Adding value and revenue toyour home care practice withGeriatric Care Management

Home Care Association of Florida Annual ConferenceOrlando, June 23, 2010

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And Alan Stanford, CEO and founder of My Health Care Manager, Indianapolis

• A national company that is dedicated and specialized in improving the well-being of older adults

• Develops and licenses industry-leading knowledge and decision support systems dealing with the issues and options of aging– Home care agency licensees in Sarasota-Bradenton-Venice,

Cincinnati, Indianapolis, Denver, Greenville, Seattle-Tacoma, and Gainesville with 40 more in discussion stage

– Provides Eldercare employee benefit program covering nearly 100,000 employees and distributed directly and by WellPoint through state Blue Cross/Blue Shield plans

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The problem: Our health care “system” is not friendly or easy to navigate for seniors

Providers and Issues■ Transportation■ Doctor #1 - Primary Care■ Doctor(s) #2 (& #3) - Specialist(s) Insurance■ Prescriptions and Renewals

Family and ■ Pharmacy - Local

Pharmacy - Mail AwayLoved Ones ■ Clinic(s)

■ Hospital(s)■ Skilled Nursing Facility/Rehabilitation■ Outpatient Treatment/Therapy■ Home Health Care Provider(s)

Seniors ■ Insurance - Medicare A & B

Caregivers and Their Health ■ Insurance - Medicare C - Advantage

Housekeepers Care ■ Insurance - Medicare DTheir Faith ■ Insurance - Supplemental

■ Insurance - Home Health Care■ Insurance - Long Term Care■ Insurance - Other (A,D&D, Cancer, etc.)■ Independent Living - Home or Facility

Professional ■ Assisted Living - Home or Facility

Advisors ■ Long Term Care - Home or Facility■ Housing Modifications■ Health Power of Attorney■ Living Will■ Communications with Trust Officer ■ Retirement/Nursing Home Options■ Other

© My Health Care Manager, Inc.

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And home care is just one of the many issues seniors and their families have to deal with

Providers and Issues■ Transportation■ Doctor #1 - Primary Care■ Doctor(s) #2 (& #3) - Specialist(s) Insurance■ Prescriptions and Renewals

Family and ■ Pharmacy - Local

Pharmacy - Mail AwayLoved Ones ■ Clinic(s)

■ Hospital(s)■ Skilled Nursing Facility/Rehabilitation■ Outpatient Treatment/Therapy■ Home Health Care Provider(s)

Seniors ■ Insurance - Medicare A & B

Caregivers and Their Health ■ Insurance - Medicare C - Advantage

Housekeepers Care ■ Insurance - Medicare DTheir Faith ■ Insurance - Supplemental

■ Insurance - Home Health Care■ Insurance - Long Term Care■ Insurance - Other (A,D&D, Cancer, etc.)■ Independent Living - Home or Facility

Professional ■ Assisted Living - Home or Facility

Advisors ■ Long Term Care - Home or Facility■ Housing Modifications■ Health Power of Attorney■ Living Will■ Communications with Trust Officer ■ Retirement/Nursing Home Options■ Other

© My Health Care Manager, Inc.

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But properly supported Geriatric Care Management services can assist in the spectrum of senior issues

Entire Yellow Background: Providers and IssuesGeriatric Care Management ■ TransportationService Area ■ Doctor #1 - Primary Care

■ Doctor(s) #2 (& #3) - Specialist(s) Insurance■ Prescriptions and Renewals

Family and ■ Pharmacy - Local

Pharmacy - Mail AwayLoved Ones ■ Clinic(s)

■ Hospital(s)■ Skilled Nursing Facility/Rehabilitation■ Outpatient Treatment/Therapy■ Home Health Care Provider(s)

Seniors ■ Insurance - Medicare A & B

Caregivers and Their Health ■ Insurance - Medicare C - Advantage

Housekeepers Care ■ Insurance - Medicare DTheir Faith ■ Insurance - Supplemental

■ Insurance - Home Health Care■ Insurance - Long Term Care■ Insurance - Other (A,D&D, Cancer, etc.)■ Independent Living - Home or Facility

Professional ■ Assisted Living - Home or Facility

Advisors ■ Long Term Care - Home or Facility■ Housing Modifications■ Health Power of Attorney■ Living Will■ Communications with Trust Officer ■ Retirement/Nursing Home Options■ Other

© My Health Care Manager, Inc.

