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Nikki Kmicinski, Executive Director Western New York Integrated Care Collaborative ACUU Conference, Albany, NY June 11, 2019
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2014-2015: AAA Leaders in Erie & Niagara Counties: Business Acumen Learning Collaborative through ACL
2016: Non-profit, Incorporated, 501(c)3 2017 – 2020: 30 month grant from Health Foundation of
Western and Central NY 10/2017: 1 full-time staff: Director 12 network members 6 contracts with health payers to provide community
based programs & services to their members: Chronic Care Mgmt, Healthy IDEAS, DSMP, CDSMP
2019- 2022: Sub-Grantee with NYSOFA for 3-year ACL Grant to bring Sustainability to CDSME.
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Convening Organization for our Network
Administrative role
Contracting and negotiations with health plans and payers
Billing and Invoicing
Credentialing
Medicare Supplier/Provider
Technical Support
Referral Processing
Training
Network Collaborations
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Medicare Reimbursement Learning Collaborative
NCOA May 2018 - April 2019 10 cohorts from: NY, PA,
OR, TX, KY, NE, CT, DE, OR, NM
Health Information Technology Learning
Collaborative
n4a’s Aging & Disability Business Institute
November 2018 – October 2019
10 cohorts from: IL, WA, IN, Washington DC, MD, MI, OR, AZ, WA, NY
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Purpose:
achieve integrated, sustainable service systems for Chronic Disease Self-Management Education (CDSME) programs
obtaining payment for CDSME services through the following distinct Medicare benefit: Chronic Care Management (CCM)
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Application WNYICC’s Team Acceptance into LC Mentors Schedule Learning Modes Main Topics Homework Outcomes
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Successes Learned about Chronic Care Management and
Medicare Supplemental Benefits Learned “how to speak” with Insurance Plans to
market Community-Based Programs
Hedis Measures, Cost Factors, Opportunities
Met colleagues from across country who are now resources and friends
Developed WNYICC Network Model
0 to 6 Contracts with health plans
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Medicare Advantage CCM benefit: broad range of services offered
supervision of a physician, physician assistant, or nurse practitioner
individuals with 2+ chronic conditions follow their medical care plan, practice preventive health care, & more effectively manage their health.
AAA/CBO’s use case managers or community
health workers to provide monthly in-home health coaching.
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CCM Benefit and CDSME Programs: Minimal time for a CDSME program can be billed under
the CCM benefit.
Many activities ancillary to CDSME can be offered under the CCM benefit:
▪ engaging individuals
▪ enrolling them in classes
▪ arranging transportation
▪ providing counseling & support throughout the program and afterward to improve health outcomes.
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Challenges Time Scheduling Team Technology for documentation, communication,
record storing, reporting and billing Culture Change for Network partners (AAA/CBO)
New concepts
New business model
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Goals:
grow the technology and business skill set of participants
encourage participants to share their knowledge and experiences with others that are just starting to develop these partnerships.
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Mentors Schedule Learning Modes Main Topics Homework Outcomes
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Topics To Date:
Vetting IT Vendors
Important features of IT platforms
Contracting
HIPAA Policies / Consent Management
Health Plan Presentations
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Apply Team Participate Do the Homework Say Yes! Reach Out Share
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Thank you!
Nikki Kmicinski, Executive Director Western New York Integrated Care Collaborative [email protected] 716-887-2749