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NWX-BPHCModerator: Matt Burke

5-24-12/1:00 pm CTConfirmation # 7818495

NWX-BPHC

Moderator: Matt BurkeMay 24, 20121:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants will be in

a listen-only mode until the question-and-answer session. To ask a question at

that time, please press star 1. Today’s conference is being recorded. If you

have any objections, you may disconnect at this time. I would now like to turn

the call over to Matt Burke. Sir, you may begin.

Matt Burke: Great, thank you very much and welcome, everyone. Good afternoon and it

may still be morning for some of you dialing-in from the West Coast and

we’re very excited to have you with us today.

Today’s session is serving an aging population 65 and older in the health

centers and this is another in a series of monthly technical assistance

enrichment sessions presented by the Bureau of Primary Health Care to our

grantees out there in the field and this comes to you from the Office of

Training and Technical Assistance and Coordination which we like to call

OTTAC here.

My name is Matt Burke. I’m a family physician and I am a Senior Clinical

Advisor here in the Bureau specifically in the Office of Quality and Data

which manages the uniform data system and some of the medical home

initiatives here in the Bureau and it’s a great pleasure and honor to speak with

you on today’s call.



We have a couple of great speakers lined-up for you and a particularly salient

topic given sort of the changing demographics of the United States population.

Aging is increasingly prevalent in today’s healthcare environment and the

population of Americans aged 65 and older is rapidly increasing.

It currently stands at about 13% of the U.S. population and by 2030 it’s

estimated that that may be as high as 20% which ranks in the tens of millions

in terms of Americans.

And as many of you may know, aging comes with a whole host of medical

and healthcare issues that are unique to that part of the life cycle and thinking

about how to best care for those persons and think about them within the

healthcare environment particularly given the underserved population that we

primarily see in the health centers is going to be the focus of today’s call

which is extremely, extremely valuable.

The purpose of today’s grant TTA enrichment call will provide you then with

a review of key demographic trends of the 65 and older population. We will

discuss key issues and services involving caring for the aging population and

furthermore provide examples from the field from several grantees who’ve

been met with success with this and our clinical leaders in this area.

We have three grantees speaking today in addition to a colleague of ours from

the Administration on Community Living. We really hope you find this call

informative and enlightening and we encourage participation.

We will have two speakers and then a question-and-answer section and then

our latter two groups of speakers followed by another question-and-answer

session which we hope will be very lively. If you have any concerns or need



additional information, please go to bphc.hrsa.gov/technicalassistance - all

one word - /trainings - plural - to ask any additional questions.

So without further ado let’s move to our first presenter who is Bob Hornyak,

the Director of the Office of Performance and Evaluation inside the

Administration for Community Living which was formerly known as the

Administration on Aging.

All of our participants can follow along with today’s session by using the

slides on the BPHC technical assistance Website. Additionally you will find

today’s agenda and bios for each of the speakers posted on that same Website

and therefore, I would like to turn it over to Bob. Please take it away.

Bob Hornyak: Matt, thank you very much and good afternoon or good morning to everyone

joining us on this call today. I’m very, very excited about joining you all and

to tell you something about the Administration for Community Living as well

as some of the demographics of older Americans so next slide, please. Thank

you. Yes, that’s good, thank you.

So I did want to spend just a minute talking about the Administration for

Community Living. As we understand it, this is the first new operating

division within HHS in about 20 years so we’re still looking at the guidebook

on all those operations but it is a new agency that Secretary Kathleen Sebelius

announced on April 16th in 2012.

And this single agency brings together the Administration on Aging, the

Office on Disability and the Administration on Developmental Disabilities.

This is really being charged to develop policies and improve the supports and

services for older adults as well as people with disabilities. Next slide, please.



And this slide is our newer organizational chart and again just want to

emphasize because we receive numerous questions about this. Please think

about the Administration for Community Living as the umbrella agency that is

really working with these other agencies that still exist.

The Administration on Aging as you can see on this organizational chart still

is a line of business if you will within ACL. The Administration on

Intellectual and Developmental Disabilities still exists. Both of those still have

their federal legislation and their leadership intact. For the Administration for

Community Living, Kathy Greenlee has a dual role.

She is still the Assistant Secretary for Aging because that is a Senate-

confirmed position but she is also the Administrator for the Administration for

Community Living. Henry Claypool is the Principal Deputy Assistant

Secretary for the Administration for Community Living and the Principal

Deputy Administrator for ACL.

We still have our regional office presence across the country. In the center of

that IA work-in is the Center for Disability and Aging Policy. We’re very

excited about this new opportunity to really enhance our ability to serve older

adults which we’ve been doing since 1965 but also expanding our reach into

the intellectual and developmental disabilities as well as physical disability

populations. Next slide, please.

So want to begin, we work very closely with the U.S. Census Bureau to

produce a profile of older Americans every year and as Matt indicated, the

older population certainly makes up about 40 million people. This is in 2010

and most of these statistics really come from the American Community

Survey or the Census Survey.



That we’re going to see this increase of about 15% since 2000 and we know

that life expectancy due to great medical advances and other technology has

been increasing certainly for females and males, more for females as you can

see from this chart.

One of the avenues that we pay close attention to is what is often termed the

oldest old. That is the population of 85 years and above that we can see in

2010 is about five-and-a-half million individuals but we also know that the

population of 65-plus is going to increase rather rapidly.

By 2030 this population is expected to grow to over 19% of the U.S.

population with the 85 population projected to increase to 6.6 million or about

a 19% increase by 2020. Next slide, please.

When we look at the marital status on the older men, much more likely to be

married than older women primarily because older women outlast or have

greater longevity than men but about 40% of older women aged 65 and above

did not have spouses at that age.

The living arrangements, I’m going to tie these stats to some services later in

my presentation because it is important to look at the living arrangements that

about 47% - almost half of these older women aged 75 and above - live alone.

We also know that almost a half a million grandparents aged 65 and above

had the primary responsibility for their grandchildren who do live in them and

our national family caregiver support program helps support specifically some

of those grandparents who are raising their grandchildren. Next slide, please.

We also know that the income of these individuals has adjusted for inflation

headed by these people has fell somewhat from 2009 to 2010. We know that



males still have a higher income primarily due to some of their pension and

other income factors.

The main sources of income solely for this population have been Social

Security overwhelming, income from assets, private pensions which are

significantly changing as well as the other sources of income that you can see.

Next slide, please. In terms of poverty about 9% of the older population were

below the poverty level in 2010 and that really hasn’t changed in the last year.

Next slide, please and the minority population, you know, it’s up from 5.7

million in 2000 to about eight million in 2010 or about 20% of the elderly and

in this profile of older Americans in 2011, overwhelming it is a white

population followed by African-Americans, Hispanic origin, etcetera.

Now we’re going to see that I believe in the next slide change significantly as

we look into the future as we - thank you - with this future growth of minority

populations, we’re going to see significant growth most specifically in persons

of Hispanic origin.

