Sustainable Care Financing Projections & Next Steps from the MediCaring Model
Explore the MediCaring Communities Model aiming to ensure sustainable care for frail older Americans at a reasonable cost. Learn about financing projections and steps for implementing this innovative eldercare system using shared savings. Dive into financial simulations, components of the model, and crucial strategies for cultivating change. Discover how to generate savings across diverse communities and track progress efficiently.
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Presentation Transcript
FINANCING FOR SUSTAINABLE CARE IN YOUR COMMUNITY: FINANCING PROJECTIONS AND NEXT STEPS FROM THE MEDICARING MODEL Jim Lee, Altarum Antonia Bernhardt, San Francisco VA Anne Montgomery, Altarum
The MediCaring Communities Model Goal: Assure that Americans can live comfortably and meaningfully at a sustainable cost through the period of frailty that affects most of us in our last years Financing the model Using shared savings to reinvest in community-based services and supports Described in 2016 Milbank Quarterly paper Financing model was developed for 4 communities Akron, OH; Milwaukie, OR; Queens, NY; Williamsburg, VA Model was verified by actuaries at Ernst and Young Demonstrates that it is possible to generate sustainable shared savings to support a re- imagined eldercare system 2
Financial Simulation Shows Savings Across Diverse Communities Per Beneficiary Per Month Savings ($) by Site, Over Time $600 $537 Year 1 Year 2 Year 3 $500 $467 $400 PBPM Savings ($) $328 $285 $269 $291 $300 $250 $253 $234 $200 $153 $136 $125 $100 $- Akron Milwaukie Queens Williamsburg 4
Components of a Financing Simulation Cultivate desire for change and reform Establish projected savings estimates Generate targeting methods Construct baseline estimates Track savings 5
1. Cultivate Desire for Change and Reform Assess scale of local need, including commitment of local leadership and an understanding of any community-specific traits or resources Identify and engage: Medical service providers Community LTSS providers Local officials List of first things to fix 6
2. Generate Targeting Methods Work with community partners to identify target population Develop roll-out processes How many people can you expect to enroll? At which pace can the roll-out take place? When can you expect to have the full roll-out complete? 7
3. Construct Baseline Estimates Work with community partners to identify: Start-up and administrative costs Trainings for administrators and providers Cost of building any necessary technical infrastructure Marketing/consumer education materials and outreach Developing standards and protocols Baseline medical costs and service use Market prices for major healthcare goods and services CMS Hospital Referral Region (HRR) public use files 8
Baseline Estimates Akron, OH Payment per Unit Utilization Rate PBPM Medicare Spending PBPM Service Unit of Service Inpatient hospitalization Covered Stays $11,435 .08 $881 Outpatient hospitalization Visits $289 1.02 $295 $70 Emergency Services Visits $571 .12 Primary Care Visits $83 3.00 $249 Specialty Care Visits $156 .76 $118 Diagnostic imaging Events $44 .82 $36 Laboratory Services Tests $31 1.51 $47 DME Events $151 .42 $63 Hemodialysis equivalent treatment Dialysis $297 .40 $118 SNF Covered Days $522 .54 $281 9
4. Establish Projected Savings Estimates Work with community partners to identify medical utilization savings estimates Potential sources Milbank article as starting point Academic literature review Federal and state resources Build in projected ramp-up timeline 10
Per Person Annual Cost Estimates Akron, OH Without MediCaring With Service Category Percent Change Absolute Change MediCaring Inpatient Hospital $966 $725 -25% -$242 Outpatient Hospital $331 $364 10% $33 Professional Primary Care $270 $351 30% $81 Skilled Nursing Facility $315 $252 -20% -$63 Medicaid-covered Long- Term Care $2,307 $2,191 -5% -$115 11
5. Track Changes Work with community partners to build a set of metrics through which to assess progress Consider establishing a dashboard to improve leaders ability to conduct continuous monitoring 12
MediCaring Communities Financial Simulation Return on Investment, Years 1- 3 350% Akron 300% 289% 279% Milwaukie Queens 250% Return on Investment (%) Williamsburg 200% 148% 150% 100% 97% 50% 0% -50% Year 1 Year 2 Year 3 -100% 13
Discussion Could this work in your community? What are some challenges that you d expect to face in your area? What are some of your community s unique strengths in this area? How would you identify community partners and sources of information? How could your organization help? 14
