Knowing Our Market SoCal Home and Care Network

1. Knowing Our Market SoCal Home and Care Network

2. 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

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

4. 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

5. Customer Groups Measurable 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

6. Customer Groups Our 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

7. Contracting Organization (CO) First/Next Name/Type of CO 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 • 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 plans Key CO person for contracting • CareFirst – Pam Mokler • Health Net – Martha Santana-Chin & the gang

8. 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

9. 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

10. 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

11. Competition and Forces We Need to Address Our primary competitors are: • Homecare agencies – the Home Instead • Make vs. buy • Commercial people – prepackaged meals providers

12. Competition and Forces We Need to Address Major sources of inertia we must overcome: • IT/technology/data • Knowing where to start • Tired… • Perfectionism

13. Competition and Forces We Need to Address Competitors’ Advantage Our advantage Feet on the ground Experience in people’s homes Cultural competence Home, home, home • Resources • IT • Full coverage – national company – • Track record in large markets • Assets • Can take risk

14. Insights Our 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

15. Action Steps The 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

16. Parking Lot (Issues for later, additional questions for speakers) • List here