integrated care boot camp part 2: how metrics, quality and

Integrated Care Boot Camp Part 2:

How Metrics, Quality and Compliance help Attract Payers

Sponsored by

The Business Institute

The mission of the Aging and Disability Business Institute (Business Institute) is to successfully build and strengthen partnerships between community-based organizations (CBOs) and the health care system so older adults and people with disabilities will have access to services and supports that will enable them to live with dignity and independence in their homes and communities as long as possible.

aginganddisabilitybusinessinstitute.org

aginganddisabilitybusinessinstitute.org

Our Funders Our Partners

Thank you to our boot camp sponsor:

• Presenters:• Paul Cantrell, Consultant, n4a, Washington, DC• Sharon Williams, CEO, Williams Jaxon Consulting,

LLC, Grosse Pointe, MI• Abigail Morgan, Senior Vice President of Business

Strategy and Performance, Direction Home Akron-Canton Area Agency on Aging and Disabilities, Uniontown, OH

• Aaron Lambert, President, Healthy Blue, Baton Rouge, LA

Integrated Care Boot Camp Part 2: How Metrics, Quality and Compliance help Attract Payers

Boot Camp Part 2

How Metrics, Quality and Compliance Help Attract Payers

n4a ConferenceJuly 28, 2019

© 2019 C3 All rights reserved. Confidential.

C3 – Who we are

• Non-profit administrative services organization formed in 2016 by a group of Pennsylvania AAAs

• Single-source contractor offering innovative

solutions to address social determinants of

health with managed care and health system

organizations

© 2019 C3 All rights reserved. Confidential.

Readiness Assessment – Preparing for Go-live

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© 2019 C3 All rights reserved. Confidential.

MCO Information Security Policy Requirements

• Privacy/Security Awareness/Training

• Cyber Security protocols & testing

• Acceptable Use Policies

• System and software updates

• Account/data security standards

• Authentication measures

• Staff Onboarding/ Offboarding

• Device security

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• Incident response

• Sovereign protections & cloud use

• Disaster recovery

• Succession policies

• File retention & backup

• Electronic record storage

• Data processing

• Insurance requirements

© 2019 C3 All rights reserved. Confidential.

Readiness Assessment – Tracking the Details

• Priority (critical or nice to have?)

• Source (of the requirement – State Contract, Regulation, Quality metric, etc.)

• Criteria (how will adherence be assessed and proven? Include timeframes, etc.)

• Details (Definitions, explanations, etc.)

• Evidence (aka “Prove it”…or, “Where’s the beef?!”)

• Audit (How will it be verified? Onsite, cloud posting, submission-based)

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© 2019 C3 All rights reserved. Confidential.

Readiness/Launch Prep/Ongoing Monitoring

• Readiness training / capacity building

• Site visits / desk audits

• Office Hours & launch-related “War Room”

• Learning Collaborative / Technical Assistance

• Community of Practice

• Quality Assurance / Perf. Improvement

© 2019 C3 All rights reserved. Confidential.

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© 2 0 1 9 C 3 A l l R i g h t s R e s e r v e d . C o n f i d e n t i a l .

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WHY COMPLIANCE MATTERS

N4A INTEGRATED CARE BOOT CAMP

JULY 28, 2019

SHARON R WILLIAMS, EO

WILLIAMS JAXON CONSULTING, LLC

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HEALTH CARE INDUSTRY: HIGHLY REGULATED

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Federal regulations

State/local regulations

Accreditation standards

Industry guidelines

Contractual requirements

Consumer demands

COMPLIANCE IMPACTS:

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Quality reporting

Performance

Brand

Bottom line

Sustainability

KEY COMPLIANCE PROGRAMMING

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Quality

Grievances/complaints, appeals (consumer/Provider)

Privacy/security

Fraud, waste abuse

Fiscal management

BEST HEALTH CARE PARTNERS HAVE STRONG COMPLIANCE INFRASTRUCTURE

• RISK MITIGATION

• RESEARCH

• ORGANIZATIONAL ASSESSMENT

• CORRECTIVE ACTION

• POLICY/PROCEDURES

• TRAINING

• AUDITING/MONITORING

• REPORTING

• RECALIBRATING

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SHARON R WILLIAMSSHARONR.WILLIAMS@COMCAST.NET

313-516-3326

THANK YOU!

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BOOT CAMP PART 2

HOW METRICS, QUALITY AND COMPLIANCE HELP

ATTRACT PAYERSABIGAIL MORGAN, SRVP BUSINESS STRATEGY

WHO WE ARE

• In Ohio: 12 AAAs

• In our area

Portage, Stark, Summit, Wayne

Private Not for Profit 501 (c) 3

30 Member Board of Directors

230+ Staff

Operating Budget $50M

Older American’s Act, Medicaid Waiver Care Management, ‘Duals Demonstration”

We provide choices for people to live independently

in the place they want to call home

HISTORY OF SUCCESSFUL PARTNERSHIPS

History of Health System Partnerships

Acute Care Transitions since 2010

Hospital and NF-based RN Assessors

Health professional training programs

On Board of Directors for local ACO & Health System

Contracted Care Management/Care Transitions for Managed Care Plans

Medicare-Medicaid Dually Enrolled beneficiaries

Medicaid Waiver under 60 Population

Medicare Advantage Acute Care Transitions

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OUR EXAMPLE:

MEDICARE ADVANTAGE ACUTE CARE TRANSITIONS

MODEL: lead AAA contractor with 3 AAA subcontracting sites for Care Transitions

Submitting proposal/bid was just the beginning

Finalizing IT platform

Detailed discussions around process mapping

Scope of work development

Reporting & Performance Standards

Communication set up

Regular meeting schedule, orientation, trainings

Between MA plan and Contracted AAA, Contracted AAA and Subcontracted AAA Sites

OUR EXAMPLE:

MEDICARE ADVANTAGE ACUTE CARE TRANSITIONS

IT, Security & Oversight

Began reviewing just prior to RFP development

Basic understanding of health plan’s wants

Pen Testing and HITRUST requirements

Health plan assurances and oversight policies

Quality Measures and Reporting

Continual discussion of what are their needs and

what can we do

Focus on medication reconciliation, past screenings,

safety assessments, community service referrals

Not everything moves forward