Responding to Health Care Reform: How Can Integrated Care Networks Help? By Diane Oyler, Ph.D. Coordinator of Neighborhood Services for the Erie County Department of Senior Services
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he size and diversity of the older adult population has always posed challenges for Area Agencies on Aging (known in many counties as the Office for the Aging). Those traditional challenges are currently being compounded by policy changes that are transforming the way home and community-based support services are delivered to the elderly and disabled. The Affordable Care Act and New York State Medicaid Redesign represents a true paradigm shift for the way the aging network will do business in the foreseeable future.
in place to support contracting with managed care organizations. The challenges facing these community-based organizations include lack of experience negotiating contracts and limited ability to accept risk-bearing terms; difficulty obtaining a national provider ID number needed for any organization that wants to do Medicare billing; lack of capacity to conduct population health analytics, quality assurance and quality improvement; and insufficient capacity to handle billing, collections and claims adjudication.
Health care reform is a welcome source of new opportunities for Area Agencies on Aging, and will strengthen community-based organizations financially and programmatically in the years ahead. However, in many counties there is a lack of local expertise to help implement reforms in a way that maximizes the potential of community-based service providers to participate in a cost-effective, sustainable way.
However, these service providers do have the experience, expertise and capacity to deliver a diverse listing of evidence-based programs and services to populations in need of high quality longterm services and supports. In order to address their challenges and position themselves so they can bring their collective strength to the marketplace, aging and disability service providers around the country are considering integrated care network models with corresponding Management Services Organizations to remove barriers to contracting with managed care organizations.
In May 2013, the Administration for Community Living, within the federal Department of Health and Human Services, launched a national learning collaborative to provide targeted technical assistance to Area Agencies on Aging to help build systems that will address new servicedelivery demands. The Erie County Department of Senior Services and the Niagara County Office for the Aging, together with a group of service providers that has been an integral part of the region’s aging network for decades, was one of nine networks selected across the country for participation in the collaborative. The goals of the national learning collaborative are comprehensive and ambitious. Short term goals include helping Area Agencies on Aging understand the new health care marketplace, and building the acumen needed to thrive in that marketplace. This requires learning about the revenue streams that can appropriately pay for services, new payment models, and developing a comprehensive understanding of how funding is tied to performance outcomes. The long-term goal is to equip Area Agencies on Aging with the expertise they need to develop updated service systems that can deliver the integrated service packages that health care reform demands. One strategy for meeting new service delivery demands that is being explored by Erie and Niagara counties is forming a community-based integrated care network. Conceptually, these networks are similar to physicians’ Independent Practice Associations (IPAs). Doctors continue to own their own practices, while the IPA is a contracting/management vehicle when it comes to working with health plans. This allows practices to expand their reach as well as the types of services offered, and offers economies of scale when it comes to core business functions. Integrated care networks offer the same advantages to communitybased organizations. The service providers that make up aging networks locally and nationally are a diverse group that have historically operated on a mixture of grants and Medicaid waiver funding. As a result, most of these organizations do not have the infrastructure and business processes
With guidance from the Health Foundation for Western and Central New York, a three-phase process has been established to guide the work of Erie and Niagara counties as they explore integrated care network models and their potential to help community-based organizations overcome the challenges they face. Phase I, the planning phase, has already been completed with resources including technical assistance and project management support provided by the Health Foundation. During Phase I, a Steering Committee laid the groundwork for deep exploration during Phase II of national network models as well as the local health and long-term services marketplace. Phase II will culminate in a formal recommendation on whether an integrated care network would be beneficial, and the type of model best suited to regional needs and culture. The work of Phase III will depend on the recommendations coming out of Phase II, and may include implementation of recommendations. The primary rationale for doing this work is to build a stronger aging network that is well-equipped, in terms of technical skills and subjectmatter expertise, to allow it to work more effectively with a formal health care system that has traditionally worked parallel to it, rather than in conjunction with it. The process of strengthening the network, using an intentionally regional strategy, will provide the additional benefit of helping to resolve long standing problems delivering service to older adults residing in more remote parts of our counties where geographic boundaries have proven to be a logistical obstacle to providing seamless service throughout the Buffalo-Niagara region. As counties adapt to and embrace new service-delivery models of caring for our aging population, we will need to address the specific needs of each county and its residents. The plan and model used by Erie and Niagara counties will be helpful to other regions of the state as they consider moving to integrated care networks. Ensuring that the older members of our community are cared for is among New York counties’ most important roles. www.nysac.org 31