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Sage Commission: The Challenge and the Context Lynn Varricchio Senior Health Planner

Finger Lakes Health Systems Agency. Finger Lakes Health Systems Agency is an organization whose sole mission is making our community healthier by helping the system to perform better. We work with every stakeholder to identify community health needs, develop appropriate solutions and measure the res

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Sage Commission: The Challenge and the Context Lynn Varricchio Senior Health Planner

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    1. Sage Commission: The Challenge and the Context Lynn Varricchio Senior Health Planner Presentation to Rural Health Network May 20, 2010

    2. Finger Lakes Health Systems Agency Finger Lakes Health Systems Agency is an organization whose sole mission is making our community healthier by helping the system to perform better. We work with every stakeholder to identify community health needs, develop appropriate solutions and measure the results. More than 1,100 people are actively working on specific FLHSA initiatives to increase access to care, improve quality and reduce costs. September 30. 2009 2

    3. September 30. 2009 3 Finger Lakes Region

    4. May 19, 2010 4

    5. May 19, 2010 5

    6. Charter This vision will be articulated in a written plan which will: Identify the range of integrated services needed to help older adults in the Finger Lakes region maintain independence and obtain quality health care; Present trends which demonstrate changes in the health status of older adults and their utilization of services; Identify consumer preferences and future policy directions for senior services; May 19, 2010 6

    7. Charter cont. Identify the programs and services which are needed to: Optimize the health and functional status of older adults; Reduce premature/unnecessary morbidity and mortality; Reduce disparities across sub-populations. Include a method for simultaneously forecasting the needed capacity for each of the major service components; Identify the barriers to achieving the major elements of the vision; Identify high level strategies by Spring 2010; May 19, 2010 7

    8. Work to be Completed by March 2011 Submit a Strategic Plan to NYS Department of Health with: Vision and Values Targeted capacities for needed services Actionable strategies to achieve the vision and objectives; Propose a system for measuring and monitoring the performance of the aging service system to: Facilitate timely identification of problems, and Hold the stakeholders accountable. May 19, 2010 8

    9. May 19, 2010 9 Sage Commission: Resources New York State: valued partner HEAL 9 funding : Mark Kissinger active participant in some meetings, June Retreat, accessing needed data. Partnering with 2020 Commission, NY Connects, United Way of Greater Rochester for selected implementation strategies; Outside consultant (Larson Allen) provided national expertise and soft-ware to do integrated planning; Extraordinary commitment and dedication of Sage Commission members; Expertise and support of FLHSA leadership and staff

    10. VISION Older adults in the Finger Lakes Region are recognized as living healthier and longer lives with access to a full continuum of health and health related services. These services are culturally and geographically sensitive, person-directed, and family centered. The service systems make efficient use of the workforce and are financially sustainable. May 19, 2010 10

    11. May 19, 2010 11 The Challenge Design a service system to support older adults in the Finger Lakes Region to age well and maintain their highest level of functioning. A continuum of services should provide: the right care at the right time at an acceptable place by the most appropriate personnel at a cost that is affordable to the person and sustainable for taxpayers

    12. May 19, 2010 12 Sage Commission: A New Approach The time is right for a new approach Break out of historical “silo” approach to organizing, planning, and reimbursing; Place the needs of patients first; Provide mix of services older adults will most benefit from; Keep older adults as healthy as possible.

    13. The Aging Services Field Is Evolving May 19, 2010 13

    14. 14 Cost and Demand NY spends $995 per person annually in LTC Medicaid compared to $376 nationally. statehealthfacts.org Between 2000 and 2015, NY’s population 65+ is projected to increase over 18%. By 2030 the 65+ population will have increased 51%. Between 2005 and 2015, Medicaid expenditures for those 65+ are projected to increase by $1.5 billion. 68% of an estimated $20 billion in “formal” LTC expenditures are now funded by Medicaid. The growth in long term care costs is unsustainable

    15. We Cannot Sustain the Current Course “As Is” Cost Projections for the Finger Lakes Region May 19, 2010 15

    16. 16 Why Long Term Care is a Priority? Long term care in New York consists of a wide range of programs and services but is complex and fragmented. For those with long term care needs, the array of available supports is unclear and can be difficult to navigate. It is hard to take responsibility for one’s future long term care needs without an understandable system. Absent a rational long term care financing policy, the continued growth in health care costs coupled with the aging of the society will force a growing share of the budget to be devoted to Medicaid long term care. May 19, 2010

    17. May 19, 2010 17 Population Change Components: FL Region

    18. May 19, 2010 18 Estimated Population Changes 2000-2035 Older adults 65 and over to increase from 13% to 21% of region’s population 75 and older population to increase from 6% to 10% in region

    19. 19 2008 Household Income for 65+ Population May 19, 2010

    20. April 20, 2012 20 Caregiver Availability Varies by County

    21. 21 Without services, where would care receiver be living? May 19, 2010

    22. Demand Predictors and Influencers September 30. 2009 22

    23. Assumptions Affecting Service Needs Health and functional status of the population Hospital use rates – impact of reforms and quality initiatives Rates of Transfer to aging services from acute care Community based service referral patterns. Reimbursement changes for home & community based services, SNF, bundling payments etc. Poverty rates Changes in use of formal services for those without family &/or living alone including caregiver availability Ability to substitute sites of care May 19, 2010 23

