nikki kmicinski, executive director western new york ...€¦ · 2014-2015: aaa leaders in erie...
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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 [email protected] 716-887-2749