Knowing Our MarketSoCal Home and Care Network

Target Populations• Dual eligibles• Medicare FFS patients• ACO members/patients• Adults with chronic conditions • Mental Health• Post-hospital

– Psych

• Homeless• Medicaid/uninsured• Veterans/VA• Caregivers/family members• At risk of SNF placement/LTC• LT Acute Care patients - a la Kindred – up to 21 days

Target populations – Characteristics & Needs• Frequent 911• In dialysis – ESRD – non-emergency medical transportation• Newly diagnosed, ready for self-management in diabetes,

chronic pain, cardiac• Dementia: Their caregivers need support• Non-medical support services• Homebound – need meals, etc.• Multiple chronic conditions with functional impairment• EOL(ish) – palliative care, hospice, advance care planning,

supportive wraparound services

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WE ARE NOT MEDICAL. We are not competitive with home health

Target Populations - Needs• Frequent 911: Self-care/self-management; psychosocial; anxiety

treatment/plans; access to primary care & urgent care; transportation

• In dialysis – ESRD – non-emergency medical transportation• Newly diagnosed, ready for self-management in diabetes,

chronic pain, cardiac – Evidence-based programs• Dementia: Their caregivers need support• Non-medical support services• Homebound – need meals, etc.• Multiple chronic conditions with functional impairment• EOL(ish) – palliative care, hospice, advance care planning,

supportive wraparound services• Aging with DD – regional center type of services post-21

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Customer GroupsMeasurable high value outcome(s) we produce for customers• Stable community living• Appropriate use of healthcare services

– Lower utilization – reduced acute & SNF

• Appropriate use of HCBS• Fall prevention• Safe environment• Diabetes management• Better health• Better self-care & self management• Less pain, more energy, sense of safety• Patient-centered/directed – goals reassessed and care plan

adjusted

Customer GroupsOur next step(s) to further develop the customer profile and test need•Data about needs of people

– In-home assessment of post-hospital older adults: 66% had med needs; 70+% with home safety, depression, etc. issues

– Is CCTP basically the same population? Let’s do a random sampling effort to determine the level of need using HomeMeds & other intake instruments…invest in producing the data we need.

– Identify what data needs to be collected– Use for planning & marketing– Pull data from CCTP quarterly reports – ASK Lewin– Get caregiver information, too.– Gap analysis on data access – use MSSPCare, SAMS, whatever

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Contracting Organization (CO) First/NextName/Type of CO• Hospitals at risk of penalty

– Map hospitals across counties

• Hospital systems– Map hospital systems in our

service area – GET FROM QIO

• Health Plans• Physician groups• SNF• CVS – MTM/CMR• Medi-Cal plansKey CO person for contracting• CareFirst – Pam Mokler• Health Net – Martha Santana-

Chin & the gang

Their mission and major interest/need

• Hospital system– Reduce penalties– If in ACO – risk and shared savings– Revenue

• SNF – penalties for sending patients back to help

Specific HCOs:• Prospect – Steve O’Dell• CalOptima – MSSP lookalike

Contracting Organization (CO) We Will Pursue First/Next

(e.g., health plan, ACO, health system, etc.)

Our next step(s) to further engage the CO•Relationship•Value proposition•Menu for MCO

– Service lines/description

•What we do that they are not doing – TRANSLATE •Pilot with a case rate, QI cycle & document findings & outcomes

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Policy or regulatory conditions to address?Are there any policy or regulatory conditions that your network will need to meet or change in order to secure a contract? If so, what are they?

•ACL get Office Duals to set requirements for stakeholder involvement and inclusion of Aging/Disability Network – protect their investment in the system•State-level ditto – require inclusion of our networks•IT - ACL & ONC

– Group group-purchasing discounts for IT systems

•Legal standing– Prototype legal structures

•Consolidate all of these efforts and convene national-level group of plan leaders to educate them and connect the dots about Aging/Disability Network – •Definition of quality•Get us on the agenda for national & state conferences

– Toolkit for target groups – about our value, structure, services, etc.

•HIPAA & state survey coverage/language

Champions

Who can endorse our network and open doors for us? • C-suite in health plans & hospitals

– Someone who is credible

• Board members• Associations

– CAHF– LeadingAge

• Consumer advocates• ACL/CMS• National advocate?

– Molly Coye, Atul Gawande

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Competition and Forces We Need to Address

Our primary competitors are:• Homecare agencies – the Home Instead• Make vs. buy • Commercial people – prepackaged meals providers

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Competition and Forces We Need to Address

Major sources of inertia we must overcome:• IT/technology/data• Knowing where to start• Tired…• Perfectionism

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Competition and Forces We Need to Address

Competitors’ Advantage• Resources• IT• Full coverage – national

company – • Track record in large

markets• Assets• Can take risk

Our advantage• Feet on the ground• Experience in people’s

homes• Cultural competence• Home, home, home

InsightsOur biggest insight(s) from this session on Knowing Our Market is/are… •LTAC/SNF market potential•Educate MCO Leaders about A/D network

– Conference?? White paper??– Compelling voice to write a compelling thought piece aimed at the

visionaries in health plans – START AT THE TOP

•We need to focus on national buying power for IT•Consistent product lines would help us come up with toolkits for everyone

– IT– Marketing materials

•We know we are already preventing healthcare utilization

Action StepsThe action step(s) we will take in the next month to engage our market are:•Meet with high-readmission hospitals to promote members’ care transitions•Product definition discussions with Health Net, CareFirst, Kaiser•Continue to solidify our alliance

– Set up a structure workgroup

•Develop collateral & business case statements for care transitions for different payers/purchasers•Develop pricing – it will vary by:

– Volume– Network extent

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Parking Lot (Issues for later, additional questions for speakers)

• List here

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