Upload
mercy-greer
View
212
Download
0
Tags:
Embed Size (px)
Citation preview
NEW CHALLENGES AND OPPORTUNITIES FOR NUTRITION PROGRAMS IN THIS CHANGING
ENVIRONMENTLinda Netterville, MA, RD, LD
Dietitian Consultant, DADS
SESSION OVERVIEW
The changing community and healthcare environment
Challenges
Opportunities
Building sustainability for the future
CHANGING ENVIRONMENT
Factors
Dem
og
rap
hic
s
Reso
urc
es
Bu
sin
ess
Healt
hca
re
CHANGING DEMOGRAPHICS
More older peopleMore healthy older people
More frail older people
More minoritiesMore HCBS, less nursing home care
MOST OLDER TEXANS 60+ YEARS LIVE IN THE
COMMUNITY
Community 4.01 M; 97.7%
Nursing Homes 95,640;
2.3%
AGID Database
TEXAS PERCENT OF 6O+POPULATION
2006 2007 2008 2009 2010 2011 201212.5%
13.0%
13.5%
14.0%
14.5%
15.0%
15.5%
16.0%
13.9%14.2%
14.5%14.8%
15.1%15.4%
15.8%
Years
% o
f Tota
l Sta
te P
opula
tion
PROJECTED POPULATION 60+
2010 Projection 2020
Projection 2030
-
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
3.8 mil 5.3 mil
6.7 mil
Texas 60+
Texas 60+
TEXAS POPULATION OF 60+
Texas -
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
1,263,643
1,645,334
594,875
472,257
60 to 64 years 65 to 74 years 75 to 84 years 85+ years
PERCENT OF AMERICANS AGE 65 EXPECTED TO SURVIVE TO AGE 90
1940 1960 1980 2000 20500
5
10
15
20
25
30
35
40
45
7
14
25 26
42
CHANGING LIFE EXPECTANCY
1910 1930 1950 1970 1990 20090
102030405060708090
51.559.2
68.1 70.876.8 78.5
11.6 12.2 13.8 15 17.3 19.2
4 4.2 4.7 5.3 6.2 6.7
Life Expectancy by Age
At BirthAt age 65At age 85
Older Americans 2012: Key Indicators of Well-Being
CHANGING RESOURCESGOVERNMENT/PUBLIC FUNDING
Older Americans ActTitle III (C1, C2, NSIP), V, VI
Other Federal Social services or community service block grants
State-Vary by State
EXPENDITURES PER MEAL-TEXAS BASED ON STATE PROGRAM REPORTS SUBMITTED TO ACL/AOA
2006 2007 2008 2009 2010 2011 2012$0.00
$1.00
$2.00
$3.00
$4.00
$5.00
$6.00
$7.00
4.77046269967109
5.185.12845439980
431
5.522130273346815.59806238079
5455.46721095020
094
5.79663687056703
$2.17$2.58$2.62
$2.84$2.67$3.05
$3.35
Congregate Meals-TX
Expenditures per mealTitle II per meal
2006 2007 2008 2009 2010 2011 2012$0.00
$0.50
$1.00
$1.50
$2.00
$2.50
$3.00
$3.50
$4.00
$4.50
$3.13$3.13$3.08$3.22$3.42$3.39
$4.01
$1.34$1.34$1.18$1.14$1.26$1.28$1.39
Home-delivered Meals-TX
Expenditures per mealTitle III per meal
% OF TITLE III IN TOTAL EXPENDITURES FOR MEALS
2006 2007 2008 2009 2010 2011 2012
43.0% 42.9%
38.3% 35.4%
36.9% 37.8% 34.7%
% of Title III Home-Delivered- Texas
FEDERAL FUNDING SOURCES
OAA Funding Medicare/Medicaid (Title III) (ACOs, MLTSS, Duals) $2.1 Billion $11.5 Billion
BUSINESS DEMANDS
Service needsQuality ServicesAppropriate services: cultural, religious, therapeutic
ChoiceDiversityHCBS Services
CHANGING BUSINESS PRACTICES
For Profits Expanding into non-traditional markets Offering competing services Restaurants, groceries, fitness options
