Transcript Center for Aging Services Technologies (CAST)

The Role of Aging
Service Technologies in
LTC Reform:
Early Medicaid Initiatives
Majd Alwan, Ph.D., Director
Center for Aging Services Technologies (CAST)
Medicaid Congress
June 6, 2008
What is CAST?
Providers of
Aging Services
Tech Industry
Partners
Government
Agencies
CAST
University
Researchers
Associations
A national coalition of more
than 400 organizations
working together to improve
the aging experience through
technology
Why We’re Here
CAST Mission
 Help older adults maximize their independence
 Support professional and family caregivers’ needs
 Improve quality of care and quality of life
 Reduce our nation’s health care costs
 Increase aging services providers’ efficiency
“Shift Left” through Technology
HOME CARE
100%
Healthy,
Independent Living
Community
Clinic
Chronic
Disease Management
Doctor’s
Office
RESIDENTIAL CARE
ACUTE
CARE
Assisted Living
QUALITY
of LIFE
Skilled
Nursing Facility
Specialty
Clinic
Community
Hospital
ICU
0%
$1
$10
$100
COST of CARE/DAY
$1,000
$10,000
Categories of Aging
Services Technologies
1. Safety in the Environment
2. Physical & Mental Health/ Wellbeing
3. Social Connectedness to others
4. EHRs & Point of Care/ Point of
Service
Cost-Effectiveness Proof
Three-month study
on the impact of
monitoring
technology on care

Billable
interventions
Hospital days
75% cost savings
Transferred more time away from paperwork
and towards direct care and reduced workloads.
New York State Medicaid
Home Telehealth
New York State Enacts Medicaid Reimbursement for
Home Telehealth in 2007
[Senate Bill S.2108-C, Chapter 58 of the Laws of New
York (budget bill)]
• State 18-month new Medicaid Waiver pilot that will
evaluate cost effectiveness and assess permanent rate
• The bill is a result of collaborative effort between Visiting
Nurse Services of NY (VNSNY) the NY Home Care
Association, and the NY legislature and executive branch
• Only providers who have existing telehealth programs are
eligible to participate.
New York State Medicaid
Home Telehealth
3-Tier Monthly Reimbursement (rates set by DOH on
2/1/08)
• Tier 1: $270/month/patient – FDA approved Class 2
Device Capable of interoperability with Point of Care
(POC) Software
• Tier 2: $310/month/patient - Interconnected with POC
software
• Tier 3: (rate to be developed) - Interconnected with
EMR and statewide health information network
• Installation Fee: Providers can bill for a "one time"
installation fee of $50 for each Telehealth user.
New York State Medicaid
Home Telehealth
Precursors to Reform:
•
Several home health agencies throughout NYS, including
VNSNY, had begun to pilot Telehealth
• Funded mostly through private grants or self-funded
• Facilitated by NYS Telehealth grants that had been
offered to HHAs since 2003
• Visiting Nurse Services of NY (VNSNY) ran a 500 patient
pilot that demonstrated reduced hospitalization and ER
visits and shared the results with the State
• VNSNY shared with the State its Telehealth Evaluation
tool for Risk & Placement Criteria which help identify
those patients who would benefit most from Telehealth in
the home.
New York State Medicaid
Home Telehealth
The rates cover:
•
•
•
•
•
Monitoring patient vital signs
Patient education
Medication management
Equipment maintenance
Review of patient trends and/or changes in
patient condition and identifying changes
necessitating intervention.
New York State Medicaid
Home Telehealth
Patient criteria for the program:
• Patients who have conditions or clinical circumstances
which require frequent monitoring; and
• Patients for whom Telehealth can appropriately reduce
the need for an unscheduled nursing visits, in-office visit
or acute or LTC facility admission (regulatory definitions
to be resolved).
• Not limited to patients with specific diagnoses;
specific conditions are listed as examples of targeted
patients, these include: CHF, COPD, wound care,
polypharmacy, mental/behavioral problems, technologydependent care etc.
