Healthcare Reform as an Accelerator Emerging Models in ... · challenges •Demonstrating Capacity...
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Healthcare Reform as an Accelerator – Emerging Models in Aging Services Zachary Sikes Senior Vice President, Innovation LeadingAge
Transcript of Healthcare Reform as an Accelerator Emerging Models in ... · challenges •Demonstrating Capacity...
Healthcare Reform as an Accelerator – Emerging Models in Aging Services
Zachary SikesSenior Vice President, InnovationLeadingAge
Who is LeadingAge
•An association of 5,400 not for profit organizations dedicated to expanding the world of possibilities for aging.
•We advance policies, promote practices and conduct research that supports, enables and empowers people to live fully as they age.
The Field Of Aging ServicesIs Evolving
Source: Adapted from previous Greystone and LarsonAllen LLP presentations
Spectrum of Services
Community
Based
Services
Wellness
Programs
Senior
Membership
Geriatric
Assessment
Case/Disease
Management
Health
& Wellness
Centers
Independent
Living
Intentional
Community
Personal
Care Assistance
Assisted
LivingTelehealth
& Home
Technologies
Day Care
Medical Social
Home Health
Skilled LTC
Respite
Care
Palliative
Care
Skilled
Nursing Care
Hospice
Outpatient
TherapiesSubacute
Rehab
Diagnostic
& Treatment
Center
Long Term Acute
Hospitalization
Acute
Hospitalization
Dementia
Assisted
Living
Board & Care
Intermediate Care
Want drivenNeed driven
Preventative Long-term care Hospital
Active adult communities Continuing care retirement communities/multi-level campus
Housing w/ Services
The Context for our Work
•The complexity and paceof change will bring opportunities and pose significant threats across the aging services continuum.
LeadingAge’s Leadership Imperatives
I. Engage Consumers
II. Create the New Financing Paradigm
III. Lead Innovation
IV. Cultivate Human Capital
V. Pioneer Technology
VI. Strengthen Not-for-Profit Leadership
What is CAST?
The Center for Aging Services Technologies is a national coalition of more than 400 organizations working together to improve the aging experience through technology
Providers of
Aging Services
University
ResearchersAssociationsCAST
Tech Industry
Partners
KEY TREND IMPACTING AGING SERVICES
Payment reform will focus
on increasing value and
lowering total costs.
1
Potential Implications for Aging Services
Robust measurement
systems
Automated data collecting processes
Significant cost of care reductions
Changing gain-sharing payer expectations
Better payer contracting data
Health Reform will DriveTremendous Change
Change is imminent.
Greater financial risk
Increased consumer-
focused quality
Operational efficiency
Elevated regulatory
risk
Collaboration
Community-based
services and care
Technology investments
LeadingAge CAST 2010-2011 Work Plan
• Objective: Prepare aging service providers for the adoption of new business & operational models
• Context: Health Care Reform • Technology: A primary enabler of future
business/care models & partnerships• Deliverables: Reports, Case Studies,
Presentations, Blue Prints, tools, and a Video.
Creating Value and Driving Adoption
Proven Technology: Efficacious, Cost-effective, Reliable, Beneficial and Fits into Operational Models.
Detailed Guidance on Implementation: Detailed Blue Prints/ Implementation Guides, and Tools.
Assistance in Finding Capital: Especially important for non-real estate based models.
Understanding the Operational/ Business Models: Business model components, case studies etc.
Effective Dissemination: Stories, Video/Multimedia, easy to use tools.
Existing Models
• Health Reform = from fee for service to fee for performance –adaptability
• From MDS 2.0 Systems to full Electronic Health Records
• Bottom Line – technology infrastructure is now a required part of our existing real-estate based business models – this market exists as this capital infrastructure is an increasingly mandatory component of the business model with funding likely to compress margins
• CAST Role: Electronic Health Records Demystified: A Primer and Provider Selection Guide, which points to tool-kits and is supported by technical assistance from CAST
Work Plan 2011 Progress Inform members of
existing models/ payment
mechanisms
Educate members on
ACOs
ACO White Paper: http://www.leadingage.org/uploadedFiles/Content/About/Sponsors/Aon/Dixon_Hughes_ACO_Whitepaper_0311.pdfACO Self-Assessment Tool:http://www.leadingage.org/On_Line_Self_Assessment_Tool_Helps_Providers_Prepare_for_ACOs.aspx
State Payment Policies for ASTs: http://www.leadingage.org/uploadedFiles/Content/About/CAST/CAST_State_Paymen_%20Analysis.pdf
Work Plan 2011 Progress
Conduct Scenario Planning
CAST Scenario Planning Report: http://www.leadingage.org/uploadedFiles/Content/About/CAST/CAST_Scenario_Planning.pdf
Uncertainties: Funding• Availability of
reimbursement/public funding:– Health Reform is implemented
– Public funding programs Medicare/ Medicaid are eliminated.
