1. Consolidating Data Sources to Improve Public Access to Benefits and Public Accountability Tom Snedden Director Pharmaceutical Assistance Pennsylvania Department of Aging 717-787-7313 tsnedden@pa.gov September 19, 2013

2. “Enhancing the quality of life of all older Pennsylvanians by empowering diverse communities, the family and the individual.” Pennsylvania Department of Aging-- Mission 2

3. Two main goals of Pennsylvania Department of Aging are prevention and protection. Pennsylvania Department of Aging-- Priority Areas 3

4. Prevention Prevention from instability in health and wellbeing through assessment and service care coordination nutrition programs transportation PACE and PACENET and pharmaceutical assistance health and wellness programs: PrimeTime Health, Healthy Steps, Chronic Disease Self Management Promote advocacy for consumers of long-term care Encourage partnerships among communities and agencies Pennsylvania Department of Aging-- Priority Areas 4

5. Protection Ensure vulnerable Pennsylvanians are protected from abuse Safeguard rights of residents in facilities Continually monitor services provided Pennsylvania Department of Aging-- Priority Areas 5

6. Pennsylvania Department of Aging-- Constituent Growth 6

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8. In Pennsylvania, there are more than 300,000 residents who are over the age of 85 (2.4%); PA ranks 4 th among states in percentage of population age 85. Additionally, 22% of PA population is age 60 and over; PA ranks 4 th in percentage of population age 65 and over. Pennsylvania’s Aging Population Source: US Census Bureau 8

9. Pennsylvania’s Aging Population Pennsylvania’s age 60+ population is projected to increase by 1.045 million from 2010 to 2030 Source: US Census Bureau 9

10. County % of Population Age 60 Years and Over Source: US Census Bureau Rural counties (green) have highest percentages of population age 60+ (tan and brown). 10

11. Americans are living longer with more complex conditions and disabilities. One in five Americans will be eligible for Medicare by 2030 More than 20% of older adults have at least five chronic conditions Heart disease Diabetes Arthritis Osteoporosis Dementia This group of 20% accounts for 80% of all Medicare spending http://www.americangeriatrics.org u The Aging Population 11

12. Americans are living longer with more complex conditions and disabilities. Older adults access healthcare more than younger adults and children 26% of all physician office visits 35% of all hospital stay 34% of all prescriptions 38% of emergency medical services and responses 90% of all nursing home use http://www.americangeriatrics.org u The Aging Population 12

13. The Pennsylvania Department of Aging funding sources do not include any general fund revenue. Pennsylvania Department of Aging-- Funding 13

14. Older adults need access to benefits and resources to reach and maintain economic security and a healthful life. u The Aging Population and Access 14

15. Serves over 960,000 older adults annually 52 Area Agencies on Aging, serving all 67 counties Prescription medications for 350,000 older adults In home and community services to over 520,000 older adults 12.1 million meals served annually Average person served by PDA is a woman age 78 who is widowed · Pennsylvania Department of Aging-- Current Service Delivery 15

16. To address prevention and protection, PDA administers: Home and Community Based Services Pharmaceutical Assistance (PACE) Health and Wellness Programs Protective Services Advocacy (Ombudsman) PENNCARE and PACE 16

17. Protective Services--Increasing 17

18. Pre-Admission Assessment--Increasing 18

19. Nursing Home Population Trend Nursing Home Population--Decreasing 19

20. Nursing Facility Bed Trends--Decreasing 20

21. Ensure Pennsylvanians will age and live well and our communities are places to age and live well Provide Pennsylvanians with access to care in the right setting, with the right intensity and at the right time Bring the best of Pennsylvania to Pennsylvanians Pennsylvania Department of Aging-- Direction 21

22. Using technology in a person-centered approach to improve benefit access by identifying and contacting unenrolled eligible seniors Using technology to overcome barriers to successful enrollment Using technology to be accountable Our Direction with Data Technology 22

23. Multiple Barriers to Benefit Access Stigma Complicated applications Lack of awareness Fear No transportation 23

24. Multiple Barriers to Benefit Access Estimated rates of unenrolled eligible individuals for government benefits are in the 30 to 90% range, depending on the program. Pathways to Success: Meeting the Challenge of Enrolling Medicare Beneficiaries with Limited Incomes, NCOA, 2005 24

