Building “Win/Win/Win” Relationships through AT Reuse: A Closer Look at Medicaid Collaborations Sara Sack, Ph. D. Director, Assistive Technology for Kansans and KEE: Kansas Reuse Program Washington, DC August 31, 2015

Roadmap Creating a clear and precise message—agreed upon terms, stated values, policies & procedures Understanding the pros & cons of reuse A brief look at one program: Kansas (Oklahoma data will be presented next) Identifying goals of collaborative partners Building in safeguards—for all. Consumers, manufactures & providers, and the Reuse program Call for research

Step 1: Use the Same Terms as Other Programs : Defining AT Reuse Exchange Reassign/Redistribute Refurbish Remanufacture Recycle

Defining AT Reuse Exchange: Connects users to directly exchange AT, similar to eBay or classified ads. Reassign/Redistribute: Accepts AT for sanitization, identifies appropriate users, and matches to new consumer. Refurbish: Similar to reassignment, but in addition the program restores AT to its original configuration, which may include repairing and replacing parts. Remanufacture: Similar to refurbishing, but strips and builds AT to new configuration. Recycle: End-of-life breakdown of AT for disposal and/or reuse in refurbishing and remanufacturing.

Step 2: Figure Out Who is or Might Be Interested in DME Reuse and Why (1 of 2) Benefits of DME and AT more widely known Improved health and safety Minimizes doctor visits and returns to hospitals Reduces or delays assisted living and nursing home placements Enables some people and/or caregivers to keep working Billions spent on Durable Medical Equipment every year $120 billion spent annually for DME equipment and supplies; 15% of which is paid for out-of-pocket by consumers. (2011 Senior Care report) Medicare reported spending $8.6 billion on DME in fiscal year 2007; recent census data indicates total national expenditure of $4.3 billion

Why the Interest in DME Reuse? (2 of 2) Increased demand for DME One in five Americans report having some level of disability Aging population Growing number of people who are Medicaid eligible New technology National campaign to Reduce, Reuse, and Recycle Potential partners such as Veterans Administration, education systems, Vocational Rehabilitation and others are thinking about reusing technology Reduced consumption of natural resources such as aluminum, glass, plastics and fuel Reduced use of landfills

Step 3: Figure Out if Your Program is Interested and Who Your Partners Might Be Materials on the Pass It On website to guide model selection and suggestions for approaching partners Review the AT Reuse Partnerships with Medicaid: A Guide for Consideration and Development (2015) document for additional information Involve potential partners early in the discussion process and develop a clearly defined set of values and policies that are good for everyone—the consumers, the vendors and manufacturers, and the reutilization program Understand the potential positive and negative consequences of operating a DME reutilization program. Talk openly and build in safeguards to prevent negative consequences.

Overview of the KS Reuse Program Started in 2003 after concerns from legislators regarding constancy of Medicaid DME expenditures—wanted tracking Collaboration between the KS Technology Act Program, the University of Kansas, and Kansas Medicaid Lightly used, nearly new DME valued at over $120 (new, demonstration model, or refurbished with an end product that closely meets original manufacturer standards) Track, recover, refurbish/repair, and reassign Full range of durable medical equipment (SGDs, manual and power wheelchairs, feeding pumps, Bi-PAP and CPAP machines, electric hospital beds, gait trainers, scooters, etc.)

Overview of the KS Reuse Program Statewide—6 collection/distribution sites (use the AT Sites) Pick-up and delivery provided if needed Give away All persons with disabilities and chronic health condition, Medicaid beneficiaries and those likely to become eligible Work closely with local vendors to refurbish and provide some delivery/set-up Serious focus on safety and liability Attention to acquisition of new and relationship with vendors

KS Reuse: Data from Start-Up Period and Recent Years Year Consumer Requests Donations Value of Donations Reassigned Devices Value of Reassigned Devices Year 1 (2003) $325,568127$183,941 Year 2 (2004) $384,054269$320,045 Year 9 (2011) 1,158777$1,126,051701$949,206 Year 12 (FY 2014) 1,483937$1,035,959854$839,201 Since 2003, recovered over $10 million and refurbished & reassigned over $8 million

Careful Attention to Our Goal: Increase Access to and Acquisition of DME & AT Provision of new and used technology Identify situations where used technology might be appropriate Those waiting on eligibility decisions Short-term illness or changing needs Provision of equipment that is not covered by customer plans Serve as back-up or secondary equipment Choice of the consumer—high end, nearly new equipment

Recognize the Goals of Potential Reuse Partners Goals of non-profit partners and state funding agencies may be different KS perspective– Cost containment can’t be the goal Problems with cost containment and shifting to a provision of used technology position Appropriate fit and safety of the consumer is at risk Health and stability of the DME industry is jeopardized When Europe shifted to a reutilization model and significantly reduced the purchase of new equipment, innovation and manufacturing of DME stopped. Much was lost. To date, very little reutilization of DME in Europe Valuing our relationship with manufacturers and providers must become a goal—truly needs to be a Win for all programs

Raise Your Voice for Research Research (and thought) is needed Not the comparison of receiving a device (new or used) versus no device although general, well-designed efficacy studies are still needed Focus on receiving the most appropriate device to meet medical and functional needs that may result in real savings in healthcare costs What gains can be made in education when students have access to technology? Where can use of technology result in improved educational and employment outcomes? How can we as good partners help ensure that manufacturers can engage in research and innovation and manufacture their products at a fair price that encourages continued production in the US?

Questions/Comments: Sara Sack, Ph.D. Director, Assistive Technology for Kansans and Assistive Technology Programs Kansas University Life Span Institute 2601 Gabriel Ave. Parsons, Kansas