• Potential growth in private-pay market: – Will likely remain slow
– Unless consumer willingness to save and pay for long-term care changes (implementation of CLASS)
– Growth in low-cost mobile applications
• Spur innovation
– Will hurt low-income seniors
• Stifle innovation
• Will spur innovation
Uncertainties: Adaptability• Providers ability to build
internal competencies and align with the operating environment:– Building on strengths: successful
programs/ specialization and getting rid of unsuccessful operations, harnessing appropriate technologies
– Understanding local markets, competition, offering needed/complementary services and building strategic partnerships
• Spur innovation
Emerging Models: Success FactorsIntegrated/ Coordinated
Health Care Models
• Resolving implementation challenges
• Demonstrating Capacity
• Manage higher acuity patients
• Have appropriate technologies
• Positioning as “sub-acute operators”
• Capacity to manage technology/data
• Partner with other LTSS providers to increase their collective capacity
• Ability to work with other providers in networks.
Community-Based Support Services Models
• Availability of reliable technologies
• Robustness of private pay market
• Awareness of solutions, their efficacy and cost-effectiveness
• Tax credits, state option, and CLASS act may contribute to growth
• Ability to demonstrate independence and reduce costs
• Willingness to invest in technology
• Providers’ entrepreneurial spirit
• Willingness of providers to see caregivers as their market.
Real-Estate Based Models
• Housing market
• Down & unlikely to recover soon
• Use the campus as a launching pad for HCBS delivery
• Providers’ entrepreneurial spirit
• Beyond the campus, without overspreading
• Focus on existing successful services
• Funding sources
• Public funding for affordable-housing
• The CLASS Act will help housing residents purchase services.
Enabling TechnologiesIntegrated/
Coordinated Health Care Models
• Telehealth
• Interoperable EHRs and HIE
• Care coordination tools
Community-Based Support Services
Models
• Remote monitoring and assistive devices
• Care coordination tools
• Wellness & quality of life
• Telehealth
• Interoperable EHRs and HIE
Real-Estate Based Models
• Remote monitoring and assistive devices
• Care coordination tools
• Wellness & quality of life
• Telehealth
• Interoperable EHRs and HIE
• Facility management.
Work Plan 2011 Overview II
Identify future business models
Create a Video: how such models work
from the providers’ perspective
- identify business model components- case studies
Produce detailed Blue Prints/
Implementation Guides
- Visually compelling provider case studies
- Implementation blue-prints
Finance plan-Financing options
Business Model Components and Case Studies
Describe:
• Organization and technology-enabled care model(s) implemented/explored
• Services offered, types of technology used, and population served
• Implementation details, including finances, and risks involved
• Lessons learned and how challenges were addressed
• Impact the model had on residents/clients and the organization
• Keys to success and any advice to other providers considering a similar model.
Conducting interviews with executives of over 20 provider organizations
Resources• www.LeadingAge.org
• www.agingtech.org
• Aging Services What Does the Future Hold for
Us?
• CAST Analysis of State Payment Policies for ASTs
• ACO White Paper
• ACO Self-Assessment Tool
• A Look into the Future: Evaluating Business
Models for Technology-Enabled Long-Term
Services and Supports
• The Idea House (5K sqf)
• Imagine the Future of Aging
• Leading by Example: CAST’s Role in Helping
LeadingAge Members Turn Core Competencies
into Sustainable Business Models
• Health Information Technology Toolkit for
Nursing Homes
• Health Information Technology Toolkit for Home
Health Agencies
• Bringing Aging Services to the Table: A Role for CAST in the Implementation of Health Reform
• CAST and IFAS Publish a Review of Hypertension Telemonitoring
• Use of health information technology in home health and hospice agencies
• A Roadmap for Health IT in Long Term and Post Acute Care (LTPAC) - Executive Summary 2010 -2012
• A Roadmap for Health IT in Long Term and Post Acute Care (LTPAC) 2010 -2012
• Moving Toward Adoption: Exploring Strategies to Expand the Implementation of Appropriate Aging Services Technologies
• A Road Map for Health IT in Long Term Care 2008 - 2010
• Use of Electronic Information Systems in Nursing Homes: United States, 2004
• The State of Technology in Aging Services: Summary
• The State of Technology in Aging Services
Thank You…
With acknowledgement to LeadingAge & CAST sponsors,
providers and staff for their work, expertise and with
appreciation to LarsonAllen whose expertise developed
some of the content in this presentation.