So we know that this demographic is going to change and change fairly

rapidly from 2010 to 2030 and that was one of the avenues that we hope to

partner certainly with a number of different groups including the health

centers in preparing for this change. Next slide, please.

So I just want to say a little bit about the Administration on Aging and its

services since AoA still exists. We serve about 11 million seniors per year and

their caregivers through our state units on aging, the 629 area agencies and

256 tribal organizations and many, many volunteers and service providers.



You can see the millions of meals that are provided each year and rides to

physicians’ offices, clinics, senior centers, the amount of personal care, 35

million hours of personal care provided to these seniors and the number of

caregivers who do assist their care recipients and the respite hours that are

critically needed for caregivers of older adults or of grandparents raising

grandchildren to allow them to provide that care longer. Next slide, please.

As we were talking about the statistics previously in terms of poverty and

other demographics, the Older Americans Act does serve a population of 60

and above. That’s why this is somewhat different from the other slides of 65

and above and we know there’s almost 58 million individuals in this country

aged 60 and above.

Our clientele represents about 11 million of those or about one in five older

adults. When we look at our services, while about 9% of the U.S. population

of elderly live in poverty.

Our clientele represents about 30% of those individuals who are in poverty

and when we look at the near-poor, certainly almost between 73 and 85%

depending on just which services meet that classification of near-poor being

defined as below 150% of poverty. Next slide, please.

And (unintelligible) vulnerable, as we indicated before about the population

who live alone primarily women, again when we look at our clientele between

55 and 69% of our clients live alone, again depending on types of services,

higher rate of diabetes than the U.S. population in general, higher rate of near-

poor, higher rate of minority receiving services and certainly a large rural

population - over a third of our in-home service clients - live in rural areas.



The next slide, please, so one of the issues I think we should always look at

and one of the areas that the aging network as we call it, the state units on

aging and our area agencies and ADRCs is to partner.

We look forward to partnering with health centers and to find the area agency

in your agency, the Eldercare locator at this location is an easy way to find

those individuals and the services and next slide, please.

We wanted to include some data resource links to the American Community

Survey demographic data at this site, agednet.org. We also work with the

Census Bureau to do a special tabulation on aging for that 60-plus population

and on a number of other special demographics so that we can do better

planning at the local community level as well as at the state level.

The rest of these resources are certainly available through the Web links and

next slide, please. This is my contact information. I look forward to having

other contacts with participants on today’s call and look forward to questions

and Matt at that point I’m going to turn it back to you.

Matt Burke: Bob, I can’t thank you enough. This is really fantastic and I hope folks are

taking away sort of the magnitude of this issue that these folks, these

Americans are going to occupy a very large slice of our population pie and I

think you did a really excellent job framing the issue and so thank you very

much, that was perfect.

I’d like to move now to our next presenter, Dr. Marty Lynch. He is the

Executive Director of Lifelong Medical Care, a health center in Berkeley,

California and as we’re staring down the pipe of 90-degree weather that’s

humid here in Washington this weekend, that sounds like a very lovely place

to be so without further ado, Marty, you are on.



Marty Lynch: Thanks, Matt. Yes, it’s beautiful out here right now. It is today. Welcome to

everybody. I also want to comment before I start that congratulations to Bob

on the new Administration for Community Living. From our point of view it

makes so much sense to tie the issues of aging and disability together and

work on those together so congratulations, Bob.

Well, let me start by saying just a minute about Lifelong. The thing I want to

say to all of you is that we’re one of those health centers that actually started

with an elderly population. We were founded by the Gray Panthers who were

a senior advocacy group as the over-60 health center many years ago back in

the 1970s.

And over the years we’ve gone to serving all ages but we still have a special

place in our heart and in our mission to serving elderly and disabled as well so

that’s just a touch about us.

The twist just reviewing for the health center perspective that these numbers

that Bob talked about are big and are important but one thing we know about

health center numbers is there’s also a lot of folks right behind these elders in

our health centers as our own populations age.

So that that 45 to 64-year-old group is the biggest bubble in the health center

world so maybe, you know, many of us may be baby boomers and heading

that way but our populations of patients that we serve and the populations in

our communities have a big bubble there that’s going to be coming our way.

And then I would just reiterate that this over-65 population is going to double

and that over-85 population is probably going to grow even more and within

those populations I think probably everybody knows it but it’s worth saying



that most people prefer to stay in the community if at all possible and that

nursing homes are not an option that most people prefer to choose. Next slide,

please.

This is just a visual representation of the numbers and the growth of the 65-

plus population. Next slide, please, so I think the takeaways for us are that our

existing patient populations in our communities are aging and that in our

populations in health centers, we’re going to see more poverty.

Bob talked about the near-poor. The poverty level is at 9.3% of elderly are not

so high but if you look at the number of elders between 100% and 200% of

the poverty level, you get really big numbers because a lot of elders are living

on fixed incomes where Social Security might get you out of poverty but

doesn’t necessarily get you to any kind of a comfortable life.

Also more disability as we age and I think again would be common sense but

it’s a good reminder and as you get up into those 75-plus that we call the old-

old or the 85-plus that we call the oldest old, those disability numbers really

go up fast and health centers that are working with the population have to be

ready to deal with it. Okay, let’s move, next slide.

I also just want to give a nod to some of our special populations that we serve

in health centers. I know in the San Francisco Bay area, the homeless

population and remember most of us are healthcare for the homeless grantees

of one sort or another, we serve that population, that population on average is

going up as well.

And when you get a homeless population that’s moving up towards an

average age of 55, many of the homeless researchers would say that person

looks like a 70-year-old in the rest of the population because they have a lot of



road miles on them if you want to think of it that way; lot of stress in their life,

lot of health problems.

And I think the you know, you got to say these mental health, substance abuse

and housing issues are in fact important and then I would say on the disabled

side just to say that the independent living centers that maybe we’ve worked

with our communities, their population’s aging, the HIV and AIDS population

is aging as well. Next slide, please.

What we know about the health center population specifically if you look at

national UDS data, we’d say that 7% of our population are over 65 and that

varies by state of course. A state like California is only 5% but the hard

numbers have gone up close to 50% in the last 10 years so that today more

than a million elders are served by health centers and that number I mentioned

a minute ago about the bubble behind them is really moving on us.

So yes, we have a history as a movement of serving moms and kids in many

community health centers but that is going to be changing and then just

acknowledge there are some health centers and maybe they’re the ones on the

line today who really do a lot of work already with the elderly and for them

it’s just really an expanding population. Next slide.

So a little bit on differences. I always say that if you’re 65 years old and

healthy and I hope this is true because I’m not very far away that your needs

are similar to an adult population and that hopefully you can advocate for

yourself. You can get through our health center systems but of course most

people will have Medicare at 65 but that as the population ages further or is a

complex population, then you do have these functional disabilities, more

dementia and more comorbid chronic medical problems. Next slide, please.