25. The PACE Application Center Department of Aging outreaches to eligible seniors using multiple, measurable databases. Model developed by Benefits Data Trust (BDT) for outreach, assistance, enrollment, evaluation. 25

26. The PACE Application Center Key components of data-sourced outreach Benefits specialists reach people “where they are” by tracking multiple attempts and formats Allows for analysis of key metrics Provides trained outreach staff with tools that emphasize respect, patience, and empathy Support is refined, as needed, immediately 26

27. The PACE Application Center Key components of data-sourced outreach Customized databases manage eligible senior contacts and response information Mail, telephone calls, and post cards coming from an identifiable, trusted source Person-centered management system is two-way: Outreach to seniors and Seniors as incoming callers who ask for support 27

28. The PACE Application Center Key components of data-sourced outreach Person-centered management system securely stores documentation to fulfill verification requirements of benefit programs System manages documentation follow-up tasks for benefits specialists Benefits specialists submit documentation on behalf of senior applicants 28

29. The PACE Application Center Elements of person-centered application management and documentation Age Residency Household size Household income and assets Household expenses Medical expenses Medical coverage Enrollment status in benefits programs 29

30. Overcoming the Barriers to Benefit Access Increasing awareness—by contacting enrollees in other programs to identify eligible individuals Reducing stigma—by training call center staff to educate targeted eligibles, one-on-one Eliminating complicated application processing—by streamlining and supplementing the process with the use of current data 30

31. Overcoming the Barriers to Benefit Access Removing fear—by providing application assistance together with information management No transportation—Obviate the need for applicant travel 31

32. Overcoming the Barriers to Benefit Access Increasing awareness—by identifying eligible seniors in benefit databases who are not enrolled in other public benefits for which they are eligible: PACE and PACENET prescription coverage Part D Extra Help program for Medicare prescription assistance Property Tax and Rent Rebates SNAP enrollment for nutritional assistance LIHEAP heating assistance PennDOT low-income registration 32

33. Identifying Unenrolled and Determining Eligibility—Data Sources 33

34. Identifying Unenrolled and Determining Eligibility 34

35. Identifying Unenrolled and Determining Eligibility Outreach cover letter for PACE enrollment application mailing 35

36. The PACE Application Center Results of Targeted, Coordinated Benefits Access Higher response rates Better quality responses Reduced outreach costs Reduced time with screening ineligible persons Higher enrollments Healthcare savings 36

37. The PACE Application Center Results of Targeted, Coordinated Benefits 37

38. The PACE Application Center Results of Targeted, Coordinated Benefits Access—PACE 38

39. The PACE Program—Access AVERAGE PACE BENEFICIARY WIDOWED FEMALE, 78 YEARS OLD, LIVING ALONE IN HER OWN HOME, MANAGING 3-4 CHRONIC DISEASES, USING 4 OR 5 MAINTENANCE DRUGS, TO TREAT CARDIOVASCULAR DISEASE, ARTHRITIS, DIABETES, OR GASTROINTESTINAL PROBLEMS. 39

40. The PACE Program—Access 40

41. The PACE Program—Accountability 41

42. The PACE Program—Accountability PROTECTING A VULNERABLE POPULATION Outreach Program to Seniors, a statewide direct outreach, outbound call activity, targets unenrolled eligibles to screen for enrollment into PACE, Medicare Part D, the Low-Income Subsidy, and Property Tax and Rent Rebate Program. Drug Utilization Review checks for harmful therapy before the pharmacist dispenses the drug by reviewing for interactions, duplicate therapies, and over- or under-utilization. For exceptional circumstances, a medical exception allows the prescriber to indicate the diagnosis and medical rationale to explain use of the drug. The Independent Drug Information Service brings non-commercial, evidence-based drug information directly into the physician office. Visits include data about comparative effectiveness, safety and costs. Improving the Health of Seniors with Mental Health Problems delivers counseling and care management to cardholders newly prescribed an antidepressant, anxiolytic, or antipsychotic. This patient-centered care program promotes patient involvement by providing timely assessment and access to mental health services. There is also a component for caregiver support. 42

