CCA, Massachusetts, Partner discussed on The Healthcare Policy Podcast


Sixty five and older the average age in that group Of there's over ten thousand people is roughly eighty years old And then the group that is under the age of sixty five so twenty one to sixty four. And that's the one care program that age is is is in is around fifty So when you when you sort of nap both of those out it would give the appearance of a younger population but that would be misleading So that's why we look at it. SORTA through those two those two lenses. Okay thank you you mentioned Cares provided Both in a in a clinical setting. And and then you do some home care You did start piloting in twenty fifteen a mobile integrated health program. Could you tell us a bit more about that. I think that approach is still growing in frequency. I'd be happy to do so you know. One of the one of the bright spots about our organization is that we we have many practicing and vibrant and curious physicians and clinicians and in two thousand and actually goes back to two thousand and thirteen Some of our lead physicians were Looking at the reasons for people being admitted to the hospital and they were concluding cluding that people really could have been treated and served in the community and and instead what was happening. Was that people. Not only we're going to the emergency room getting set up to a floor in the hospital but oftentimes being discharged in a worse condition than they arrived. Medications were changed changed their care for their their care. Management relationship was getting disrupted and our physicians. At the time that they're there must be a way we can. We can intervene intervene and and what we piloted was the opportunity for the the patient. Actually call their care partner or health outreach worker when they had a escalating condition that they thought as a consumer would require them to go to the emergency room and we piloted sending out highly trained paramedics. That were trained on our protocols Four advanced care in the community and we train the paramedics on How how to how to manage and treat both the geriatric population but as but as well a population that could have significant behavioral health challenges or physical Michael Disability and we piloted this and we We learned that through this experiment that about eighty eighty five percent of the occurrences that historically were playing to the emergency room could be avoided and treated in the community At the same time we learned that for that population there was not a subsequent trip to the hospital within seventy two hours which is usually the the period of if time where if something's not not been resolved their recurrences that someone will go to the Er and at the same time there was a net promoter score of ninety nine which means that ninety nine percent of the time the consumer would refer the service to a friend to us so it was a it was a remarkable success. And we've been we piloting and measuring it and perfecting it and it really became a real program Ah towards the end of two thousand fifteen and then by two thousand seventeen. We started to evaluate whether we could commercialize it and offer it to every one of the subscribers that were enrolling in. CCA's programs and here we sit now in two thousand nineteen. The program is is serving about half the state and by early next year. We will be statewide in. This program will be eligible for all of our consumers so it's better remarkable success. Great thank you. Let me go to one other. Ask you to highlight one another. And that's medically You're medically tailored meals program. This was discussed in a April twenty eighteen health affairs. Article that Several of your staff co-authored This article begins by noting. Food Insecurity is associated with seventy seven billion dollars in excess healthcare care expenditures each year And of course we do know It's a fairly pronounced thirteen percent of households report feud food security Problems and we do know insecurities associated with poor house and increase a big ticket. Health Services is explaining the Excess health expenditures annually. So could you explain How you are conducting running or managing this meals program? Yeah so this is a really good one because one of the things that you know. Obviously we want to provide food security to anyone that is vulnerable vulnerable. And that's really critical for us. We went further to say if we're providing the security of getting someone food if we actually took the meals and tailored them to an individual's diagnosis so in other words. If someone is a diabetic that requires a low sodium diet for example Should we tailor the meals is there potentially a positive impact on doing that And what we learned and was published in the study a you're describing. Is that providing just a meal for an individual there. There's there's there's there's there's not a return on that investment asks meant other than to get someone that's the security they need with the food which from a from a from a social perspective and social responsibility ability as well as program perspective. It's absolutely the right thing to do if we can go. One step further and tailor the the food to someone's Munns medical diagnosis which obviously takes a few extra steps and coordinating The care plan with the meals. Then there's also a positive impact on that individuals. Israel's healthcare costs so so that becomes a scenario whereby we are we are aligning with the person's clinical needs and at the same time creating food security for them and the program is is not only covering it's cost but it's saving money in the long run right. The conclusion of that article said that This severance showed promise and curtailing the use of selected costly health services for a dual eligible. So exactly your point we could run through I did mention you. Run these I found interesting on behavioral. Real health matters these crisis stabilization units. Again you're this. ICMP plus program where you take the highest risk patients from partners healthcare and care for those any number of others. But I do have to sadly get in the question of financing of course always relevant Roland. Obviously how social insurance isn't known or not for paying providers generously. So how are you managing integrating health and social care under your financing limitations. That's a great question