I just listed for you in case you weren’t familiar with the AVL, the Activities

of Value Living. In the aging world, a lot of us use these to measure disability,

functional disability so these are basic things. Next slide, and then the

instrumental activities which of course also are got to get done if you’re going

to live successfully in the community. Next slide, please.

I think the note about some of those is for people who have those daily living

problems, they become just as important and probably more important in day-

to-day life than the medical care that we’re providing at our health centers so

that our medical care can’t really be effective unless we also deal with

disability and some of the psychosocial issues that the population is

experiencing.

And you know, quite frankly many health centers are not as familiar with the

ranging disability care as we might want to be and that includes even our type

of health center that’s specialized, we have a lot to learn so next slide.

The - I do want to mention briefly a quick story from one of our Gray Panther

founders on this kind of community psychosocial issue, it’s not really a

functional issue - but she always used to say to me Marty, do you think Mrs.

Jones is going to pay attention to her blood pressure meds if the gas and

electric company is turning off her utilities? You know, you’ve got to deal

with that stuff if you want the person to pay attention.

So then from there clearly primary medical care is important and provided by

physicians and mid-levels and all of us in health centers have worked hard on

best practice. Chronic disease care, that’s important for this population.

Medication management, because if people have complex problems, they’re

probably taking numerous meds. They may be going to specialists and



remember if they’re on Medicare, they probably have better access to

specialists than our uninsured population does.

So they’re getting medications from a variety of sources, very important to

take the time to review with our patients on a regular basis. Have them bring

them in in a shopping bag and then the other thing to say really is I think the

multidisciplinary team for the elderly population is just key.

Whether that’s in hallway consults between a social worker or a health

worker, you know, community health worker or whether it be in team

meetings where we talk about our most complex patients. Next slide, please,

so a little bit on that.

I think we count on a type of case management that both deals uses nurses to

deal with medical case management, education, triage, ordering durable

medical equipment, that sort of thing but also we count on the psychosocial

service side to setup a lot of the community services and deal with the family

issues and such and work very closely with our docs.

And then of course we add-on and think it’s important to add-on dental.

Podiatry particularly for this population because mobility is so important.

Mental health, lots of depression, people with severe mental illness aging into

this population and then of course if you can find a way to do it for people

who have cognitive problems neuro-psych testing.

Usually using a clinical psychologist, Ph.D. level clinical psychologist is

important. Next slide, please. We use internists often but I know we have a

family practitioner on the line who is part of our speaking panel and we have

used family practitioners.



We actually do have some folks who are sub-boarded in geriatrics but they are

hard to come by. More important is simply - what’s the right way to say it -

more important is that interest in working with older people. Whatever your

training is, if you have that interest and ability to work with people, you’ll be

okay.

Obviously longer visit times for the population, lots of that chronic disease

management we talked about and motivational interviewing to find out what

the patient actually wants to work on and then tying-in these functional and

maybe cognitive dementia issue that may interact with the medical problems.

And we know depression, isolation, substance abuse whether it be alcohol or

something harder are all issues. Next, please, so I mentioned a little bit about

this a second ago so I think I’m going to skip it.

But just to say you can’t, you know, we can’t skip that, social work,

psychosocial, whatever kind of person we use to do that part of the case

management, very important part of the team and obviously getting more

attention nowadays in the patient-centered medical home or health home

approach.

Next slide. We also think that you can do this job with trained community

health workers and that there’s a real place for peers in this process. Many of

you may use peers for things like diabetes groups or maybe centering

pregnancy type of services for younger populations.

But we think there’s work for peers in terms of supporting elders as well

whether it be on community living issues or whether it be on depression

support or whether it’d simply be on dealing with all these variety of medical

and disability problems.



The team meeting I would just say the focus that I think are the very complex

patients. You’re not going to talk about all your patients in a team meeting but

regularly review people that are in the hospital, how are they transitioning out,

who are the folks that really need a brainstorm amongst the different providers

on our team who would be the nurses the doctors, the social workers, that

range of staff.

How do you, you know, how do you deal with the most complex problems,

getting that person into their homes, keeping them into their home, dealing

with the dog with fleas, you know, dealing with the housing situation, dealing

with family members wanting one thing and the patient wanting another.

Those are all issues that can be dealt with in team for the folks who need it.

Next. I think the men should care once you get into that 80-85 population, you

know, some numbers say as much as half the population will have some type

of dementia.

Now that may be overstated but nonetheless it’s clear that this is a serious

issue and somehow your providers have to get training and be familiar and

ready to deal with patients and their family members in this area.

We also have found that just the fact in an elderly clientele of people being at

the end of their life having their own end-of-life issues is a big part of our

practice and we try to think okay, how do we interact with hospice better?

How do we do enough (palutive) care in our own settings and what does that

look like for our different populations so that’s, you know, that’s a key issue.

Advance directives, you know, maybe got called death panels and, you know,

in the latest health reform discussion but in fact people do what to have some



control of what the end of their life is going to look like and want their wishes

to be noted so we have to help them.

Mental health just to mention the warm handoff, we know that from our other

populations and finally on this slide this dignity-driven decision-making is just

all about respect and involving people in their own care. That’s what that

one’s about. Next slide.

Okay, so that’s the respect where capital letters R-E-S-P-E-C-T, we need it.

Over the years what I’ve seen is the dear and honey doesn’t cut it and

obviously, you know, as our population ages expectations change cohort-to-

cohort but I think you can never go wrong with respect so that’s I think the

basic communication and respect are key issues here.

That’s also an issue in terms of how we do customer service from the front

desk on up so that bone issues for an 80-plus population if you’re asking

people to use an auto-attendant, that can be a problem. If you can get them a

voice on the other end of the phone and a person to deal with, it works better.

Next slide.

The people ask me always, do we need a separate clinic for the elderly, you

know, how does that work with older people being in with the kids and all

that? I think it really depends on your population and on the preferences of the

elderly.

But I do think there’s some physical issues and people by the way accomplish

this in all kinds of different ways, an afternoon clinic or a morning clinic or an

actual facility if they want to do something separate but certainly there’s a

slower pace.



There’s more space needed for folks to move around with walkers and

wheelchairs and that sort of thing and some, you know, some ADA disability

act system applications that can be helpful.

The, you know, accessibility is an important issue when dealing with this

population. I think certainly security concerns you all know. People want to

come in during the daylight in this population even more so. Next.

So just a nod to the fact that health centers across the country do many special

services outside of their clinics and this slide just gives a nod to what some of

those are and lots of different partnerships and lots of approaches. Next slide.

So I think we ought to mention business and policy issues because folks want

to know are we going to lose money if we take a Medicare-only population

and, you know, what’s that look like and we have to acknowledge that the

Medicare payment system for FQHCs looks different than Medicaid.

And that the rate is actually capped. The numbers are a little different for

urban and rural areas but in fact we know that Medicare does not pay our full

FQHC costs and in most states the Medicaid FQHC PPSs from a Perspective

Payment System typically does pay us at cost.

