NEW CHALLENGES AND OPPORTUNITIES FOR NUTRITION PROGRAMS IN THIS CHANGING

ENVIRONMENTLinda Netterville, MA, RD, LD

Dietitian Consultant, DADS

SESSION OVERVIEW

The changing community and healthcare environment

Challenges

Opportunities

Building sustainability for the future

CHANGING ENVIRONMENT

Factors

Dem

og

rap

hic

s

Reso

urc

es

Bu

sin

ess

Healt

hca

re

CHANGING DEMOGRAPHICS

More older peopleMore healthy older people

More frail older people

More minoritiesMore HCBS, less nursing home care

MOST OLDER TEXANS 60+ YEARS LIVE IN THE

COMMUNITY

Community 4.01 M; 97.7%

Nursing Homes 95,640;

2.3%

AGID Database

TEXAS PERCENT OF 6O+POPULATION

2006 2007 2008 2009 2010 2011 201212.5%

13.0%

13.5%

14.0%

14.5%

15.0%

15.5%

16.0%

13.9%14.2%

14.5%14.8%

15.1%15.4%

15.8%

Years

% o

f Tota

l Sta

te P

opula

tion

PROJECTED POPULATION 60+

2010 Projection 2020

Projection 2030

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

3.8 mil 5.3 mil

6.7 mil

Texas 60+

Texas 60+

TEXAS POPULATION OF 60+

Texas -

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

1,263,643

1,645,334

594,875

472,257

60 to 64 years 65 to 74 years 75 to 84 years 85+ years

PERCENT OF AMERICANS AGE 65 EXPECTED TO SURVIVE TO AGE 90

1940 1960 1980 2000 20500

5

10

15

20

25

30

35

40

45

7

14

25 26

42

CHANGING LIFE EXPECTANCY

1910 1930 1950 1970 1990 20090

102030405060708090

51.559.2

68.1 70.876.8 78.5

11.6 12.2 13.8 15 17.3 19.2

4 4.2 4.7 5.3 6.2 6.7

Life Expectancy by Age

At BirthAt age 65At age 85

Older Americans 2012: Key Indicators of Well-Being

CHANGING RESOURCESGOVERNMENT/PUBLIC FUNDING

Older Americans ActTitle III (C1, C2, NSIP), V, VI

Other Federal Social services or community service block grants

State-Vary by State

EXPENDITURES PER MEAL-TEXAS BASED ON STATE PROGRAM REPORTS SUBMITTED TO ACL/AOA

2006 2007 2008 2009 2010 2011 2012$0.00

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

$7.00

4.77046269967109

5.185.12845439980

431

5.522130273346815.59806238079

5455.46721095020

094

5.79663687056703

$2.17$2.58$2.62

$2.84$2.67$3.05

$3.35

Congregate Meals-TX

Expenditures per mealTitle II per meal

2006 2007 2008 2009 2010 2011 2012$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

$4.00

$4.50

$3.13$3.13$3.08$3.22$3.42$3.39

$4.01

$1.34$1.34$1.18$1.14$1.26$1.28$1.39

Home-delivered Meals-TX

Expenditures per mealTitle III per meal

% OF TITLE III IN TOTAL EXPENDITURES FOR MEALS

2006 2007 2008 2009 2010 2011 2012

43.0% 42.9%

38.3% 35.4%

36.9% 37.8% 34.7%

% of Title III Home-Delivered- Texas

FEDERAL FUNDING SOURCES

OAA Funding Medicare/Medicaid (Title III) (ACOs, MLTSS, Duals) $2.1 Billion $11.5 Billion

BUSINESS DEMANDS

Service needsQuality ServicesAppropriate services: cultural, religious, therapeutic

ChoiceDiversityHCBS Services

CHANGING BUSINESS PRACTICES

For Profits Expanding into non-traditional markets Offering competing services Restaurants, groceries, fitness options

Non-Profits Becoming more entrepreneurial Developing community partnerships Identifying other funding streams