43. The PACE Program—Accountability 2011 STUDY—THE PACE IMPACT ON MEDICAID  PACE supports many seniors prior to Medicaid enrollment.  Compared who “had” and “did not have” PACE in a 5-year period prior to long-term care or nursing waiver  PACE seniors remained in the community longer, with better health  PACE delayed entry into and lessened the utilization of these services  With early PACE drug coverage, PACE enrollees with later Medicaid enrollment had lower costs due to deferred services entry; savings estimated at $815.3 million annually. 43

44. The PACE Program—Accountability 44

45. The PACE Program—Accountability The Survey on Health and Well-Being assesses important aspects of providing a prescription benefit. The voluntary and confidential survey, now in its 13th year, measures health status, quality of life, attitudes, health related behavior, activity limitations, and satisfaction with the Program. 45

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47. Questions? tsnedden@pa.gov THANK YOU 47

48. Information and data slides follow Budget performance measures PACE / PACENET Program PACE / PACENET Enrollment and Claims Dept. of Aging Organizational Chart State Plan on Aging Goals Benchmarking Reports 48

49. Budget Performance Measures 2009-102010-112011-12 Pennsylvanians 60 years and older 2,644,1752,702,6052,705,875 Pennsylvanians 85 years and older 309,255305,675315,545 Persons served in community who are clinically nursing home eligible 13,12512,275 Pre-Admission Assessment: Assessments/recertifications 103,990105,725 Referrals to nursing home 38,16539,140 Referrals to community services 45,46545,660 Persons receiving assistance: Congregate meals 131,640132,630 Personal assistance services 1,5651,470 Attendant care services 1,6651,8802,090 Home delivered meals 38,07536,425 Home support services 6,8056,595 Personal care services 13,70513,125 Protective services 15,52017,790 Families receiving caregiver support 7,0207,120 49

50. Budget Performance Measures Comprehensive PACE Program 2009-102010-112011-12 Older Pennsylvanians enrolled (average)133,560125,105120,175 Total prescriptions per year4,930,6104,398,2804,233,835 Average PACE cost per prescription$24.16$24.30$20.74 PACE Needs Enhancement Tier (PACENET)2009-102010-112011-12 Older Pennsylvanians enrolled (average)175,770182,480183,955 Total prescriptions per year5,843,3555,942,9006,097,700 Average PACENET cost per prescription$28.73$28.02$21.04 50

51. PACE / PACENET Program PACE Prescription drugs, including insulin, insulin syringes & needles Generic medications:$6 copay (30-day supply) Brand name medications:$9 copay (30-day supply) Can get 90-day supply with PACE & Part D PACENET Prescription drugs covered including insulin, insulin syringes & needles Generic medications:$8 copay (30-day supply) Brand name medications:$15 copay (30-day supply) Can get 90-day supply with Part D Pay PACENET deductible or Part D monthly premium Source: PACE 2010 Annual Report For more details on PACE: www.aging.state.pa.uswww.aging.state.pa.us 51

52. Pharmaceutical Assistance Contract for the Elderly (PACE) Source: PACE 2010 Annual Report For more details on PACE: www.aging.state.pa.uswww.aging.state.pa.us 52

53. Department of Aging Organizational Chart SECRETARY Office of the Budget -------------------------------------- Comptroller Bureau of Pharmaceutical Assistance (PACE) Divisions: PACE Cardholder and Enrollment Operations Research and Evaluation Intra-Governmental Council on Long - Term Care Office of General Counsel ------------------------------------- Chief Counsel Governor’s Policy Office ------------------------------------- Policy Office Legislative Liaison Office Deputy Secretary of Aging Operations and Management Office Bureau of Advocacy Divisions: Ombudsman Protective Services Education and Outreach Office Human Resource Office Bureau of Finance Divisions: Budget Procurement Contracting Bureau of Aging Services Divisions: Housing and Community Services Older Americans Act Services Bureau of Quality Assurance Divisions: Quality and Compliance Licensing Metrics and Analytics PA Council on Aging Press Office Aging and Disability Resources Office Department of Aging Organizational Chart 53

