Systems Integration Grants Commonalities and Unique Elements

System Integration Kick-Off MeetingNovember 7-8, 2011

System Integration Goal

Objective 1: Coordinate the integration of a statewide set of programs that includes a Single Entry Point/No Wrong Door (SEP/NWD) access for individuals.

• Information, Referral and Access• Options Counseling and Assistance• Streamlined Eligibility Determinations for Public Programs and Assistance in Applying for these

Programs• Person-Centered Care Transitions Across Multiple Settings

 Objective 2: Ensure access to a comprehensive, sustainable set of high quality services relevant to the population residing in the state’s service area.

• Comprehensive set of services• Robust quality assurance system• Sustainable service system

 

System Integration TeamsOverall Point: Joseph LugoTeam Lead Dementia Components: Jane Tilly

Planning Phase

Implementation Phase

Proposed Planning Phase

Proposed Care Transition Models*

*Applicants will establish measurable targets for achieving maximum population coverage for each year of the cooperative agreement period (e.g. 25%, 50%, 75%).

Most Commonly Proposed Areas of Performance Measurement

African Proverb

To go fast…..

To go far…..

To do both…..

go alone

go together

go to the Aging Network

PartnershipsCommon Partners

Medicaid, SUAs, ADRCs, AAAs, CILs, Alzheimer’s Associations, health care providers, minority services associations and organizations, consumers

Examples of Unique Partners

State Commission on Minority Health

Latin American Association

Center for Pan Asian Community Services

SAGE (Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders)

Wisdom Steps Health Preventive Program for Native Elders

Governor's Office and Lieutenant Governor’s Office

State Coordinating Council for Services Related to Alzheimer's Disease and Related Dementias

Senior Services Property Tax Levy Staff

AARP

Workforce Development Office

Private Health Plans

Unique Areas of Activity/Emphasis: Georgia

• Web-based technology plays a fundamental role in achieving overall project goals, in particular streamlining access and eligibility determination• “technology when you want it, people when you don’t”

• Achieving "high touch"" with Medicaid“• Focus on broader array of and greater access to services that are evidence-based or evidence-informed, requiring all AAAs to offer in their Title III D and E programs by year 3

• Using Baldrige criteria for quality improvement and the Measurement Analysis Plan (MAP) for all AAAs, including capacity of consumers to provide feedback on satisfaction via the web-based system

• Sustainability using internships, program contributions, and creative uses of CMS and Medicaid waivers

Unique Areas of Activity/Emphasis:Minnesota

• Focus on increasing coverage of evidence-based programs and CT by health plans

• Use of health care homes as foundation for systems change and integration• Strong relationship with Governor office and Lt. Governor and building upon existing gubernatorial initiatives like Senior One Stop

• Use of Living Well at Home (LWAH) framework and Rapid Screen© as focal point for risk management and support planning across services—in particular options counseling, care transitions and identification of persons with dementia

• Focus on disability and enhancing DLL with new tools that support employment, health, and self-sufficiency

• Developing a 3-tier dementia training statewide• Emphasis on sustainability using private pay models/cost-sharing, and building capacity of AAAs and local networks to enter into risk agreements in light of healthcare reform

• Incorporating Self-Directed Services across all programs in AAAs

Unique Areas of Activity/Emphasis:New York

• Development of dementia screening tool as part of NY Connects I&A screening tool

• Make care transitions available statewide, with emphasis on serving persons with dementia

• All staff at NY Connects will be trained to be dementia-capable and increase knowledge about self-directed services

• Building options counseling statewide including new protocols and dementia-capable emphasis partnering with their Alzheimer’s Association chapters

• Use of Multiple Chronic Conditions (MCC) framework to integrate programs and services

• Embedding care transitions into Electronic Medical Records• Expanding use and capacity of their resource directory to include care transitions 

Unique Areas of Activity/Emphasis:Ohio

• Focus on linking universal assessment with Electronic Health Records• Enhancing Ohio Benefit Bank to include new tools, benefits and resources• Focusing Part B on partnership with VAMCs using evidence-based program (Partners in Dementia Care or PDC) in two regions: Cleveland and Akron

• Standardization of consumer satisfaction tools statewide• Expectation that all AAAs will offer Care Transitions Intervention • Exploration of alternative reimbursement streams for services, with goal of 3 new funding streams identified by year 3

• Train ADRNs and AAAs to become more disability, dementia, and person-centered capable

Commonly Anticipated Challenges

• Funding to sustain programs — in particular to expand care transition activities and programs

• Population trends — changes in diversity, sheer numbers, interests, and system capacity to meet these changes

• IT/MIS — continued fragmentation, silo’d by program and service

• Building capacity to become “dementia-capable” across all programs and services requires enormous energy, time, training, and follow up

ADRC 5-Yr Statewide PlansFunding Sources

• Reviewed existing and potential/planned funding sources identified by 14 states in their 5-Yr Statewide ADRC plans• Alaska, Arizona, Colorado, Kentucky, Minnesota, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, South Dakota, Vermont, West Virginia, Wyoming

• Distinguished between current funding sources and possible or planned funding sources identified

Most commonly cited funding sources: •State Funds, •ADRC Grant•SHIP•MIPPA

Number of States Relying on Different Types of AoA Funding

Number of States Relying on Different Types of CMS /Medicaid Funding

Number of States Relying on Other Sources of Funding

Other Potential Funding Sources

• Balancing Incentive Payment Program (ACA 10202)• Department of Labor Disability Navigator Funding• Health Plan Exchanges• Federally Qualified Health Center