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The problem is huge today, and getting worse.

• Over 40 million seniors (65+) today and growing at 12% a year to around 70 million by 2050.

• Problems are overwhelming– Family members remain the key source of help for their

parents, but many are working and raising their own families from many miles away.

– The Medicare and Medicare Advantage insurance programs primarily limit their reimbursements to symptoms, diagnoses and problems, not the complex set of inter-related issues of “aging,” and Part D is confusing.

– The problem is larger than the resources available to help.

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Health care is a provider-based “system”, with business models defined by reimbursement sources

Senior Health Care Continuum

Consumer Provider

Families Navigation Support Providers Payors / Others*

My Health Care Manager Primary Care Physician■ Navigation ■ Well-being■ Compassion ■ Holistic & Psychosocial Medicare A■ Education & Compliance ■ On-going assistance Specialists,Clinics & Hospitals Medicare B■ Technology and tools ■ Caregiver assistance

Independent Geriatric Care Manager ? ? Medicare Advantage

Commercial Geriatric Care Management Companies

Skilled Nursing Facility & Rehabilitation Other Insurance

Skilled Nursing

Home Health

Companion Service

Disease Management

Community & Faith Based Services

Prescription Medicines Medicare D

Senior Living CommunityIndependent Living Long Term Care

Assisted Living InsuranceSkilled Care Medicare

Advance Directives

Estate Planning*(Medicaid

Money Management Not Included)

© My Health Care Manager, LLC 2007

What is Geriatric Care Management?

• Most common agreement on definition:– Guidance on aging issues including coordinating, coaching and

advocacy in liaison with health team– Usually provided by professionals in an unlicensed service area– Most often privately paid for by the senior or their family

members– Holistic in approach addressing many components of a person’s

life that are not addressed by health care providers– Family communications are usually enhanced– Services tend to be ongoing rather than episodic

• With the complexities of caring for seniors, Geriatric Care Management is more important than ever before

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Who provides Geriatric Care Management?

• Historically a cottage industry known for individuals or small groups practicing on a solo basis in local areas– The National Association of Professional Geriatric Care

Managers has standards, qualifications and a code of ethics for its members who must hold a certification in care management

– Some individual Geriatric Care Managers are practicing in your service areas and may be referring home care cases (www.caremanager.org) + zip code

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• Some new entrants are combining Geriatric Care Management with home care into a single branch office offering– SeniorBridge (www.seniorbridge.com) is an early leader in the

combined office offering with 11 offices in the Northeast, 15 in Florida and 5 others plus a care network

– LivHome (www.livhome.com) is expanding out of their Los Angeles start with offices in California, Illinois, Massachusetts, Maryland, Texas and Virginia.

• Often their expansion strategies involve acquiring local home care agencies and converting them to full-service branch offices– Acquisition challenges include valuation in a “down” market– Usually only one agency purchased in a trading area

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Who provides Geriatric Care Management? Cont’d

• My company, My Health Care Manager, is taking a different path by helping organizations already serving senior clients expand into Geriatric Care Management with systems, knowledge, experience and support– Home health and home care agencies

• Certified• Private duty

– Hospital systems• Relationship management and coordination• Continuum of Care strategies

– Senior living residences• Care coordination and facilitation• Family communications

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Who provides Geriatric Care Management? Cont’d

We’re bringing the power of technology to bear on the problem

• Knowledge Management and Decision Support technologies are required– Predictable support plans and recommendations regardless

of the caregiver’s education and experience– Best practices of caregiving and care managing from

national experts and practical care manager success

• Secure Internet technology to link, with permission, family members and providers with the care manager

• Safe and private storage of important information including a Personal Health Record that is accessible when needed

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Your agency has the option of adding Geriatric Care Management services to expand its services

Geriatric Care Management services complement current services and deal with issues usually not provided or reimbursed, such as:

– How long can I remain in my home?– How long can I keep driving?– How can we care for our parents from a distance?– How can I better understand my doctors and their advice?– What help is available to help me manage my medicines?– If I have to move, what are my options?– Who can help us improve our family communications?– If I want to move to a senior community, how do I choose it?– We need to get our plans in order. Who can we trust to help?

