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MAINE COUNCIL ON AGING PRESENTS:
Use #mainesummitonaging on social media today!
2016 MAINE SUMMIT ON AGING
Our Sustaining Patrons & Platinum Sponsors
Our Gold Sponsors
Thanks to Our Planning Committee!
Becky Hayes Boober Angie Bordeaux Nancee CampbellEvelyn deFrees Amy Gallant Elizabeth GattineMichelle Grover Peggy Hayes Adam LacherPatti Marsh Jess Maurer Mia MillefoglieJudy Rawlings Roger Renfrew Ted RooneyBetsy Sawyer-Manter Donelle Uter
Welcome by Speaker Mark Eves
Panel Presentation
Maine Voices on Healthy AgingModerated by Meg Callaway
Arthur Jacobson, WinthropCharlie Buzzell, Milo
Rich Livingston, Biddeford
Altarum Institute integrates independent research and client-centered consulting to deliver comprehensive, systems-based solutions that improve health and health care. A nonprofit, Altarum serves clients in both the public and private sectors. For more information, visit www.altarum.org
Anne Montgomery
Deputy Director, Altarum Institute
Strengthening Communities, Reinvesting Savings: What’s Next? What’s Possible?
8
POPULISM, Circa 2016
9
Americans Confronting the Age Wave
11
Federal Spending on the Major Health Care Programs, by Category
12
Total Expenditures as % of GDP, 2009*
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
Social Service Expenditure, %GDP
Health Expenditure, %GDP
*Switzerland and Turkey are missing data for 2009
Per
cent
of G
DP
13
Ratio of Social to Health Service Expenditures Using 2009 Data
14
OAA Funding Appropriations vs. Medicare Expenditures and Steady Increase in 65+ Population
15
Influences on Health
16
Healthy People 2020: Examples of Social Determinants of Health
Availability of resources to meet daily needs (e.g., safe housing and local food markets)
Access to education, economic and job opportunities Access to health care services Quality of education and job training Availability of community-based resources Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, distrust of government) Socioeconomic conditions (e.g. concentrated poverty) Culture, language and literacy
17
Time out of Mind
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“We need a major revision to the Older Americans Act”
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On Building New Models
“You never change things by fighting the existing reality.To change something, build a new model that makes the existing model obsolete.”
-- R. Buckminster Fuller
20
A Population “Age Wave” Model: Core Elements
1. Frail older adults identified and offered enrollment in a community-anchored program
2. Use of longitudinal, goal-driven care plans across all settings
3. Medical care specifically tailored to frail older adults
4. More reliable social and supportive services
5. Monitoring and improvement guided by an independent board representing community interests
6. Reinvestment of a portion of savings realized from reduction of low-value medical services would bolster provision of underfunded supportive services
21
MediCaring Communities: Getting What We Want and Need in Frail Old Age at an Affordable Cost
"For decades, Joanne Lynn’s has been the clearest, strongest, most soulful voice in America for modernizing the ways in which we care for frail elders. This essential book is her masterpiece. It offers a magisterial, evidence-based vision of that new care, and an entirely plausible pathway for reaching it. Facing a tsunami of aging, our nation simply cannot afford to ignore this counsel."
--Donald M. Berwick, MD, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, and former Administrator, Centers for Medicare & Medicaid Services.
“MediCaring Communities integrates good geriatrics and long-term services and supports, and building upon an expanded PACE program can be a tangible start. We should try this!”
--Jennie Chin Hansen, Lead in Developing PACE; Past President, AARP; and Past CEO of On Lok Senior Health Services and the American Geriatrics Society
22
Promising Opportunity: PACE Innovation Act
Law provides CMS Innovation Center (CMMI) with broad statutory authority to adapt PACE in: Eligibility Delivery system Payment And most other requirements
CMMI cannot waive: 1) Comprehensiveness of services, no co-pays and deductibles 2) Voluntary enrollment and disenrollment
23
Medically Complex At-Risk Work Group: Key Recommendations for PACE Expansion Pilot
Participants have ≥2 chronic medical conditions and/or early stages of cognitive impairment, and require assistance with ≥1 functional activity of daily living (e.g., walking, feeding, toileting) or 2 instrumental activities of daily living (e.g., shopping, housekeeping, cooking);
Participants have coverage from traditional Medicare (Parts A and B), Medicaid, or are dually eligible;
Participants are determined not yet eligible for nursing home placement; Participants reside in a community setting, private residence, apartment,
independent living situation or other state defined situation.