TECHNOLOGY TO ASSIST

Data collection and sharing information with healthcare

Billing systems compatible with healthcare

Improved service and delivery modelsRouting/scheduling

Telemedicine

THE CHANGING HEALTHCARE MARKET

Patient Protection and Affordable Care Act of 2010 Triple AimBetter careHealthier peopleSmarter spending

THE CHANGING HEALTHCARE MARKET DRIVEN BY CMS

Medicare-Title XVIII of the Social Security Act, long term disabilities, end stage renal, 65 or older

Part A

Part B

Part C- (Medicare Advantage)

Part D-(Prescription)

Medicaid -Title XIX of the Social Security Act, low income, children, elderly, blind or disabled (Jointly funded by the state)

THE CHANGING HEALTHCARE MARKET

Services must meet the needs Customer- Payer (MCO, Insurance, Hospital)

Consumer-Beneficiary (client)

Focused on quality metrics and improved outcomes

Payers assume the risk

Want a clearly defined Return on Investment (ROI)

Opens the door to For-Profit entities

CHANGING CARE SYSTEMS

Medicaid LTSS- Managed CareLong Term Services and Supports (LTSS)

Home and Community Based Services (HCBS)

Health Care/Care TransitionsAccountable Care OrganizationsBundled Payment Initiatives

LONG TERM SERVICES AND SUPPORTS (LTSS)

Target Audience Older adults People with disabilities

Include: Residential care in facilities

Home and community-based (HCBS)

Support: Managing chronic conditions

Accomplishing everyday tasks (IADL, ADL)

HOME AND COMMUNITY BASED SERVICES (HCBS)

Target Audience Older adults People with disabilities

Support Living in the Community

Funding Sources Older Americans Act (OAA)

Medicaid Social Services Block Grant (SSBG)

Education and Rehabilitation Funds

State General Funds Local Funds

CARE TRANSITIONS

Coordination and continuity of health care based on a plan of care

Include: Hospitals Sub-acute And Post-acute Nursing Facilities The Patient's Home, Primary And Specialty Care Offices Long-term Care Facilities

ACCOUNTABLE CARE ORGANIZATION (ACO)

Groups of doctors, hospitals, and other health care providers

Provided to Medicare beneficiaries.

Provide coordinated care and chronic disease management while lowering costs.

OPPORTUNITY KNOCKS!

OPPORTUNITIES-WHO ARE CURRENTLY BEING SERVED- TEXAS

Current Population

Percent

60+- TX

4,105,225 Nutrition

Program Served Total (2012) 134,760 3.3%

Congregate Served 71,318 1.7%

Home-Delivered Served 63,442 1.5%http://www.agid.acl.gov -State Program Reports- 2012

OPPORTUNITIES TO BUILD SUSTAINABLE RESOURCES

Social EntrepreneurshipFor Pay optionsHealthcare entities

SOCIAL ENTREPRENEURSHIP

Catering Contracts Expansion of Nutrition Services

Nutrition CounselingGrocery Shopping

Other Program OpportunitiesUSDA Child Nutrition Programs

FOR PAY OPTIONS

Relook at “for pay” optionsOther servicesTiered servicesExpanded services

THE ROLE OF NUTRITION SERVICES

Something Magical Happens!

CLIENTS VALUE THE PRODUCT

Home Delivered Congregate

Able to eat healthier

foods83% 78%

Meal enabled living at home

92% 60%

AoA Survey of OAA Participants, December, 2011, http://www.agidnet.org

ROLE OF NUTRITION SERVICES

Value of Nutrition to Chronic Health Conditions

Heart disease

Hypertension

Diabetes

Osteoporosis

Kidney disease

Obesity

ROLE OF NUTRITION SERVICES

Other Nutrition Services

Nutrition Counseling

Nutrition Education

Nutrition Assessment

ROLE OF NUTRITION SERVICES

Value AddWellness/Safety CheckRegular contact in the homeTrusted in the homeClient status (moved, hospital, nursing home)