Non-Profits Becoming more entrepreneurial Developing community partnerships Identifying other funding streams
TECHNOLOGY TO ASSIST
Data collection and sharing information with healthcare
Billing systems compatible with healthcare
Improved service and delivery modelsRouting/scheduling
Telemedicine
THE CHANGING HEALTHCARE MARKET
Patient Protection and Affordable Care Act of 2010 Triple AimBetter careHealthier peopleSmarter spending
THE CHANGING HEALTHCARE MARKET DRIVEN BY CMS
Medicare-Title XVIII of the Social Security Act, long term disabilities, end stage renal, 65 or older
Part A
Part B
Part C- (Medicare Advantage)
Part D-(Prescription)
Medicaid -Title XIX of the Social Security Act, low income, children, elderly, blind or disabled (Jointly funded by the state)
THE CHANGING HEALTHCARE MARKET
Services must meet the needs Customer- Payer (MCO, Insurance, Hospital)
Consumer-Beneficiary (client)
Focused on quality metrics and improved outcomes
Payers assume the risk
Want a clearly defined Return on Investment (ROI)
Opens the door to For-Profit entities
CHANGING CARE SYSTEMS
Medicaid LTSS- Managed CareLong Term Services and Supports (LTSS)
Home and Community Based Services (HCBS)
Health Care/Care TransitionsAccountable Care OrganizationsBundled Payment Initiatives
LONG TERM SERVICES AND SUPPORTS (LTSS)
Target Audience Older adults People with disabilities
Include: Residential care in facilities
Home and community-based (HCBS)
Support: Managing chronic conditions
Accomplishing everyday tasks (IADL, ADL)
HOME AND COMMUNITY BASED SERVICES (HCBS)
Target Audience Older adults People with disabilities
Support Living in the Community
Funding Sources Older Americans Act (OAA)
Medicaid Social Services Block Grant (SSBG)
Education and Rehabilitation Funds
State General Funds Local Funds
CARE TRANSITIONS
Coordination and continuity of health care based on a plan of care
Include: Hospitals Sub-acute And Post-acute Nursing Facilities The Patient's Home, Primary And Specialty Care Offices Long-term Care Facilities
ACCOUNTABLE CARE ORGANIZATION (ACO)
Groups of doctors, hospitals, and other health care providers
Provided to Medicare beneficiaries.
Provide coordinated care and chronic disease management while lowering costs.
OPPORTUNITY KNOCKS!
OPPORTUNITIES-WHO ARE CURRENTLY BEING SERVED- TEXAS
Current Population
Percent
60+- TX
4,105,225 Nutrition
Program Served Total (2012) 134,760 3.3%
Congregate Served 71,318 1.7%
Home-Delivered Served 63,442 1.5%http://www.agid.acl.gov -State Program Reports- 2012
OPPORTUNITIES TO BUILD SUSTAINABLE RESOURCES
Social EntrepreneurshipFor Pay optionsHealthcare entities
SOCIAL ENTREPRENEURSHIP
Catering Contracts Expansion of Nutrition Services
Nutrition CounselingGrocery Shopping
Other Program OpportunitiesUSDA Child Nutrition Programs
FOR PAY OPTIONS
Relook at “for pay” optionsOther servicesTiered servicesExpanded services
THE ROLE OF NUTRITION SERVICES
Something Magical Happens!