California Initiatives in
Medicaid Waiver Programs
I. Electronic Care Assessment & Management: web-based, with
medication tracking
II. Virtual Multi-Disciplinary Care Team (“Virtual MDT”):
•
Riverside County Office on Aging partnering with other local government
partners including the Community Health Agency, Dept. of Mental Health and
Dept. of Public Social Services (adult protective services)
•
Population is isolated older adults (including Medicaid enrollees) with multiple
and complex health and social issues, as well as victims of elder abuse &
neglect
•
Video-conferencing technology in clients’ homes, satellite office or congregate
setting that is convenient for the older adult enable senior to participate in the
MDT meeting and promote more frequent use of MDTs
•
The technology respects the social dynamic of presence more than phone
conferencing and email
Pennsylvania Initiatives in
Medicaid Waiver Programs
Medicaid 60+ “PDA Waiver” Reimbursement
for Home Telehealth & Telemonitoring
• Reimbursements began Sept. 1, 2007
• Covers range of telecare services provided by home
health, DME providers, pharmacies or hospitals via AAA
contract for specified older adults:
–
–
–
–
Health Status Measuring & Monitoring: $10/day
Activity & Sensor Monitoring:
$200/install $79.95/mo.
Medication Dispensing & Monitoring:
$50/mo.
Personal Emergency Response Systems: $30/mo.
• New Medicaid aging waiver to begin July 2008, with
telecare language pending CMS approval
Pennsylvania Initiatives in
Medicaid Waiver Programs
Medicaid 60+ “PDA Waiver” Reimbursement
for Home Telehealth & Telemonitoring
Requirements:
• Medical need for the services (Dr.’s order) and evidence that services are not
covered under Medicare, State Plan or other third party resources
•
Participants must:
– Meet nursing facility clinically eligible (NFCE) determination
– Meet at least three of the following needs criteria:
• Three (3) or more hospitalizations in the past year
• Frequent, recurrent, repeated or regular use of the emergency room
• Poor adherence with physician orders or medications
• Formal or informal support systems are limited or absent
• Documented history of falls within the last six months that resulted in
an injury that required medical or emergent care
• Lives alone or is at home alone for extended periods of time or care
access challenges (for example, RN shortage, rural access issues, etc.)
– Be cognitively able to operate equipment if needed or have caregiver
– Be in a residence that allow the use of the technology
Pennsylvania Initiatives in
Medicaid Waiver Programs
Virtual Care Management Pilot
• PA Department of Aging and rural AAA covering a four county
area through Medicaid Waiver program planning to pilot
“Virtual care management” to older adults at senior centers/
affordable senior housing communities (co-located) using
high-quality hands free video conferencing technology
• One care manager can serve older adults in several locations,
and/or triage to specialized provider via video conference
(mental and behavioral health, legal aid)
• Provides capacity for “walk-in” AAA services at senior centers
and increased utilization of center programs
• HUD Neighborhood Networks funding available for videoconference technology installation costs and monthly fee at
affordable senior housing communities
Opportunities to Utilize AST’s
in Medicaid LTC
• Existing State LTC Reform Efforts
– 5-year CMS “Money Follows the Person” ($FP) Grants to 30 states and
D.C. are demonstrating how to support persons who transition from SNF
to home setting with LTC services & supports
– Aging Service Technologies have great potential to be important tools for
states to use to achieve $FP goals
– Connecticut, Delaware, Georgia, Iowa, Kentucky, Nebraska, New
Hampshire, New York, North Dakota, Oregon, Pennsylvania, Virginia,
and Washington identified technology in their menu of services to
demonstrate with this population
• HCBS Medicaid Waiver (AAAs)
– Pilot use of technology to serve existing HCBS waiver population like in
PA
– Important to be able to demonstrate cost savings to meet cost neutrality
rules
• Pursue dedicated Medicaid Reimbursement for Telehealth/
Aging Services Technologies
• Pilots and objective evaluation data are key to
reform.
Questions?
Majd Alwan, Ph.D.
Director, CAST
[email protected]
(202) 508-9463
www.agingtech.org