Perform Regular In-home Assessments

KEY FINDINGS-MORE THAN A MEAL STUDY

Those receiving home-delivered meals: Improvements

Anxiety Self-rated health Isolation Loneliness

Reduced rates of: Hospitalizations Falls

KEY FINDINGS-MORE THAN A MEAL STUDY

Those receiving daily meal delivery:

Improvement in mental health (anxiety)

Improvement in self-rated health

Reductions in the rate of falls

Improvement in feelings of isolation and loneliness

Decreases in worry about being able to remain in home

KEY FINDINGS-MORE THAN A MEAL STUDY

Those receiving daily delivered compared to weekly:Feel saferHelped them to eat healthier foodMore social contactsLess loneliness

KEY FINDINGS-MORE THAN A MEAL STUDY

Those receiving daily delivered and lived alone:Decrease worry about being able to remain in the home

Improvements in feelings of isolation and loneliness

OPPORTUNITIES FOR NUTRITION PROGRAMS

Valued added serviceService and delivery structure in place

Trusted entity with long history of success

Linked to other community-based service

Community partnerships

WHAT CAN YOU DO?

Know:

Health Reform activity in your community Medicare Advantage Plans Medicaid Managed Care initiatives ACOs Bundled Payment Initiatives

Competition

Partners

Champions

41

WHAT ARE HEALTH ENTITIES SEEKING

Meet consumer needs Choice of meals, special or modified diets, flexibility)

Access to the consumerCoverage for the entire service area (1 contract)

Easy to submit referrals for servicesMeet quality metricsData provided to show improved outcomes

HOW CAN YOU COMPETE?

Organizational culture change (staff qualifications, characteristics, inter-organizational operations)

Strategic business plan

Development and structure of community-based networks

Service packages (identifying, pricing and packaging services)

Marketing and sales strategies

HOW CAN YOU COMPETE?

• Communication and negotiation techniques Addressing program capacity challenges (developing, increasing, and managing the capacity of the program to deliver services)

Continuous quality improvement (setting standards, defining and measuring outcomes, monitoring)

Risk management (identifying, accepting, and managing)

Information technology (IT) system

ASSURE THE CAPACITY OF YOUR ORGANIZATION TO DELIVERServicesMethods of production/delivery - Meals

Methods of development/delivery Steps necessary to provide to provide the product (meal, nutrition education, etc.) and services

Capacity, expertise, human resources

PILOT PROJECT

Pilot through the National Resource Center on Nutrition and Aging and MOWAT

• Understand the changing landscaper

• Identify the opportunities for the Nutrition Program

• Help to develop the skills needed to:• Develop support services• Negotiate Contracts• Billing• Reporting

PILOT PROJECT- 5 PROGRAMS

FINAL WORDS

Know Your MarketKnow Your CompetitionStudy Your CustomerOrganize, Plan, and Execute

THE ROLE OF NUTRITION SERVICES

BUILDING THE BRIDGE

Healthcare

HCBSNutrition Services

WE HAVE TO GET IT RIGHT!

DISCUSSION

What is the vision for your nutrition program?

What are the tools and resources that you need to position your program now and into the future?

RESOURCES: WWW.NUTRITIONANDAGING

.ORG Recorded NRCNA Webinars—Positioning Your HCBS Program in the Healthcare Market Webinar Series  Part 1: Overview of Health Reform Initiatives - How this Affects Your Organization and Terminology 101

Part 2: Market Analysis - Determine Health Reform Initiatives in Your Market Area

Part 3: Network Collaboration - The Need for Collaboration

Part 4: Developing a Strategy and a Business Model for Your Organization

Part 5: Positioning Your HCBS Program in the Healthcare Market

RESOURCES:

More That a Meal Studyhttp://www.mealsonwheelsamerica.org/theissue/facts-resources/more-than-a-mealThe Growth of Managed Long-Term Services and Supports (MLTSS) Programs: (January 2012)

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/downloads/mltssp_white_paper_combined.pdf