1. Overview of Steps Needed to Develop Partnerships
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Timothy P. McNeill, RN, MPH ACL/AoA Consultant

2. Development of Partnerships
Health Reform is impacting all sectors of healthcare and home and community based services
Managed Long-Term Services and Supports is shifting traditional waiver services into Managed care
Successful managed care contracting can occur using a collaborative approach
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3. Market Analysis
Market Analysis is a critical component to partnership development and sustainability
Identify the Payer landscape
Market Penetration of payers
State climate for reform
State level initiatives

4. Partnership
Partnerships can support Medicare contracting and managed care
One program can have more than one partner
Relationship must be mutually beneficial
If the negotiations are difficult in the beginning, they will likely remain difficult for the duration of the relationship
Both organizations must have a process to track and monitor services

5. Types of Partners Aging/Disability Networks Hospitals
Health Departments
Patient-Centered Medical Homes
Private Practice Doctors or Group Practices
FQHCs
Rural Health Clinics

6. EB Program Contracting Example
ACL/AoA has embraced the adoption of evidence-based (EB) programs
Medicare Reimbursement
Managed Care Contracting
ARRA and Older Americans Act funding supported expansion of EB programs
Funding supports expansion of EB programs and support the growing demand for these services
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7. History of DSMT Benefit
The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for DSMT
Benefit began in 2002
Benefit provides compensation for up to ten (10) hrs of DSMT per 12 month period
All recognized Medicare providers can submit for reimbursement
Medicare coverage
80% Payment
20% Co-insurance required

8. Stanford DSMP Program site analysis
Initially conducted an analysis of each DSMP program site
Infrastructure
Staffing mix
Delivery model
Target population
Integration with the health care delivery system

9. Recommendation Developed a hypothetical model – Anywhere AAA
Partner DSMP program with Medicare provider partner
Supplement infrastructure to meet National Accreditation and Medicare billing guidelines
Develop break-even analysis
Provide revenue projection model

10. Initiative Status
Eleven (11) programs fully accredited by the American Association of Diabetes Educators and recognized by Medicare
There are other programs that have sought and achieved accreditation. This slide represents the programs that I have supported under the ACL/AoA consulting contract

11. Business Acumen TA Initiative
May 2013, ACL launched a learning collaborative to provide expanded TA to networks of community-based aging and disability organizations (CBOs) to improve their Business Acumen

12. Business Acumen Learning Collaborative
Collaborative is supported by a team of ACL staff, contractors, and grantees
9 networks of CBOs selected across the U.S.
Goal is that each Network secure at least one contract with an Integrative Health Organization
Medicare/Medicare Advantage
MLTSS
Managed Care
Accountable Care Organizations

13. Managed Care landscape
Important to understand the market forces for managed care:
Medical Loss Ratio
PMPM (Per Member Per Month) Premium Payments
NCQA Credentialing Standards

14. Strategy Development Identify the local market drivers
Assess the landscape of health reform initiatives
Understand the political landscape
Develop a strategy
Implement the strategy
Assess current partners

15. Strategy Dev. (cont.) Identify organizational strengths
Complete a gap analysis for your organization and partners
Identify additional partners that will be needed
Understand the cost drivers and price points
Establish contract capture plan

16. CBO support of Managed Care Contracting
Meeting with MCOs have presented the following challenges for CBOs
Capacity to deliver services on a large scale with uniform quality metrics
HealthIT systems compatible with health care
Quality assurance metrics that align with HEDIS measures
Alignment of services with Health risk of the consumer
Potential replication of services currently available to consumers

17. Network Contracting Opportunities
Networks of organizations are exploring contracting as a group
A Network contracting method can provide greater coverage of defined market area and provide a single contracting point for managed care
Economies of Scale can be achieved

18. Network Contracting Issues
Funding to establish the Network
Antitrust Violation Potential
Legal Structure of the Network
Sustainability of the Network Structure
Shared Governance
Management Services Organization (MSO) Option

19. Traditional MSO Services
Electronic medical record access
Health IT consulting
Contract negotiation
Group purchasing power
General management support
Financial

20. Summary Health Reform is changing the healthcare landscape
Payers and Providers are reacting to these changes
Partnerships can provide strength in contracting in the face of change
Know your strengths, weaknesses and understand the potential of local alliances

21. Questions Questions can be submitted in this open forum or by e-mail:
Timothy P. McNeill, RN, MPH
Consultant
Direct: (202)