Adding Geriatric Care Management can enhance the value of your home health agency in 3 ways:

1. For clients and patients:– Assistance from a trusted source on all issues of aging –

not just current services

– Continuous relationship and support between medical episodes of care

– Improved family involvement in care plans and continuing family communications

– A “family friendly” point of contact for remote family caregivers

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2. For influencers and referral sources:– A sorely needed consumer-oriented addition to the

provider-dominated health care “system”

– A source of guidance through complicated and confusing health care choices

– A business partner to support other providers when their business models can’t support continuing services

• Discharge planners

• Skilled Nursing Facilities

• Physicians and their nurses

• Senior Living Residences

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Adding Geriatric Care Management can enhance the value of your home health agency in 3 ways: Cont’d

3. For your home care agency:

– New markets• The ability to serve clients before they need home care

• New positioning of your agency for referrals

– Diversification of revenues from reimbursed to private pay

– Career alternatives for nurses or social workers who desire to stay engaged with patients and work on their holistic issues and support them on all of their issues, including family communications

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Adding Geriatric Care Management can enhance the value of your home health agency in 3 ways: Cont’d

Current home care clients tend to be episodic and engaged at the later stages of aging

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Insurance with Case and Disease Management

Hospital System Hospitalization Hospitalization

Initial <30 Acute Day

Primary Care Care Repeat Physician

Patient and Consumer

Bright Yellow: Home Health

Family and Family Involvement Loved Ones

© My Health Care Manager, Inc.

Adding Geriatric Care Management services to your agency significantly increases your reach

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Insurance with Case and Disease Management

Hospital System Hospitalization Hospitalization

Initial Acute <30 Day

Primary Care Care Repeat Physician

Patient and

Consumer Geriatric Care Management

Family and Family Involvement Loved Ones

© My Health Care Manager, Inc.

Just as in home care, the business model is driven by clients, costs and margins

• Clients– A key advantage is providing new services for current cases

– Referral sources increase with the additional services

• Costs– Early economics are significantly affected if dedicated

personnel are used or if a variable labor/cost model is used

– Non-chargeable time is used for agency development

• Margins– A goal of 40-50% gross margin is the target, before SG&A

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Clients come from new sources

• Independent trusted advisors– Estate planners and trust attorneys– Financial planners and bankers– Elder law attorneys

• Providers with business models limited by reimbursement who want to help their patients– Discharges to hospital home health– Skilled Nursing Facilities– Physicians and other health care providers– Senior Living Residences

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Rates and services vary

• Often quoted hourly rates range from $75 to $200 per hour with $100 to $125 frequently experienced

• Current services available range from hourly services to one-on-one relationships, with some Geriatric Care Managers serving as court-appointed guardians or working with or for elder law attorneys

• There is no consistent definition of services, quality or charges throughout the U.S. which makes it difficult for consumers to make choices and decisions

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Cost drivers are controlled by management

• An early decision is whether to establish a new identity and location for the service– Name and logo

– Physically separate location or entry?

• A proven development and marketing leader is key– Either a shared current one or a new hire

• The amount of overhead assigned is a company-by-company decision

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Margins are directly affected by chargeable time for Care Managers and sales expenses

• If a potential Care Manager is currently in your agency and you can pro-rate the time, costs are transferred as billings progress

• A more serious commitment involves dedicating Care Managers to the Geriatric Care Management practice

• The decision to dedicate a full or part-time business development person is critical for momentum

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We’ll be seeing the impact of health reform as more is learned and experienced

• Accountable Care Organizations (ACOs) may emerge as the driving force behind coordinating care between physicians and care providers, hospitals and home care– Home care agencies partnering with ACOs may add continuity of

care and oversight dimensions to the challenges ACOs will face in meeting CMS objectives

– Geriatric Care Management services align with CMS objectives

• Current CMS reimbursement rates will continue to be under tremendous pressure for reduction, thus diversity in revenue sources becomes critically important

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And, if you have any doubts by now, we do believe Geriatric Care Management can add value and revenue to your home care practice!

• Now it’s time for questions and discussion

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Susanne Wise, RN, MBAswise@takecarehomehealth.com

Take Care Private Duty Home Health CareTake Care Advisor

3982 and 3920 Bee Ridge RoadSarasota, Florida 34233

www.takecarehomehealth.comwww.takecareadvisor.com

Alan Stanfordastanford@myhealthcaremanager.com

My Health Care Manager, Inc.8520 Allison Pointe Blvd.

Indianapolis, Indiana 46250317-598-8921

www.myhealthcaremanager.com

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