integrated care boot camp part 2: how metrics, quality and
TRANSCRIPT
Integrated Care Boot Camp Part 2:
How Metrics, Quality and Compliance help Attract Payers
Sponsored by
The Business Institute
The mission of the Aging and Disability Business Institute (Business Institute) is to successfully build and strengthen partnerships between community-based organizations (CBOs) and the health care system so older adults and people with disabilities will have access to services and supports that will enable them to live with dignity and independence in their homes and communities as long as possible.
aginganddisabilitybusinessinstitute.org
Our Funders Our Partners
Thank you to our boot camp sponsor:
• Presenters:• Paul Cantrell, Consultant, n4a, Washington, DC• Sharon Williams, CEO, Williams Jaxon Consulting,
LLC, Grosse Pointe, MI• Abigail Morgan, Senior Vice President of Business
Strategy and Performance, Direction Home Akron-Canton Area Agency on Aging and Disabilities, Uniontown, OH
• Aaron Lambert, President, Healthy Blue, Baton Rouge, LA
Integrated Care Boot Camp Part 2: How Metrics, Quality and Compliance help Attract Payers
Boot Camp Part 2
How Metrics, Quality and Compliance Help Attract Payers
n4a ConferenceJuly 28, 2019
© 2019 C3 All rights reserved. Confidential.
C3 – Who we are
• Non-profit administrative services organization formed in 2016 by a group of Pennsylvania AAAs
• Single-source contractor offering innovative
solutions to address social determinants of
health with managed care and health system
organizations
© 2019 C3 All rights reserved. Confidential.
Readiness Assessment – Preparing for Go-live
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© 2019 C3 All rights reserved. Confidential.
MCO Information Security Policy Requirements
• Privacy/Security Awareness/Training
• Cyber Security protocols & testing
• Acceptable Use Policies
• System and software updates
• Account/data security standards
• Authentication measures
• Staff Onboarding/ Offboarding
• Device security
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• Incident response
• Sovereign protections & cloud use
• Disaster recovery
• Succession policies
• File retention & backup
• Electronic record storage
• Data processing
• Insurance requirements
© 2019 C3 All rights reserved. Confidential.
Readiness Assessment – Tracking the Details
• Priority (critical or nice to have?)
• Source (of the requirement – State Contract, Regulation, Quality metric, etc.)
• Criteria (how will adherence be assessed and proven? Include timeframes, etc.)
• Details (Definitions, explanations, etc.)
• Evidence (aka “Prove it”…or, “Where’s the beef?!”)
• Audit (How will it be verified? Onsite, cloud posting, submission-based)
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© 2019 C3 All rights reserved. Confidential.
Readiness/Launch Prep/Ongoing Monitoring
• Readiness training / capacity building
• Site visits / desk audits
• Office Hours & launch-related “War Room”
• Learning Collaborative / Technical Assistance
• Community of Practice
• Quality Assurance / Perf. Improvement
© 2019 C3 All rights reserved. Confidential.
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© 2 0 1 9 C 3 A l l R i g h t s R e s e r v e d . C o n f i d e n t i a l .
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WHY COMPLIANCE MATTERS
N4A INTEGRATED CARE BOOT CAMP
JULY 28, 2019
SHARON R WILLIAMS, EO
WILLIAMS JAXON CONSULTING, LLC
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HEALTH CARE INDUSTRY: HIGHLY REGULATED
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Federal regulations
State/local regulations
Accreditation standards
Industry guidelines
Contractual requirements
Consumer demands
COMPLIANCE IMPACTS:
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Quality reporting
Performance
Brand
Bottom line
Sustainability
KEY COMPLIANCE PROGRAMMING
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Quality
Grievances/complaints, appeals (consumer/Provider)
Privacy/security
Fraud, waste abuse
Fiscal management
BEST HEALTH CARE PARTNERS HAVE STRONG COMPLIANCE INFRASTRUCTURE
• RISK MITIGATION
• RESEARCH
• ORGANIZATIONAL ASSESSMENT
• CORRECTIVE ACTION
• POLICY/PROCEDURES
• TRAINING
• AUDITING/MONITORING
• REPORTING
• RECALIBRATING
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BOOT CAMP PART 2
HOW METRICS, QUALITY AND COMPLIANCE HELP
ATTRACT PAYERSABIGAIL MORGAN, SRVP BUSINESS STRATEGY
WHO WE ARE
• In Ohio: 12 AAAs
• In our area
Portage, Stark, Summit, Wayne
Private Not for Profit 501 (c) 3
30 Member Board of Directors
230+ Staff
Operating Budget $50M
Older American’s Act, Medicaid Waiver Care Management, ‘Duals Demonstration”
We provide choices for people to live independently
in the place they want to call home
HISTORY OF SUCCESSFUL PARTNERSHIPS
History of Health System Partnerships
Acute Care Transitions since 2010
Hospital and NF-based RN Assessors
Health professional training programs
On Board of Directors for local ACO & Health System
Contracted Care Management/Care Transitions for Managed Care Plans
Medicare-Medicaid Dually Enrolled beneficiaries
Medicaid Waiver under 60 Population
Medicare Advantage Acute Care Transitions
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OUR EXAMPLE:
MEDICARE ADVANTAGE ACUTE CARE TRANSITIONS
MODEL: lead AAA contractor with 3 AAA subcontracting sites for Care Transitions
Submitting proposal/bid was just the beginning
Finalizing IT platform
Detailed discussions around process mapping
Scope of work development
Reporting & Performance Standards
Communication set up
Regular meeting schedule, orientation, trainings
Between MA plan and Contracted AAA, Contracted AAA and Subcontracted AAA Sites
OUR EXAMPLE:
MEDICARE ADVANTAGE ACUTE CARE TRANSITIONS
IT, Security & Oversight
Began reviewing just prior to RFP development
Basic understanding of health plan’s wants
Pen Testing and HITRUST requirements
Health plan assurances and oversight policies
Quality Measures and Reporting
Continual discussion of what are their needs and
what can we do
Focus on medication reconciliation, past screenings,
safety assessments, community service referrals
Not everything moves forward