So if a person only has Medicare versus being a dual-eligible, it is possible

that you’ll be getting a little bit lower rate than your Medicare rate. On the

other hand it’s also possible that that’s a much better rate than you’re getting

for an uninsured or a commercial population.

Right now CMS is re-looking and looking at re-basing the rate and they’re

gathering data from our coding in health centers to help decide what that’s

going to be.



NACHC the National Association is on top of that but we’ll see in the next

couple of years where that goes, just a reminder of how important it is even in

our system to code accurately what you’re doing because it is going to help set

that base. Next slide and of course there’s a time issue. You’re not going to hit

the old 4200 number that I know doesn’t really get used anymore.

You’re not going to hit that for an elderly population. I haven’t found out

what for full-time provider staff, I haven’t found out if their - over many years

working in this area - I’ve never had a hard number but I think for myself

3500 for full-time provider may be reasonable. The case management that’s so

required for this care can be hard to pay for.

Some states allow it as part of your Medicaid cost, others don’t. Some place

sometimes you’ll be paying for it yourself, sometimes you’ll be paying for it

with grant monies, maybe Older Americans Act monies but it’s not easy to

support and finally as your patients age, we think aggressive health plans will

compete for them so just keep that in mind. You want to keep them.

Next slide, so big market for us so and our communities are aging and

remember, rural markets and inner-city areas where we live and where we

work, they are definitely aging and we have those fixed-income elders and we

have complex problems that we’re a little more used to working with than

many of the private sector docs.

The health home I think that Medicare is pushing now becomes another

opportunity and health centers are also pushing becomes another way to

position us better for elder care. Let’s go to the next slide, please.



Also the - what’s the right way to think about it - I think there’s more talk and

more demos around the country that are really looking at case management

and disease management fees separate from a PPS structure so I think they

become another option.

I also think as we move more older people into managed care type of

arrangement, there’s more opportunities for health centers to negotiate shared

savings or bonuses that also fall outside of the standard FQHC PPS

reimbursement system so some financial opportunities as well. Next slide.

On the other hand, stuff we don’t know basically. We don’t really know how

many health center patients are dual-eligibles which now are getting a lot of

attention from CMS, the Center for Medicare and Medicaid Services in terms

of improving care and where we have I think tremendous opportunities to do a

good job that improves quality and improves patient experience and saves

money.

The ADL functional disability measures, again not such good data on what

our health center population looks like. Also we claim in the health center

world that we save money in the big picture and we get good quality

outcomes, I don’t know that we have the data that says that about this

population per se.

We’re going to need that data, not just on the family population as well so

we’re really talking about, you know, both paradigm shift in terms of where

our services and our populations are going but also a data need shift. Next,

please.

I think also some special things to mention. Again I sort of referred to it but

let’s mention PACE at least because some health centers choose to sponsor



program of all-inclusive care for the elderly which is managed care program

for very, very disabled elders who would otherwise be nursing home-eligible.

Some health centers make that a part of their package of care and it’s complex

but some of the best integrated care around for very needy older folks. I

mentioned the Medicare advantage and duals program. I just think got to

concentrate, got to think about them in your area and pay attention to what’s

going on.

And just because you’re in a rural area doesn’t mean that this stuff may not be

coming to your community sometime in the next few years and then of course

the state-based demonstrations but let’s not say more about that. Next slide,

please so it is timely to think about health reform.

Yes, we’re all waiting with bated breath for what happens with the Supreme

Court decision and the next election in terms of the future of health reform but

again CMS is pushing innovative programs. They’re pushing duals plans.

They’re pushing other ways to bundle services and payment for the Medicare

population including the so-called accountable care organizations including

payment tied to discharge and readmission that pushes hospitals to think about

partnering better with community partners so some real possibilities there,

also the technology that helps care for people is growing. Next slide, please.

So a few recommendations. We just think it’s wise to plan for this population.

It may be a no-brainer but let’s say it and to use that patient-centered medical

home tool. We’re going to have these folks so, you know, let’s plan for it and

let’s do a great job in our community for this population.



Case management is critical, got to find a way to pay for it but it’s critical.

Other services like adult day healthcare or some of these others we’ve

mentioned can be an important part and it may vary by your state and what the

opportunities are there. Next slide.

Bob being on the phone earlier was really helpful I think in terms of planning

to partnership possibilities. I think all those aging service providers out there

that we may or may not have partnered with in our community are sources of

referrals and sources of extra services for our folks.

We can’t do it all and we also don’t know everybody so those kinds of

partnerships I think are going to be important for us. I think the duals

population will drive how much you do that you have in your health center.

And will drive how much you do in terms of contracting either with a

Medicare special needs plan which is a type of Medicare HMO that

concentrates usually on the duals or with a state-level or CMS-sponsored

duals pilot but what I would say is demand a share of any savings you produce

if you contract with those kinds of entities.

Don’t just get paid on a fee-for-service basis or a primary care cap basis and

then, you know, I think the PACE program is a tremendous opportunity but

you got to be sophisticated. It take start-up costs. It’s not an easy program to

run so for some who have high volume might be appropriate. Next slide,

please.

So here is my contact information. I look forward to a few questions later on

and happy to contact or be responsive to any of you by e-mail as well. Matt,

back over to you.



Matt Burke: Marty, that was fantastic. I loved it. I think you did a really nice job framing a

bunch of the issues in terms of what elder care needs might be, how you go

about thinking about structurally how to set some of that up in your own clinic

as well as thinking about sort of all-important payment policy and how that

might affect your ability to develop and sustain these programs.

So I think that was very, very well done. At this time we’d like to spend 10

minutes and take maybe three to five questions from folks on the line directed

towards Bob and Marty here so operator if you don’t mind opening the call up

to questions for people on the phone.

Coordinator: Thank you. To ask a question at this time, please press star 1. You will be

prompted to record your name. It is required to introduce your question. You

may withdraw your question by pressing star 2. Once again to ask a question,

please press star 1. One moment, please. One moment. We have a question

from Mr. (Jimenez). Your line is open.

(Ricardo Jimenez): Yes, this is Dr. (Ricardo Jimenez). I am the Medical Director of consumer

community health centers, one of the largest CHCs in the State of Washington

and I’m a family physician as well.

One of the things that I am intrigued by Marty’s presentation is I think it was

outside the slides but productivity-wise it seems we’re being always

constantly reminded of the 4200, the magic 4200 number which basically

technically impair us to develop a format, a structured visit for the elderly.

Are we doing something at the central level Marty if I may somebody is

giving feedback to HRSA that, you know, they at least need to balance that

expectation 4200 patients per one FTE family physician because that really

impairs the clinical side of a CHC to successfully lobby for the



implementation of an elderly visit as much as we have a prenatal visit, an

AIDS visit, the chronic diabetic visit and so forth.

And so Marty I don’t know if you have any input in that regard.

Marty Lynch: Well I will tell you, thank you, it’s a really good question, I will tell you that

at the National Association of Community Health Centers has an elderly

subcommittee. We have talked about this issue over the years and I know

NACHC has talked to HRSA about it.

