Innovations Driving Better Care and Outcomes

Innovation is constantly driving change in healthcare. Some health plans are quick to adapt and implement new programs to improve care and outcomes. Learn how one plan has led the way with an innovative program for dually eligible members that delivers medically tailored meals. They will share how the plan implemented this program and its significant impact on utilization and costs.

Transcript

1. An Apple a Day… Lori Wiviott Tishler, MD MPH Vice President of Medical Affairs, CCA
2. An Apple a Day
3. 3 • Based in Massachusetts, CCA is a not-for-profit, community-based healthcare organization. • Dedicated to improving care for individuals dually- eligible for MassHealth (Medicaid) and Medicare. • Mission of providing the best possible care, individually tailored to the members and patients we serve. • Nationally recognized for innovative model of care that improves quality and health outcomes while reducing overall cost of care. What is Commonwealth Care Alliance?
4. 4 Two Plans: 27,000+ Complex Members 14x cost of caring for One Care-eligible population averages to about $2,858 per member per month, 14 times the average for general population 63.5% have a serious mental illness such as schizophrenia, bipolar disorder, or severe depression (excluding substance use disorders) 49% have four or more chronic conditions 31.6% have a substance use disorder (excluding tobacco and nicotine) 7.5% are homeless 76.2 average age 65% are nursing home certifiable, yet are able to live at home 58.7% primarily speak a language other than English 63% have four or more chronic conditions 55.9% have diabetes 10.7% have a major physical disability (paralysis, spinal cord injury, multiple sclerosis, muscular dystrophy, cerebral palsy, ventilator-dependent, etc.) One Care Senior Care Options Updated 8/18, Statistics as of 12/1/17
5. 5 CCA has been able to show results in improving care for Senior Care Options members and helping them avoid hospital stays: • 27% decline in acute admissions per 1,000 from 2011 to 2017. • 5.7% decline in 30-day hospital readmission rate from 2012 to 2017. • 4% decline in total cost for providing ambulatory medical care, per member per month, from 2016 to 2017. • 1.9% decline in total cost for acute inpatient care, per member per month, from 2015 to 2017. Positive Results CCA has been able to show results in improving care for One Care members and helping them avoid hospital stays: • 3.3% decline in acute admissions per 1,000 from 2015 to 2017. • 6.7% decline in 30-day hospital readmission rate from 2015 to 2017. • 2.1% decline in Emergency Department visits per 1,000 from 2016 to 2017.
6. 6 Long-Term Services and Support Are Key We recognize the importance of long-term services and support in helping individuals maintain their independence, remain community-dwelling, and preserve functional status. Developing partnerships with community-based organizations is central to our approach. Image: California Collaborative for Long Term Services and Supports: http://www.ccltss.org/
7. 7 Something Important Was Missing From the Previous Slide...
8. 8 Food Insecurity Is Not Conducive to Good Health Outcomes (or Decreased Costs) • In 2016 up to 9.7% of Massachusetts households were food insecure, leading to an estimated increase in health care costs of 2.4 billion dollars (77 billion across the US). • Costs more to care for people with diabetes, obesity, chronic pulmonary and heart disease, among other chronic illnesses.
10. 10 Food as Medicine • Partnering with Mass General, AARP Foundation, and Community Servings we examined the impact of home delivered meals covered by CCA on utilization metrics. • Medically tailored meals vs. “Standard” Meals- on-Wheels type vendor. • The cost was $350 for the home delivered meals and $146 for the non-tailored meals. Each member got 5 days of lunches, dinners (and healthy snacks in the MTM group). • Each member was referred by their caregiver and met CCA criteria for authorization of home delivered meals.
11. 11 Both Groups Did Better
12. 12 Other Data
13. 13 It Makes Sense (and Cents) Economically
14. 14 Is Food Medicine?
15. 15 What are you tackling? What’s most important to you and your organization?
16. Thank You!