    24. Cont. Assumptions Affecting Needs Workforce availability (all positions) Impact of technology on independence and workforce Universal design in communities, safe streets, Accessible, safe, affordable housing with smart technology Access to capital for construction, funding for technology, alternative models of care/service, etc. Impact of reimbursement changes Impact of cultural norms, disparities in health status, etc. Reduction of premature admission to institutional residences May 19, 2010 24

    25. The consumer and treatment professionals are to determine if community placement is appropriate; Person must agree to the plan of care; Plan of care is reasonable given resources of the State and needs of others with similar disabilities. OLMSTEAD PROVISIONS: Most Integrated Setting May 19, 2010 25

    26. Health status of the population is improving; Preferences of the population is for more home care or home-like care; Reimbursement policy at the federal level favors more balance between home and community based care and institutional care; The availability of caregivers is expected to decline 15% in FLHSA region; Since there is an expected decline in family care givers, and 80% of care is provided by family and friends, caregivers must be provided more support and services; The financial resources of seniors were increasing, but are now expected to decline. TRENDS IN AGING POPULATION May 19, 2010 26

    27. 27 Preventing and Managing Chronic Disease is Critical Data about individuals with chronic disease is plentiful, but key data are as follows: People with 5 or more chronic conditions see 14 Physicians and fill 57 prescriptions per year Seventy-five percent (75%) of Medicare spending funds beneficiaries with 5 or more chronic conditions The number of 65+ people with chronic diseases & disabilities is expected to double between 2000 and 2030. Older adults with one ADL difficulty spend on the average $14,775 compared to $4,289 with no problems with ADLs. 36% of older adults with severe disabilities had incomes 125% below the federal poverty level compared to only 11% without a disability. Source: Long Term Care: Option in an Era of Health Care Reform; Joshua Weiner, PhD., March 9, 2009; pgs 5 -8.

    28. 28 Key Public Health Indicators for Finger Lakes Service Area

    29. September 30. 2009 29

    30. May 19, 2010 30

    31. September 30. 2009 31

    32. May 19, 2010 32

    33. May 19, 2010 33

    34. Wild Cards There continue to be issues that will impact aging services demand in the future that we can’t predict: Obesity and inactivity levels of elders Changes in the health and functional status of elders State of the national and state economy Changes in personal wealth Innovations in treatment Innovations in services Public policy changes impacting payment for services Length of stay trends for various services May 19, 2010 34

    35. Sage Commission INTEGRATED APPROACH TO MODELING September 30. 2009 35

    36. 36 As Is Model – Main Dashboard

    37. 37 “As Is” and “Draft Proposed” Scenarios for 2025

    38. 38 As Is Model – Funding Dashboard

    39. Sage First Year Work Groups 2009-2010 Education, Training and Support for Caregivers; Housing Options; Mobility Planning and Transportation Services; System Elements and Design; Work force; Second Year Additional Groups 2010-2011 Payment Reform: Planning A Financing System that supports Sage Vision; Developing Strategies to Achieve Capacity Targets September 30. 2009 39

    40. 40 NY Aging Services Health Care Reform Principles – 2009+ Support and enhance family care giving resources. Increased consumer choice and control for older individuals, persons with disabilities, and chronic illness. Ensure access to an appropriate array of home and community based long tern care supports and institutional care when necessary. Reduce costs and promote payment mechanisms that support and reward better performance. Encourage personal planning for long term support needs – including greater awareness of private sources of funding. Reverse the institutional bias in Medicaid eligibility. Enhance quality measurement to enable care in the setting most appropriate for an individual’s needs. Improve coordination of long term care and post acute care services. Utilize enhanced health information technology to better inform beneficiary choices, clinical decisions, payment, and care coordination functions. Source: Adapted from a Mark Kissinger’s presentation to the NY Home Care Association, 2008 Annual Conference, 6/3/08; pg 17

    41. Increased emphasis on each individual’s unique needs for meaningful life, wellness and prevention; Increased emphasis on a less medical approaches to meeting needs; Greater support for caregivers; Increased options for community-based care; Care Giver Work Group Housing Work Group… changes to assisted living for low income Transportation Work Group Expected reductions in total SNF capacity for the region; Greater work force needed for community services IMPLICATIONS OF Plan: September 30. 2009 41

    42. IMPLICATION OF PLAN cont. September 30. 2009 42

    43. The Sage Plan will place greater emphasis on wellness, maintaining health and functional status, and reducing health disparities. Service utilization will be affected not just by the aging of the population, but also by: the health status of the population the preferences of the population; public policy, and court decisions. funding for appropriate housing. the ability to pay for various alternatives If you are going to be compassionate, be ready for action." Archbishop Desmond. TAKE AWAY MESSAGES September 30. 2009 43

    44. September 30. 2009 44

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