My understanding is that from a HRSA point of view that’s not an official

application of this standard that maybe Matt or somebody will speak to that

but I want to tell you that there’s still a risk with it though because I think it’s

in people’s mind as a general standard, Number 1.

And Number 2 what we’re seeing is states in Medicaid rate setting trying to

apply that kind of standard so and then discounting your rate if you’re not

reaching 4200 so clearly that’s a disincentive to serve the elderly, the disabled,

any complex population, the homeless, you know, that are going to take a lot

of time.

So it’s a really important question and I think we do need to do more work on

clear guidance not just from HRSA but probably from CMS because of course

the states really rely on CMS more than HRSA for guidance on how they run

their Medicaid programs. Matt, do you want to say anything about that?

Matt Burke: I do and that’s great. That’s actually very well answered Marty and Dr.

Jimenez it’s a really important question and I don’t want to punt to CMS

necessarily but in terms of payment policy, it’s a little bit more in their real



house than ours. Marty is correct that that is not an official HRSA

requirement.

I don’t have the institutional knowledge but it is my understanding that many

years ago that may have been more formally codified but is no longer and

would not necessarily for an individual provider or a group of providers to fail

to reach that productivity threshold, there would be no punitive action taken to

service area competition applications or grant renewal funding or opportunity

to be part of other HRSA-based demonstrations.

I think it has persisted over the years as a loose HRSA guideline because folks

that meet that productivity threshold like Marty said will just naturally by

consequence fall into the favorable zone with respect to state payment reform

and payment policy.

But none of that is mediated through HRSA here so people can see fewer

visits and be totally fine from a HRSA compliance and a HRSA grant

perspective.

You do raise a really good question about it being, you know, as we continue

to build-out constructs like medical homes and patient care particularly as the

population ages and becomes more comorbid over time, longer visits are

going to be important for quality.

And that level of thinking is good and sound and I think national payment

policy is the thing that hasn’t caught up to it yet and that might be an area with

NACHC or with HRSA representation to help you contact CMS.

We might be able to lobby for that a little bit better but for right now, I think

the larger answer to your question would be to build-out the systems that are



appropriate for your patients and get them paid-for within your state

regulatory environments and then we’ll move forward from there.

Coordinator: Once again to ask a question, press star 1. One moment. (Mehandalen), your

line is open.

(Mehandalen): Hi. I’m looking at Slide 31 and 38 Marty and really appreciate your

presentation. We’re in a colony in an area where the proportion of seniors is

21% already and so what I’m asking is how do we care for this population

when we’re getting 30% lower reimbursements in our costs?

And secondly how do the 75% of health centers that are receiving more than

the cap, how do they do that and is the rest of our 25% of health centers

eligible for that same enhanced reimbursement?

Marty Lynch: Well, thank you again. Really serious question. Let me clarify the slide first of

all and my numbers on my printed version - oh here it is, up on the screen, on

38 - so the 75% number just says it’s says it the other way. Basically 75% of

health centers have actual costs that are higher than the cap so they’re not

getting paid their costs just like you aren’t.

(Mehandalen): Okay.

Marty Lynch: Okay, so that’s a clarification on that. Then I would say a couple of things, a

couple of strategies. Number 1 is we believe in the health center population

there is a lot of opportunity for qualified people for Medicaid as dual-eligible

coverage as a supplemental coverage to Medicare.



Depending on your state policy, many, many, many states then do wrap-

around Medicare payment up to the full amount, not all so I don’t know what

your state does but many, many, many states do.

So one strategy both for the patient because remember if the patient qualifies

for Medicaid, then the state pays their Part B - that’s B and in Boy - their

outpatient Medicare premium that otherwise would come out of their Social

Security check, that’s almost 100 bucks a month so it’s good for the patient

that way.

And it’s good for the health center in terms of getting that Medicaid rate so

you don’t have that gap. The only other things we’ve seen particularly is this

issue of if you’re in an area that does have managed care contracting to see if

there’s some shared savings, bonus payments for quality, case management

fees that can be negotiated.

Otherwise I don’t think there’s a magic answer to this. Maybe if somebody

else, you know, if somebody else later in the speakers is going to answer or ha

thoughts on it, I’d appreciate it but it is a challenge.

(Mehandalen): Thank you.

Matt Burke: All right. I’m getting prompted here from this end that for the interest of

everyone’s time we would like to move forward. Luckily contact information

for our speakers is available. If folks would like to reach out to them

afterwards, that would be great.

But I think we’re going to move forward with the presentation.



It is sad but I think we have to say goodbye to Bob Hornyak at this time, our

colleague from the Administration on Community Living who has to sign-off

but as I just mentioned, his contact information is available and he can be

reached if folks have questions or follow-up afterwards so thanks so much for

your time, Bob.

Bob Hornyak: Thank you very much, Matt.

Matt Burke: Have a good afternoon. Okay. In moving on, we would now like the

perspectives from the field from two health center grantees. Our next

presenters are from Hudson River Health Care, a health center in New York

State’s Hudson River Valley. Allison Dubois is the Chief Operations Officer

and Elizabeth Phillips is the Director of Health Education Services at Hudson

River and at this point I would like to turn the conference over to them.

Allison Dubois: Great, thanks so much. This is Allison and we’re hopeful just to be able to

share some experiences that we’ve had in terms of serving the senior

population and talk about what the challenges have been and our lessons

learned so next slide.

Just a little bit of background information about Hudson River Health Care.

We are a federally-qualified community health center and we were founded in

the early ’70s by four founding mothers who really struggled with access

issues and the ability to find services that were cost-effective, culturally

appropriate and in the home community.

And so since that time we have really worked with additional communities in

the surrounding area to bring our services to those communities. Our mission

is to increase access to comprehensive primary and preventive healthcare and

to improve the health status of the community. Next slide.



This is a map of our service area so if you’re familiar with New York. One of

the issues that we have at the health center is the geographic spread of our

community but this gives you an indication of the area that we’re serving.

Next slide, please.

As I mentioned, the health center does have 22 locations. We’re serving

80,000 patients with increasing numbers of under and uninsured as a part of

our service area. We have seen significant growth and has grown by 80%

since 2006. Next slide.

So I’m grateful to have the opportunity to talk about our WISE program,

Wellness Information for Senior Empowerment which is both the umbrella

name of our program as well as the specific program title that we share in the

community and it includes specifically a program that serves seniors in two

housing complexes but also welcomes community members and seniors from

the community to participate.

That program is hosted by a social worker and meets weekly, provides a

healthy snack, provides information about health issues, often times focusing

on chronic conditions which tends to be the focus area of the individual tour

member of the group.

And really while it includes, you know, significant and comprehensive health

education really addresses - focus as another component of it - looking at

social isolation and so the group provides us an opportunity to engage with

seniors, to have them spend some time with a social worker and with their

peers and then also can be used as a setting for group visits.



