Dec 19 Call Notes

Adult Care Home Sub Group

Medical/Health Homes and Population Management Work Group

Participants: Tim Daaleman, Susan McCracken, Jennifer Wehe, Lou Wilson, Janet Schanzenbach, Lynne Perrin, Nidu Menon, Elise Bolda

Briefly presented Nursing Home (NH) Support Sub Group’s graphic for consideration by the Adult Care Home (ACH) Group

Important to recognize ACH have differing populationswithin facilities

Discussion of NH differences among residents -

  • It seems like in the NH model the level of support from CCNC seems to be different; the amount of support and the role/relationship is shifting over the five tiers. As expectations increase the payment structure also shifts. Resources to create incentives increase. For example, in Tier 1 the PCP is not engaged with the facility, we want to incentivize this engagement.
  • acute rehab – post-acute; The current model is primarily for the long term resident but the needs of the short term acute patient has been taken into consideration
  • long term cognitive impairment – total care

The graphic as an organizational model has appeal –

  • Concern for underlying fiscal model having a split PMPM
  • It comes down to “who is accountable for the patient”
  • In the true PCMH, the PCP practice is responsible
  • Need to be clear about who is at risk, who shares savings
  • Where is the accountability for resident with divided PMPM and multiple players

Resident differences – tremendous differences in needs and variety, from the aging population to a mental health consumer – how can we apply to various populations

  • If we’re going to be person-centered, standards for the different tiers need to be different according to the population
  • Tiers address ACH variability
  • Need to create graphic for ACH with room for 2 sets of standards based on resident populations’ needs (e.g. older adults; cognitive/behavioral health considerations)

Industry is underfunded – need to begin with a set of minimum standards, everybody does that one thing then up to tiers 2-3

  • For instance – attending physicians review and act on medical recommendations – needs to be in place in every tier – - reality is that it doesn’t always work that way, need to create incentives
  • For example: advanced directives are included at Tier 1 for NH, at Tier 3 the expectation increases to a process for & action to reviews & discuss advanced directives every 6 months

What is relationship with acute care hospital?

  • ACH relationships vary from a provider that sends someone to stay with the patient when they get to the hospital to providers who ambulance and don’t send anything else

Do we need 5 Tiers or fewer? It may be just necessary to have three. If tier 1 is minimum and tier 3 where we want to get and Tier 5 is the ideal- Why don’t we collapse Tiers 1-3 into 1 and push for everyone to get to where we want them to be.

The reason to have five was the recognition that there will be need to have incentives for facilities that are reluctant to change..."

Training is another facet that will help a Tier 1 to get to Tier 3.

Areas for consideration for differing Tiers

  • Hospital relationship standards
  • Advanced directives standards
  • Administrative burden
  • Workforce – training – AHEC-s
  • Medications – reconciliations & review
  • formulary?
  • Type of resident

Important consideration: smaller Family Care Homes (FCH) are reluctant to be separated as group that is different than ACH

  • current standards are similar or almost the same
  • resident populations are not the same – people aren’t up at night, or as heavy care and have fewer medical needs
  • fear is of split reimbursement

Question, many members have a pharmacy they work with doing med review – how would that work with medication reconciliation done with Network?There is a concern that this med review/reconciliation is not being done by an independent body at this time.

There are data we can look at – NHs have pharmacists review requirements, there’s been some work in NH poly-pharmacy using independent pharmacists. Staff is looking into evidence based practices in pharmacy and will look for independent pharmacists review literature.

  • Email exchange of ideas about topics of standards and Tiers encouraged.
  • Staff will prepare graphic template to be filled in as much as we can through email exchange.
  • January 6 call 8-9 a.m.

Call-in-Number 1-866-939-8416

Participant ID 7902696#