceived Facilitators/BarriersPerceived Facilitators/Barriers
FACILITATORSPartners:
HospitalsPhysiciansCommunity OrganizationsState Policy Provider NetworkAAA NetworkInsurance PlansEducation/Research
Nursing Facility
BARRIERSNursing FacilityNursing ShortageCultural ChangeConsistency and uniformity
Preliminary DataPreliminary DataStratification by risk level.pdfStratification by risk level.pdf
6.6%
22.2%
71.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Low Moderate High
Keep It Going After 2 yrs!Keep It Going After 2 yrs! Data and Outcome Success
$ Ohio’s Medicaid Nursing Facility Costs
State Policy and Practice Change for Waiver Members.
Thank youThank you