So that has been a really great opportunity for us to really maximize the group

dynamic as well as ensuring that we’re getting folks in for preventive health

services as well. Next slide, please.

So some of the challenges of that model in terms of working with the group is

the diversity of the group and so there are individuals who are both, you

know, anywhere from 65 to 85. We have a number of different cultures. We

have some who have English as a second language, both men and women and

so it’s often challenging to find activities that are really appropriate and

engaging for a group that is as diverse as that.

And, you know, there’s some real practical challenges in terms of

demonstrating healthy food choices on limited and fixed budgets and doing

that while you’re still addressing, you know, some of the disabilities and

issues around teeth and chewing.

So some of those things have been challenging as well physical limitations

which have limited some of the other activities outside of the public housing

and senior housing settings where we have often wanted to do activities. Next

slide.

So some of the approaches that we’ve had in terms of looking at overcoming

those challenges is to really take the time and talk with the participants about

their interests and their concerns so that we can develop programming that’s

responsive.

We are, you know, certainly trying to focus activities that use a little bit less

fine motor skills. While we do have a diverse age group, the majority of the

participants do tend to be I think as Marty defined them the old-old, not the



oldest-old but and so, you know, really just trying to be responsive to those

needs and to work within the diversity. Next slide.

That program has dovetailed really nicely with a program that we call HUGS

which is Health Unites Generations and that’s an inter-generational program

that links a youth from the community to the seniors who are in the program

and other seniors as well and again as a way that we have looked to address

the social isolation of residents and has provided just a really rich experience

for both generations to share their experiences, to share their preconceived

notions, to do some activities and programming together.

You know, the youth have received a small stipend which has been focused on

helping to promote positive youth development and honestly to be frank,

that’s the way that we’ve funded some of this program is to focus on the youth

enhancements of it and get some grant dollars to do that.

But at the same time tap-in to the senior population which, you know, is really

was in need of some additional programming. Next slide. Of course, this

presents the challenge of dealing with even greater diversity so this group

setting brings that challenge, addressing group stereotypes.

This program is housed in Peekskill which is more of an urban center and so

there’s a lot of stereotypes and preconceived notions about young people and

safety concerns and whether that was an issue for seniors, that the young

people would be in the building and so we had to work through a lot of that in

order to really get the full benefit of the program. Next slide.

And I think I really talked about this and I think one of the most exciting

things is to see some of the joint programming that has come forward in terms

of looking at cultural celebrations and joint journaling projects that the seniors



and the youth have done together to really be wonderful examples of working

through some of the stereotypes and finding warm relationships between them

on the other side which has been really wonderful. Next slide.

I’m going to introduce Liz Phillips who is our Director of Health Education is

going to talk about another specific program, the CDSMP program which has

been really valuable for us as well as an organization.

Elizabeth Phillips: Yes, thank you and I am excited to share about our entrée into the Chronic

Disease Self-Management Program. In essence it’s an evidence-based

program that was developed by Stanford University.

In essence it’s a workshop that’s given two-and-a-half hours for once a week

for six weeks and it’s conducted in community setting such as senior centers,

churches, libraries, very portable program and it’s really designed for adults

ages 18 and up.

However, we’re focusing on working with our older adult population as well

as the general public and the principles of the program focus on self-

management and what’s rather unique is that this is made available to any

person with a chronic condition or their caregiver or their significant other.

So at Hudson River Health Care we simply refer to this as the healthy choices

program. Next slide, so in terms of offering this program, we actually do this

in partnership with our local healthy aging organizations such as our

Department of Senior Services and what our approach has been to train our

staff.

We really wanted to have a rather, you know, interdisciplinary group of staff

involved in this first phase and as you can see, we’re looking at both our



registered dietitians. We have clinical assistants, we have social workers, case

managers, and health educators that have been a part of the training.

They basically serve as peer leaders. The program is really designed to be led

by the health leaders. Ideally they are either a person who has a chronic

disease themselves or they themselves are a caregiver, some of them with a

chronic condition. Next slide, please.

So in terms of our program startup, we began with a rather successful startup.

We were able to use some funding from one of our HIV capacity grants that

actually allowed us to obtain a license which is really required for any

organization that’s looking to be authorized to offer the CDSMP program.

And when we first began our, you know, our initiation into the program, just

in the last six to seven months staff were able to deliver seven workshops

again in various locations. We reached a total of about 80 participants, the

majority being adults who are ages 55 and up and of which 75% actually

attended at least four sessions or more.

Kind of looking ahead, our organizational goal is to be able to deliver at least

two to three workshops per year and for us because we have a wide network

of about - we are located in about 10 counties and 23 health centers - we’re

really looking to be a little bit more strategic in terms of how we offer this

program to our communities where we have a presence as well as our health

center patients. Next slide, please.

So as I mentioned, you know, there’s certainly some investment in terms of

starting-up with the program aside from the training and the licensing but it

also gave supervisors a really great opportunity to look at the collaborations



that we have, those existing relationships with other healthy aging providers

and other community-based organizations. Next.

So while we really enjoyed a great, you know, startup, we also recognized that

there have been, you know, some challenges and one of the things that we

have to look to is how we can build our cadre of peer leaders because it

certainly has - there’s a time commitment - and in addition to staff we would

like to be able to involve community health workers as well as AmeriCorps

members

So that’s an ongoing effort that we need to look at in terms of developing our

peer leaders. The program itself because it is new it’s a new program for us

although it’s been around the country and in the state for a couple of years, we

do need to look at marketing.

We need to make sure that people are aware that this is something that’s being

made available and in terms of locations, as you can imagine we’re looking at

space whether again it’s through house of worship or senior center so we need

to again reach out to those partners for them to be able to consider being a

host site and so those are some of the things that we have to continue to look

at. Next slide.

So I think I would also just, you know, highlight the fact that, you know, one

of our strategies in terms of reaching out to the community is by hosting what

we call an open house and that really allows us to share how the health choice

program works.

It allows us to introduce it to staff as well as residents and also to other

providers and one of the things that we’ve realized for example in working

with the senior nutrition centers, they have a very full schedule.



So quite often we need to be flexible to try to, you know, work within their

existing calendars but nonetheless they really received the program because

it’s considered like an enrichment in terms of health and wellness.

You know, the program itself is very different in that it complements any

health education program that may be existing at your health center site or

within your community but with the CDSMP program we really focus on the

process.

The participants are able to experience such techniques as problem solving,

how to deal with fatigue and pain. They also are taught in terms of how they

can, you know, look at what we call action plans so they can figure out the

things that they want to do.

So with all of that, you know, we’re recognizing that this program in itself

really supports the health center mission and it’s turned out to be quite an

asset both for our staff professionally and as well for how we’re able to

augment our relationship with other healthy aging providers in the community

so with that I think I would like to just turn it back over to Ally.

Allison Dubois: Great, and I think, you know, one of the things that we are highlighting here in

this conversation is the care management and case management and support

services that wrap around the primary care services that we offer.