I mean first of all Massachusetts has been a pioneer in this concept of creating the the reimbursement structure structure. That aligns both Medicaid which is the state's Healthcare spending with with Medicare which is the federal government's healthcare spending Massachusetts and a pioneer in. This I mean the scope program was launched in two thousand three as an integrated Demonstration that combined the financing so Semester spent a pioneer. I think the folks that that we are serving through these programs are individuals that would would potentially be costing more money and receiving a lower quality of healthcare as well as health and wellbeing if they were in fee for service alone because again we are reducing the avoidable Trips to the emergency room in the hospital which are very costly Ashley Healthcare occurrences We are able to to our approach. Looks at the entire person so that we are able to to you know. Essentially in a lot of these instances spend very small dollars on on food and heat security or if someone has copd needs needs. and An air conditioner I mean again. You're talking about the decision to spend a couple of hundred dollars to provide someone an air conditioner and avoid you know. What could it'd be a ten thousand dollar admission to the hospital because they have trump? Someone has trouble breathing in the warm weather. So we've been a pioneer. We've had that flexibility. We do have to continue to demonstrate seven straight to the state and federal government that there is a return on that investment We have to live within the rates. We use the traditional Medicare advantage edge rate-setting methodologies. We're using mainstream risk adjusted individualized rate-setting methodologies And that aligns with the state's Medicaid rate-setting which is A multi A multifaceted Rate Sell based on someone's Conditions so. We've we've been able to demonstrate that we can live within the these premiums And at the same time You know the last three years in a row. CCA has received the highest Rating of consumer satisfaction based on the CAP survey in. It's one care program. And we've been receiving for four and a half stars from the CMS Medicare advantage quality rating system so so so it is providing this robust healthcare and access to whole person care that I described throughout the podcast But being fiscally responsible role in creating and delivering product at the consumers are finding very very beneficial. Okay thank you. I've my my last question is I wasn't trades interested by reading a bit about this Program Winter Street ventures which I understand in is basically a skunkworks for developing accelerating and scaling a innovation. Can you I found that particularly particularly intriguing. Can you provide an overview of that activity be happy to so winter street. Ventures was my brainchild creation and early. Two Thousand House in Sixteen I'd only been at the Organization for about five months and Learn about the wealth of Entrepreneurs preneurs that were coming through. CCA's doors to learn more about our populations and had thoughts and ideas and Solutions is to solving very difficult. Healthcare problems that we were facing everyday and and there was a few consistent teams that we realized one of which was the entrepreneurs brewers were short on funding They didn't have A think tank to align themselves with to learn more about what healthcare looks like on the frontlines ends either as a provider or health insurance company and they didn't have a a willing audience to test their products with and we happen to have all three so We launched winter street ventures which is exactly what you accurately described it as David. It's It's a IT'S A. It's adventures accelerator. That's putting you know very small capital dollars to work But but is helping spawn Entrepreneur's ideas Around solving the challenges that we're facing every day and just to give you a very very brief example We invested in a company That uses technology to create a proactive voice environment event using the Amazon Alexa. Whereby right? Now unless you say Hey Alexa the the the device will not respond to you and this software Allows that to be proactive meeting. That Alexa will start talking to you before you have to use a wake word and that is really Brilliant brilliant for us because we have so many individuals that are under our care that we need to check in on every day and and figure out if there if they've if they've you've if they've woken if they've had food if they've taken their medications if they're aware of an upcoming healthcare appointment and this technology is is fully customizable sizable per person and can really align with one's fluid care plan and and And it can run automation and if someone responds you know for example if the if if lexuses Hey David did you take your medication today and you say no. I'm not taking it immediately. Your manager or your care partner that I I talked about earlier. We'll get an alert. You need to check in with this with your patient. Because he's not taking his medication or whatever. Whatever that negative response aunt's baby so it's just one example of something that historically that would be four five outbound phone calls that we would have to make and using some type of Robo calling methodology and this is a much more intimate approach that we can? We can push out into the community for less than a dollar a day. Interesting interesting interesting thank you. That's not this life pot I read about is it. That's something else that incorrect product I just described is his life pod. Okay thank you well. It's very interesting conversation. Chris sorry were worried about our time. I'll of course give you The last word. Would you like as a summary comment to make first of all. I appreciate your you're interested in our organization we We believe that our purposes to lead lead the way in transforming our country's health care for individuals rules with you know what we describe as the most significant needs. And and we've we've done this for very long time in Massachusetts and we believe that the type hypoth- care that that this state has pioneered is a pathway for A good healthcare platform for the super users that we're finding being Being paid for by the taxpayers and there are methodologies like what. CCA's doing that can provide someone a better.

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