54. Goal 1 Goal 1: Improve access to care for older individuals at the right time, setting, and intensity. We have increased visibility of the state and regional staff at facilities and AAAs as well as increased activities regarding community outreach. We have an increase in program activities between FY 10/11 and FY 11/12 in several key areas such as resident/family councils, information and consultations to individuals, information and consultations to facilities, and technical assistance to Ombudsman and Volunteers. The State Office is in the midst of implementing a newer version of the Ombudsmanager system, which went live on March 18, and will allow for even better and more accurate data reporting. Goal 1 54

55. Goal 2 Goal 2: Empower older individuals to remain in the setting of their choice by serving as a catalyst in developing communities as places in which to age and live well. Collaborative undertakings were initiated with the medical schools and health systems of Temple University, University of Pennsylvania, and University of Pittsburgh. These collaborations are aimed at identifying and enrolling eligible persons in PACE who are patients of the hospitals and emergency rooms of these three institutions. Patients enrolled in PACE may then apply for other benefits, such as Medicare Part D, the Medicare Low Income Subsidy (Extra Help), and Supplemental Nutritional Assistance (SNAP). Patients not eligible for PACE may be enrolled in other federal, state and pharmaceutical industry sponsored pharmacy benefits. We have implemented additional reporting strategies to capture the data that is necessary to determine the effectiveness of local Link partnership development activities and trainings. We are moving forward with various exit surveys and/or pro active follow-up to collect the type of data that will provide some measure of their efforts. We are implementing Options Counseling with two pilots programs, classroom Options Counseling trainings and on-line modules in partnership with P4A. Goal 2 55

56. Goal 3 Goal 3: Direct older individuals to the supports necessary to maximize their health and well-being. Financial Exploitation Recovery and Protection: By implementing an electronic background check process, we have reduced the time for employment determination from 4-6 weeks to 2-4 days. In addition, the cost for background checks was reduced approximately 20% per applicant. The Department’s Institute in Protective Services at Temple University continues to provide expert assistance in investigating and prosecuting financial exploitation which has led to eight arrests, $640,000 in restitution/repayment agreements, over $100,000 in recovered assets, and over $761,000 assets have been protected. APPRISE counselors discuss preventive benefits during counseling sessions. APPRISE volunteers conduct community presentations and include preventive benefit message. Goal 3 56

57. Goal 3, continued Goal 3: Direct older individuals to the supports necessary to maximize their health and well-being. Endorsement through American Health / Silver & Fit Programs is in progress opening the door to Medicare Advantage participants to attend Healthy Steps Programs. Four caregiver webinars have been offered. Obtained evidence-based status through US Administration on Aging for Healthy Steps for Older Adults (falls prevention) program and transitioned counties to evidence-based programs. Healthy Steps for Older Adults expanded from 21 agencies in FY 2011-12 to 39 agencies currently. Chronic Disease Self-Management expanded to 17 counties and 28 Master Trainers in FY 2012-13 and 40 workshops will be held through June 2013. Goal 3, continued 57

58. Goal 4 Goal 4: Revitalize and redesign aging services to further enhance the lives of older individuals. Revisions to the Aging Service Policy & Procedure Manual are being made and the Administration and Hearing & Appeals Chapter is close to finalization. An Area Agency on Aging (AAA) workgroup was convened to provide feedback on the Manual. The AAAs were surveyed regarding senior centers in preparation for the Senior Center Chapter. Cost sharing is being reviewed and revised. State Plan subgroups are meeting to identify and determine what reporting is needed. Goal 4 58

59. Protective Services (PSDASHDB) Aging Waiver Service Utilization Report (AWSUDB) Options Service Utilization Report (OPSUDB) Waiting List Report (WAITLTDB) Assessment Report (ASMTDB) Rebalance Report (REBALDB) Aging Waiver Service Order Report (AWUPDDB) Enrollment & Services Report (ENRSERDB) Senior Center Report (SRCNTRDB) Meals Report (MEALSDB) Benchmarking Reports Current Benchmarking Reports 59