We do have a gerontologist on our staff in one of our locations and have in a

number of our health centers up to 11% of our patients who fall into this

category and so the ability to utilize this type of programming to address some

of the ongoing social isolation and care management and chronic disease



management issues that we’ve been talking about are a priority for the

population.

One of the things that I, you know, we’re just particularly proud of our some

of the warm and fuzzy moments which for example would be the senior prom

which is the culmination of our intergenerational program and turns out to be

a really wonderful community event.

The mayor comes and a number of elected officials and has the young people

and our seniors. I think this might be the Electric Slide that we’re seeing on

the slides right now so, you know, there’s just some really wonderful

opportunities to creatively some of that additional support that our senior

population needs.

So we again thank you for inviting us and we’re happy to answer any other

questions about our programming as we move forward in the call. Thanks so

much.

Matt Burke: Allison and Elizabeth, that’s really exciting stuff and thank you for that great

presentation. I think it shows a lot of creative muscle in terms of developing

programs and finding ways to get them financed and they’re extremely

patient-centric and appear to have very good community purchase also, kind

of that perfect mix of all of those elements that create sustainability and actual

change agency.

So it’s very, very exciting for us to hear on this end and I’m sure everyone is

really pleased to hear this also so thanks so much for your time. We’ll hold

questions until one more session and then you folks in Jackson-Hinds will

take a joint Q&A session right at the end of the call but thank you very much.



Our next set of presenters as I just alluded to is from Jackson-Hinds

Comprehensive Health Center in Jackson, Mississippi. We have three for this

last section, Dr. Lynda Jackson-Assad, Dr. Ayanna Jenkins and Dr. Bob

Hutchins. Dr. Jackson-Assad is the Medical Director for Jackson-Hinds.

Dr. Ayanna Jenkins is the Clinical Director of the Copiah clinical site and Dr.

Bob Hutchins is a physician in adult medicine department in the Jackson-

Hinds Comprehensive Health Center so after that, I would like to just turn it

over to Dr. Jackson-Assad.

Lynda Jackson-Assad: Yes, thank you. We here at Jackson-Hinds Comprehensive Health

Center are honored to be a part of this information series. On this slide you’ll

see - next slide, please - this is Jackson-Hinds Comprehensive Health Center

and we are under the direction of Dr. Jasmin Chapman, our Chief Executive

Officer. She has been at the community health center for 32 years and our

CEO for 14 years. Next slide, please.

Next slide, please. Some basic information about Jackson-Hinds. Jackson-

Hinds Comprehensive Health Center was established in 1970 and we are the

largest provider of primary healthcare services to the uninsured and

underinsured in Central Mississippi and we are one of the oldest federally-

qualified health centers in the nation.

We are a joint commission-accredited institution. Next slide, please. Jackson-

Hinds Comprehensive Health Center is comprehensive in name and in scope.

Here at Jackson-Hinds we have adult medicine, OB-GYN, optometry.

We are one of two community health centers in this state that has optometric

services on-site. We have dental, pharmacy, pediatrics, WIC and nutrition and

nutrition is important in the elderly population.



We have diagnostic lab and X-ray. We have EPS CT or Medicaid screening,

transportation which is vitally important to all aspects of community health

center, social services and school-based clinics. We also operate an elderly

housing complex known as Alex Waites. Next slide, please.

Jackson-Hinds Comprehensive Health Center operates 15 clinics and we serve

three counties, Hinds, Warren and Copiah Counties and in that vein we have

freestanding full-based clinics.

We have 17 additional schools that we serve via our two mobile units and we

have dental services are provided via mobile units in our Jackson public

school district which is the largest school district in the state and our

Hazelhurst and Hinds County schools. Next slide, please. I will now turn it

over to Dr. Ayanna Jenkins.

Ayanna Jenkins: Thank you, Dr. Assad. Now we’re actually going to address several

healthcare-related challenges that affect the geriatric population and how

providers and staff here at Jackson-Hinds work together to address these

issues. We’re also going to discuss how important it is to integrate ancillary

enabling services when caring for geriatric patients. Next slide, please.

As you can see here, mostly females comprise the largest population in those

patients over the age of 65 here at Jackson-Hinds. Next slide, please. In our

elderly population, patients are overwhelmingly treated mostly for

hypertension and diabetes. Next slide.

Again this kind of reiterates the fact that we are very good at reaching out to

our female patients but we’ll discuss later on in our presentation how we’re



going to work to reach out to our male elderly population well. Next slide,

please.

Now we’re going to get pretty much into the meat of our presentation this

evening. We’re going to discuss nine challenges that are certainly not limited

to the geriatric population but they definitely impact how adequately

healthcare is delivered to elderly patients. I’m going to pass the presentation

over to Dr. Bob Hutchins now.

Bob Hutchins: Thank you. To discuss those challenges versus nine as we have noted,

transportation is of course vital to getting the patient to medical care. Many of

our elderly patients have very limited financial resources. They cannot drive

themselves or a family member cannot drive them.

Our solution here at Jackson-Hinds has been to provide a transportation - next

slide, please - provide transportation via van. Patients are contacted the

evening prior to their appointment and the morning of their appointment to

ensure they have adequate time to prepare for pickup and the appointment.

Next slide, please.

Chart Number 2 is the visit itself. Clearly visits for a geriatric patient can be

challenging and they require more time particularly if they are using

wheelchairs and walkers and they may need assistance with registration.

A solution has been to start the preparation for a geriatric appointment by

providing morning appointments, of allowing extended time if deemed

necessary by the provider and our scheduling staff being available to assist

geriatric patients with registration and completion of forms. Next slide, please.



This up, okay. The third challenge we devised is the medical history and in

elderly patients, obtaining a good medical history self can present a challenge

because of cognitive function and other problems with understanding courses

in giving history.

A solution had been to encourage family members to accompany the patient

or a caregiver who’s knowledgeable about their health issues and concerns or

to provide a written note with those concerns and new problems so they can

be addressed. Next slide, please.

The medical examination itself (provides) a challenge in geriatric patients.

The medical assistants here began the examination process by collecting the

needed data, reviewing health maintenance information, instructing patients

and family members concerning health maintenance issues, i.e., flu,

pneumonia, smoking documentation and need for age and disease-specific

referrals exclusive of podiatry, optometry and dental.

Our solution has been that the medical assistants are assigned to a specific

provider. They get to know those clients that the physician serves. This

promotes familiarity and trust. They may express to the medical assistant

some medical concerns that they may have residents in expressing to the

provider, just open up another avenue of communication with our patients.

That may mean the assistants or the medical assistant, a nurse in transferring

patients from and to and from the exam tables. Nurses provide a role in going

over the medication to reinforce compliance and comprehension of

instructions.

Sometimes these instructions need to be reinforced by being repeated several

times and the team members providing that in a different manner also helps to



ensure compliance. The geriatric ADLs are noted in the chart in the electronic

health records and they are addressed by the provider. Next slide, please.