24
Medically Complex At-Risk Work Group: Key Recommendations for PACE Expansion Pilot (2)
Participants have option to retain current community physician; Payment is tier-based, with a set of care services associated with
each tier, and developed with actuarial assistance; All Medicare services are covered through the PACE Medicare
capitation, and Medicaid services (for duals) as needed are covered; Services or items considered medically necessary for implementing
care plan that meets participant’s care needs are covered.
25
Examples of Tiered Services in a PACE Expansion Pilot
Tier 1: IDT assessment and care planning; care coordination (navigation, transitions, provider communication); patient/family education;Tier 2: In-home nursing visits and phone contact to assist with medication management and “self-administered” treatments; in-home social work visits and phone contact to assist with management of psychosocial issues and service coordination; transportation to medical appointments;Tier 3: LTSS “light” services that do not qualify the individual as NH eligible – e.g. housekeeping, grocery shopping, meal preparation, some ADL assistance, check-ins, caregiver respite. Could also include a set amount of respite per year, in a personal care/assisted living facility, in-home staffing, or adult day care.
26
THE AGING NETWORK TODAY
Provides: • Home delivered and congregate
meals, • Transportation • Personal care• Information and referral/assistance• Case management,• Benefits/health insurance
counseling• Family caregiver support programs
Source: National Association of Area Agencies on Aging . Area Agencies on Aging: Local Leaders in Aging and Community Living. Washington, DC. Retrieved from http://www.n4a.org/files/LocalLeadersAAA.pdf
27
HCBS SERVICERS ARE OF MAJOR IMPORTANCE FOR OLDER ADULTS AND COMMUNITIES DURING AGE WAVE
28
Average LTSS Expenditures for Seniors at 65 (2015-19)
Favreault M & Dey J. Long-term services and supports for older Americans: risks and financing research brief. Washington, DC: ASPE. 2015.
29
Kathy Greenlee: “Because of our ATTITUDE…
…we have developed new business opportunities and new business partners….[I]n response to the opportunities of both the Affordable Care Act and managed long-term services and supports, we have made significant changes in our own models of community-based care.
We have stepped up and never backed down.”
30
THANK YOU!
Anne.Montgomery@altarum.orgDeputy Director, Center for Elder Care and Advanced Illness, Altarum
Institute202-776-5183
Panel Presentation
Reflections from the Field
Dr. Roger Renfrew Rhonda Selvin, APRNTed Rooney, RN, MPH
Addressing Older Adult Population SegmentsWhere and with what resources/guidelines?
FrailChronic
Conditions Impaired FunctionChronic
Conditions Functional
Robust
? Geriatric supportCentral Clinic or in PCMH
Complex Care Management with CBOs
PCMH with CBOs
PCMH
PCMH: Patient Centered Medical HomeCBO: Community Based Organizations, i.e., Spectrum, KVCAP, Public Health
Question & Answer Session
MAINE COUNCIL ON AGING PRESENTS:
Use #mainesummitonaging on social media today!
2016 MAINE SUMMIT ON AGING
Award Presentation
MCOA Annual AwardsOffered by Judy Rawlings,
MCOA Co-Chair
Steve Farnham, AAAARena Heath, Volunteer
Join Our Network to Help Forge New Solutions for Older Mainers!
Become a member of MCOA today!Visit www.mainecouncilonaging.org/join
Lessons of the Day & Wrap Up
Reflections on the DayModerated by Jess Maurer
Charlie Buzzell, MiloArthur Jacobson, WinthropRich Livingston, Biddeford
Dr. Roger Renfrew Ted Rooney, RN, MPH Rhonda Selvin, APRN
Thank you for joining us!
2016 MAINE SUMMIT ON AGING
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