knowing our market socal home and care network. target populations dual eligibles medicare ffs...
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Knowing Our MarketSoCal Home and Care Network
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Target Populations• Dual eligibles• Medicare FFS patients• ACO members/patients• Adults with chronic conditions • Mental Health• Post-hospital
– Psych
• Homeless• Medicaid/uninsured• Veterans/VA• Caregivers/family members• At risk of SNF placement/LTC• LT Acute Care patients - a la Kindred – up to 21 days
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Target populations – Characteristics & Needs• Frequent 911• In dialysis – ESRD – non-emergency medical transportation• Newly diagnosed, ready for self-management in diabetes,
chronic pain, cardiac• Dementia: Their caregivers need support• Non-medical support services• Homebound – need meals, etc.• Multiple chronic conditions with functional impairment• EOL(ish) – palliative care, hospice, advance care planning,
supportive wraparound services
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WE ARE NOT MEDICAL. We are not competitive with home health
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Target Populations - Needs• Frequent 911: Self-care/self-management; psychosocial; anxiety
treatment/plans; access to primary care & urgent care; transportation
• In dialysis – ESRD – non-emergency medical transportation• Newly diagnosed, ready for self-management in diabetes,
chronic pain, cardiac – Evidence-based programs• Dementia: Their caregivers need support• Non-medical support services• Homebound – need meals, etc.• Multiple chronic conditions with functional impairment• EOL(ish) – palliative care, hospice, advance care planning,
supportive wraparound services• Aging with DD – regional center type of services post-21
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Customer GroupsMeasurable high value outcome(s) we produce for customers• Stable community living• Appropriate use of healthcare services
– Lower utilization – reduced acute & SNF
• Appropriate use of HCBS• Fall prevention• Safe environment• Diabetes management• Better health• Better self-care & self management• Less pain, more energy, sense of safety• Patient-centered/directed – goals reassessed and care plan
adjusted
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Customer GroupsOur next step(s) to further develop the customer profile and test need•Data about needs of people
– In-home assessment of post-hospital older adults: 66% had med needs; 70+% with home safety, depression, etc. issues
– Is CCTP basically the same population? Let’s do a random sampling effort to determine the level of need using HomeMeds & other intake instruments…invest in producing the data we need.
– Identify what data needs to be collected– Use for planning & marketing– Pull data from CCTP quarterly reports – ASK Lewin– Get caregiver information, too.– Gap analysis on data access – use MSSPCare, SAMS, whatever
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Contracting Organization (CO) First/NextName/Type of CO• Hospitals at risk of penalty
– Map hospitals across counties
• Hospital systems– Map hospital systems in our
service area – GET FROM QIO
• Health Plans• Physician groups• SNF• CVS – MTM/CMR• Medi-Cal plansKey CO person for contracting• CareFirst – Pam Mokler• Health Net – Martha Santana-
Chin & the gang
Their mission and major interest/need
• Hospital system– Reduce penalties– If in ACO – risk and shared savings– Revenue
• SNF – penalties for sending patients back to help
Specific HCOs:• Prospect – Steve O’Dell• CalOptima – MSSP lookalike
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Contracting Organization (CO) We Will Pursue First/Next
(e.g., health plan, ACO, health system, etc.)
Our next step(s) to further engage the CO•Relationship•Value proposition•Menu for MCO
– Service lines/description
•What we do that they are not doing – TRANSLATE •Pilot with a case rate, QI cycle & document findings & outcomes
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Policy or regulatory conditions to address?Are there any policy or regulatory conditions that your network will need to meet or change in order to secure a contract? If so, what are they?
•ACL get Office Duals to set requirements for stakeholder involvement and inclusion of Aging/Disability Network – protect their investment in the system•State-level ditto – require inclusion of our networks•IT - ACL & ONC
– Group group-purchasing discounts for IT systems
•Legal standing– Prototype legal structures
•Consolidate all of these efforts and convene national-level group of plan leaders to educate them and connect the dots about Aging/Disability Network – •Definition of quality•Get us on the agenda for national & state conferences
– Toolkit for target groups – about our value, structure, services, etc.
•HIPAA & state survey coverage/language
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Champions
Who can endorse our network and open doors for us? • C-suite in health plans & hospitals
– Someone who is credible
• Board members• Associations
– CAHF– LeadingAge
• Consumer advocates• ACL/CMS• National advocate?
– Molly Coye, Atul Gawande
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Competition and Forces We Need to Address
Our primary competitors are:• Homecare agencies – the Home Instead• Make vs. buy • Commercial people – prepackaged meals providers
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Competition and Forces We Need to Address
Major sources of inertia we must overcome:• IT/technology/data• Knowing where to start• Tired…• Perfectionism
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Competition and Forces We Need to Address
Competitors’ Advantage• Resources• IT• Full coverage – national
company – • Track record in large
markets• Assets• Can take risk
Our advantage• Feet on the ground• Experience in people’s
homes• Cultural competence• Home, home, home
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InsightsOur biggest insight(s) from this session on Knowing Our Market is/are… •LTAC/SNF market potential•Educate MCO Leaders about A/D network
– Conference?? White paper??– Compelling voice to write a compelling thought piece aimed at the
visionaries in health plans – START AT THE TOP
•We need to focus on national buying power for IT•Consistent product lines would help us come up with toolkits for everyone
– IT– Marketing materials
•We know we are already preventing healthcare utilization
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Action StepsThe action step(s) we will take in the next month to engage our market are:•Meet with high-readmission hospitals to promote members’ care transitions•Product definition discussions with Health Net, CareFirst, Kaiser•Continue to solidify our alliance
– Set up a structure workgroup
•Develop collateral & business case statements for care transitions for different payers/purchasers•Develop pricing – it will vary by:
– Volume– Network extent
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Parking Lot (Issues for later, additional questions for speakers)
• List here
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