Reconciliation on the medication list.

As noted in the geriatric population, this can be a challenge in task because of

comprehension, hearing problems, etcetera. Our solution has been to have

asked of the patient to bring all their medications to each visit. As you know,

geriatric patients sometimes can hoard many medications and we review the

medication list with the actual medications in the patient’s possession.

The discarded - discontinued medications - are discarded. Sometimes patients

refuse to discard their medications and they are taken to prevent inappropriate

use. This ensures compliance and understanding of medications. Patients

provided with the new medication list of any new prescribed medications and

a clinical summary. Next.

Pharmacy can present a challenge as we alluded to earlier in elderly patients

not have transportation or requiring finances that are needed for other things

to go pick the medicine up. They may have no third-party coverage for

medications.

Here at Jackson-Hinds we do participate in the 340B pharmacy program. This

has allowed us to eliminate transportation concerns and costs to the elderly

patient in obtaining medication. It provides the provider with readily-available

informational compliance, availability and coverage on this description of

various prescription plans. Next, please.

Social services. Social services under any medical agreement or environment

is essential but even more so an asset in providing services to the elderly

population.



At Jackson-Hinds our social workers perform eligibility assessments, assist

patients that cannot afford their medications to obtain them via a prescription

assistance program and elder ancillary prescription programs. Social worker

also provides home visits when a provider deems that there are extenuating

circumstances of concerns. Next. Next slide, please.

Home evaluations are essential in the elderly. Living quarters for the geriatrics

(and some proposed), health and safety risks. These inspections are necessary

to identify the improper lighting, positioning of furniture and rugs that

contribute to injuries.

Home evaluations have a unit life by us as a center utilizing home health

agencies as well as social workers to help identify those risks that are present

in the home. Also involving other agencies that may provide safety

equipment, i.e., bathtubs and shower rails and (style seats). Next, please. Next

slide.

Lastly one of the areas of concern in dealing with the elderly has been durable

medical equipment as requires. While they provide much needed supplies and

equipment and services to our elderly, many of our patients are bombarded

with cold call solicitations for durable medical equipment and DME

equipment.

This results in multiple (forms) being sent to the provider and duplication and

of services with potential for fraud. Our solution has been to ask patients to

bring the forms in to ensure that this is one, a legitimate request and that the

services were initiated or requested by the patient and the company itself is

legit.



We also encourage them to use well-known national and local vendors or

request referrals from friends and family of vendors with whom they have had

satisfactory services. Now I will turn to the presentation to Dr. Ayanna

Jenkins.

Ayanna Jenkins: Thank you, Dr. Hutchins. Just briefly I want to discuss two issues that we at

Jackson-Hinds readily experience when dealing with Medicare and of course

our elderly patients - I’m sorry, next slide, please, thank you - and of course

our elderly patients primarily utilize Medicare health services.

Basically preferred medication panels change quite frequently and this affects

whether or not the patient can afford their medication. It can confuse the

elderly patient regarding what their appropriate regimen is and it can affect the

improvement or decline of specific medical conditions.

We have begun working with our in-house pharmacy, local pharmacies and

caregivers to ensure that medications have been appropriately reconciled with

the patients and their caregiver.

Also we have issues often times dealing with billing for Medicare but one way

we seek to address this issue is that we will have our medical records and

billing staff to verify the correct Medicare plan that covers the patient prior to

the visit to ensure that our patients are not over or undercharged and now I’ll

turn the presentation over or back to Dr. Lynda Jackson-Assad.

Lynda Jackson-Assad: Next slide, please. Thank you. Here you see our elderly housing

complex which is called Alexander Waites. Next slide, please. Next slide.

Jackson-Hinds under its corporate umbrella operates an elderly housing and

handicapped housing complex and a Jackson-Hinds employee acts as a

facilitator for the residents.



In 1986 with a grant from HUD we established this complex. More than 70%

of the tenants are 65 years of age or older and approximately 80% of the

tenants use Jackson-Hinds as their primary healthcare provider. Next slide,

please.

We have actually not only do we work with these tenants, we have established

trust with them and that is why they come to us. When necessary the manager

from the elderly housing complex, she keeps the primary care providers

abreast of the resident’s medical condition and we make sure all of this

information is HIPAA-compliant.

The residents are assisted in receiving enabling services such as transportation

to the physician offices as well as other activities in the community. Again the

biggest thing when you operate an elderly housing complex is that you must

have trust.

We also work with different types of community organizations such as Meals

on Wheels to assist the elderly. As we know, they must have proper nutrition

in order to maintain their health.

Other activities that Jackson-Hinds manager helps them with would be

educational presentations within the elderly housing complex and many of our

elderly are very, very religious and we also have Bible studies done on site.

Very, very important is that the manager also inspects the apartments for any

hazards and following HUD guidelines and these things are done regularly.

Now Dr. Jenkins and Dr. Hutchins will also discussed lessons learned and tips

for other health centers.



Ayanna Jenkins: Thank you, Dr. Assad. This slide briefly summarizes the challenges that we

address in our presentation but they only represent a portion of concerns that

influence adequate healthcare of the elderly population.

It is crucial to focus on those ancillary services as well as quality of medical

care to ensure that the elderly patient as a whole receives the adequate

assistance that they deserve.

Matt Burke: Pardon me, this is Matt. I need to step in and I’m so sorry. I know we are on

your very last slide but I see that we are at time and I wanted to give the

audience a chance to ask one or two questions of the folks at Jackson-Hinds or

Hudson River Health Care because I think that that’s really important and this

is very valuable also but hopefully because all of our contacts are up online,

we can communicate offline with each other as we see fit.

So my deep apologies for that. It was a great presentation, really, really

innovative work going on in Mississippi which as you mentioned has the

oldest health center in the United States dating back to 1964 so the

institutional knowledge and the work that you guys do is fantastic.

So with that, operator, if you could please open us up for just a couple of

questions and then we’ll wish everyone a happy Memorial Day and move on

with our afternoon I think.

Coordinator: Thank you. To ask a question, please press star 1. Be sure to record your name

so I may introduce your question. You may press star 2 to withdraw your

question. Once again to ask a question, press star 1. One moment, please. And

at this time there are no questions.



Matt Burke: Well in that case I think for the sake of time please I would encourage folks

still on the phone to e-mail the presenters if they have any questions. I would

like to on behalf of HRSA and the team here personally thank all of our

presenters today who did a fantastic job.

I know Marty and Allison and Elizabeth are probably still on the line but also

Ayanna, Lynda and Bob very much thank you as well as our first Bob who

has now left us for other appointments this afternoon.

Please e-mail Stephanie Crist for any logistical considerations. That’s S-C-R-

I-S-T @hrsa.gov and I wish everyone a happy Memorial Day. We shall be in

touch.

Man: Thank you.

Woman: Thank you.

Man: Thank you all.

Woman: Bye bye.

Coordinator: Thank you for participating in today’s conference. You may disconnect at this

time.

END

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