Alaska’s Continuum of CareA Skilled Nursing Facility Perspective

—Dennis Murray, ASHNHA

There are 17 skilled nursing facilities in Alaska. Most of them are co-located in a community with a hospital. Only 2 are

free-standing

New SNF’s and Additions

96 Beds-8 Cottages: Providence Extended Care Center

50 beds: Providence Transitional Care Facility---To open mid-year, 2014

18 Bed SNF-- part of Norton Sound Health Corporation in Nome

SNF---18 Beds: Part of Maniilaq in Kotzebue

YKHC Elders SNF—18 Beds, Opens in October

Hospital Readmissions

CMS Initiative: Reducing Off-Label Use of Antipsychotics

Federal Legislation

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DHSS Strategic PlanningLTC Recommendations to DHSS from

Stakeholder Group• Recommendation 1| Educate the public. • Recommendation 2| Develop additional levels of care along the continuum of long-term

services and supports; and, incentivize movement towards the lower end through increased coordination at both the individual and systems level.

• Recommendation 3| Reduce costs, diversify payers and increase private investment. • Recommendation 4| Improve quality and encourage innovation. • Recommendation 5| Develop in-state capacity for populations with specific needs. • Recommendation 6| Develop workforce and support caregivers. • Recommendation 7| Determine the appropriate number, type and location of skilled

nursing and assisted living beds.

DHSS Comprehensive Behavior Collaborative

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Recent Research on Long Term Services and Supports Users

Septembe 22, 2013Provided by the American Health Care Association (AHCA)

19

Community Dual

Community M

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Institutional D

ual

Institutional N

ondual

No LTC Dual

No LTC Dual (M

edicaid-O

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No LTC (M

edicare-O

nly)$0

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 LTC $

Medical Care $

Overall Spending in the Community is Roughly the Same as Nursing Center Care for Dual Older Adults

Spending is Roughly the Same in Total (e.g., Medicare and Medicaid)

Kane, R., Wysocki, A., Parashuram S., Shippee, T., Lum, T. Effective of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries. Medicare & Medicaid Research Review 2013: Volume 3, Number 3.

Overall Spending in the Community is Roughly the Same as Nursing Center Care for Dual Older Adults

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Executive Summary of Research Findings

• Recent research indicates that Medicare spending is higher for people using home and community-based services (HCBS)) than nursing center residents

• Certain demographic trends could exacerbate medical care challenges for people using HCBS

• Such findings have notable implications for state and federal efforts to integrate Medicare and Medicaid for people who are dually eligible

• Questions still linger about HCBS cost effectiveness and the new research raises further questions about outcomes for people enrolled in HCBS

• Traditional managed care does not appear to be the solution

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Higher Acute Care Costs in the Community

• Some studies point to higher rates of avoidable hospitalization and emergency room use among HCBS participants

• Historically, states have focused only on Medicaid outlays • Increased Medicare spending for expanding HCBS programs

was not considered or not a primary concern for states• Low Medicaid reimbursement correlates with high

Medicare spendingR. Tamara Konetzka, Sarita L. Karon, and D.E.B. Potter. Users Of Medicaid Home And Community-Based Services Are Especially Vulnerable To Costly Avoidable Hospital Admissions. Health Affairs, 31, NO. 6 (2012): 1167–1175;Kane, R., Wysocki, A., Parashuram S., Shippee, T., Lum, T. Effective of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries. Medicare & Medicaid Research Review 2013: Volume 3, Number 3.

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Focus on Duals Could be a Game Changer

• Financial Alignment Demonstration– Federal and State motivation to keep Medicaid and Medicare spending

down– Memoranda of Understanding have Medicare and Medicaid savings targets– Plan metric to reduce hospitalizations related to quality withhold

• Fully Integrated Dual Eligible (FIDE) Special Needs Plans – Plan interest in coordinating both Medicare and Medicaid in hopes of

broader control and margin– Plans have a strong incentive to manage down costs in both programs

23

Caregiver Capacity Could Exacerbate Medical Care Challenges

1990 2000 2010 2020 2030 2040 2050012345678

Boomers turn 80

Boomers turn 45

Boomers turn 65

Caregiver Support Ratio, United States

Redfoot, D., et. al. The Aging of the Baby Boom and Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers. AARP Public Policy Institute. Insight on the Issues 85, August 2013.