special delivery: getting care to vulnerable populations renée markus hodin community catalyst...
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Special Delivery: Getting Care to Vulnerable Populations
Renée Markus HodinCommunity Catalyst
Families USA Health Action 2009January 29, 2009Washington, DC
The Role for Consumer Advocates
© Community Catalyst 2009
About Community Catalyst
• National nonprofit consumer advocacy organization
• Founded 1997• Working in 45 states• Affordable, accessible
quality care• Consumer voice
© Community Catalyst 2009
The Integrated Care Project
• SNP Consumer Education Project
• Partnership with Commonwealth Care Alliance
• Our view of managed care
© Community Catalyst 2009 4
A Crisis in Value
The United States is doing an especially rotten job of delivering chronic care, at spectacular cost.”
Susan Dentzer, Editor-in-Chief, Health Affairs
“Reform Chronic Illness Care? Yes, We Can”
January/February 2009
© Community Catalyst 2009
Vision for Systemic Delivery Reform
Integrated acute and chronic care -- medical, mental health, community care, self-care and social supports -- promotes optimal health, function and independence
Organized and coordinated delivery -- of all necessary medical and non-medical resources and services
Flexible, person-focused approach to benefits and care -- not the typical insurance model
Improved value – integrated care is high quality and cost-effective
© Community Catalyst 2009
Best Practices
Specialized primary care networks
Interdisciplinary team approach to care
Comprehensive health assessment and reassessment
24/7 access
Fully organized networks of alternatives to hospital and institutional care
Meaningful patient and family involvement in care management
Meaningful outcome measurements
Single electronic medical record
Member education
Consumer voice in plan and governance
© Community Catalyst 2009
ConsumerConsumer&&
Support PersonsSupport Persons
Primary Care
Primary Care
Ho
spit
als
Ho
spit
als
Residential Residential
ServicesServices
Medical Medical
Specialists
Specialists
Mental Mental Health
Health
Rehabilitation
Rehabilitation
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Home Care / PCA
Home Care / PCA
DME / Supplies
DME / Supplies
……islands of careislands of care
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How Persons with Disabilities How Persons with Disabilities ExperienceExperience the Health Care System the Health Care System
© Community Catalyst 2009
Member&
Support Persons
Primary Care Physician
Coordinator
Transportation
Residential Settings
Physician Specialists
Mental Health Providers
PCA
Home Care
Home Modification
Housing w/ Services
Cognitive Rehabilitation
Independent Living Skills
Rehabilitation Therapies
DME
Chore Services
Supplies
Behavior Services
Family Counseling
Adult Day Program
Alternative Services
Structured Day Program
?
?
Acute Care
Emergency Response
System
Home Delivered Meals
Dental
DisabilityDisabilityCareCare
A Health Care System that Works
© Community Catalyst 2009
Integrated Care Vehicles
Special Needs Plans (SNPs)
Medicaid Initiatives
Medical Homes
Chronic Care Model
© Community Catalyst 2009
Special Needs Plans (SNPs)
Authorized by MMA in 2003
Target populationsDualsChronic illnessInstitutionalized
769 approved plans
© Community Catalyst 2009
SNPs: Promises and Pitfalls
Promises
Improve quality for vulnerable populations
Contain Medicare and Medicaid costs
Model for Medicaid-only enrollees
Pitfalls
Lax oversightFew “special”
requirementsRisk adjustment may
not accurately reflect members level of need
© Community Catalyst 2009
MIPPA Requirements
Care Management/Model of Care
Disclosure of Information
Quality Reporting
Contracting
© Community Catalyst 2009
The Three-Legged Stool
Committed and knowledgeable policymakers
Mission-driven health plans with commitment to patient-driven care
Informed and engaged consumer advocates
© Community Catalyst 2009
Consumer Advocate Roles
Member feedback
Governance
Policy Advocacy
Model of Care
Advisory Committees
© Community Catalyst 2009
For More Information
Renée Markus HodinProject Director
Community Catalyst617.275.2810