CLIENTS VALUE THE PRODUCT
Home Delivered Congregate
Able to eat healthier
foods83% 78%
Meal enabled living at home
92% 60%
AoA Survey of OAA Participants, December, 2011, http://www.agidnet.org
ROLE OF NUTRITION SERVICES
Value of Nutrition to Chronic Health Conditions
Heart disease
Hypertension
Diabetes
Osteoporosis
Kidney disease
Obesity
ROLE OF NUTRITION SERVICES
Other Nutrition Services
Nutrition Counseling
Nutrition Education
Nutrition Assessment
ROLE OF NUTRITION SERVICES
Value AddWellness/Safety CheckRegular contact in the homeTrusted in the homeClient status (moved, hospital, nursing home)
Perform Regular In-home Assessments
KEY FINDINGS-MORE THAN A MEAL STUDY
Those receiving home-delivered meals: Improvements
Anxiety Self-rated health Isolation Loneliness
Reduced rates of: Hospitalizations Falls
KEY FINDINGS-MORE THAN A MEAL STUDY
Those receiving daily meal delivery:
Improvement in mental health (anxiety)
Improvement in self-rated health
Reductions in the rate of falls
Improvement in feelings of isolation and loneliness
Decreases in worry about being able to remain in home
KEY FINDINGS-MORE THAN A MEAL STUDY
Those receiving daily delivered compared to weekly:Feel saferHelped them to eat healthier foodMore social contactsLess loneliness
KEY FINDINGS-MORE THAN A MEAL STUDY
Those receiving daily delivered and lived alone:Decrease worry about being able to remain in the home
Improvements in feelings of isolation and loneliness
OPPORTUNITIES FOR NUTRITION PROGRAMS
Valued added serviceService and delivery structure in place
Trusted entity with long history of success
Linked to other community-based service
Community partnerships
WHAT CAN YOU DO?
Know:
Health Reform activity in your community Medicare Advantage Plans Medicaid Managed Care initiatives ACOs Bundled Payment Initiatives
Competition
Partners
Champions
41
WHAT ARE HEALTH ENTITIES SEEKING
Meet consumer needs Choice of meals, special or modified diets, flexibility)
Access to the consumerCoverage for the entire service area (1 contract)
Easy to submit referrals for servicesMeet quality metricsData provided to show improved outcomes
HOW CAN YOU COMPETE?
Organizational culture change (staff qualifications, characteristics, inter-organizational operations)
Strategic business plan
Development and structure of community-based networks
Service packages (identifying, pricing and packaging services)
Marketing and sales strategies
HOW CAN YOU COMPETE?
• Communication and negotiation techniques Addressing program capacity challenges (developing, increasing, and managing the capacity of the program to deliver services)
Continuous quality improvement (setting standards, defining and measuring outcomes, monitoring)
Risk management (identifying, accepting, and managing)
Information technology (IT) system
ASSURE THE CAPACITY OF YOUR ORGANIZATION TO DELIVERServicesMethods of production/delivery - Meals
Methods of development/delivery Steps necessary to provide to provide the product (meal, nutrition education, etc.) and services
Capacity, expertise, human resources
PILOT PROJECT
Pilot through the National Resource Center on Nutrition and Aging and MOWAT
• Understand the changing landscaper
• Identify the opportunities for the Nutrition Program
• Help to develop the skills needed to:• Develop support services• Negotiate Contracts• Billing• Reporting
PILOT PROJECT- 5 PROGRAMS
FINAL WORDS
Know Your MarketKnow Your CompetitionStudy Your CustomerOrganize, Plan, and Execute
THE ROLE OF NUTRITION SERVICES
BUILDING THE BRIDGE
Healthcare
HCBSNutrition Services
WE HAVE TO GET IT RIGHT!
DISCUSSION
What is the vision for your nutrition program?
What are the tools and resources that you need to position your program now and into the future?
RESOURCES: WWW.NUTRITIONANDAGING
.ORG Recorded NRCNA Webinars—Positioning Your HCBS Program in the Healthcare Market Webinar Series Part 1: Overview of Health Reform Initiatives - How this Affects Your Organization and Terminology 101
Part 2: Market Analysis - Determine Health Reform Initiatives in Your Market Area
Part 3: Network Collaboration - The Need for Collaboration
Part 4: Developing a Strategy and a Business Model for Your Organization
Part 5: Positioning Your HCBS Program in the Healthcare Market
RESOURCES:
More That a Meal Studyhttp://www.mealsonwheelsamerica.org/theissue/facts-resources/more-than-a-mealThe Growth of Managed Long-Term Services and Supports (MLTSS) Programs: (January 2012)
http://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/downloads/mltssp_white_paper_combined.pdf