Achieving Medicare Reimbursement to Sustain …...Achieving Medicare Reimbursement to Sustain CDSME...

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Achieving Medicare Reimbursement to Sustain CDSME Programs: A Road Worth Traveling Yuliya Gaydayenko, MA, LMSW Jewish Family Service of Metropolitan Detroit Kristin Overton, MBA Spectrum Generations Annette Demeny, DTR Centralina Area Agency on Aging Moderator: Karol Matson, RD, CDE Partners in Care Foundation May 23, 2018

Transcript of Achieving Medicare Reimbursement to Sustain …...Achieving Medicare Reimbursement to Sustain CDSME...

Page 1: Achieving Medicare Reimbursement to Sustain …...Achieving Medicare Reimbursement to Sustain CDSME Programs: A Road Worth Traveling Yuliya Gaydayenko, MA, LMSW Jewish Family Service

Achieving Medicare Reimbursement

to Sustain CDSME Programs: A Road

Worth Traveling

Yuliya Gaydayenko, MA, LMSWJewish Family Service of Metropolitan DetroitKristin Overton, MBASpectrum GenerationsAnnette Demeny, DTRCentralina Area Agency on Aging

Moderator: Karol Matson, RD, CDE Partners in Care Foundation

May 23, 2018

Page 2: Achieving Medicare Reimbursement to Sustain …...Achieving Medicare Reimbursement to Sustain CDSME Programs: A Road Worth Traveling Yuliya Gaydayenko, MA, LMSW Jewish Family Service

Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 2

Medicare Reimbursement Learning Collaborative

Ten community-based organizations

work together over a 12-month period

toward achieving Medicare

reimbursement for their CDSME

programs and accreditation for their

diabetes programs (for those focused

on diabetes self-management

education and support services).

Integrated, sustainable service

systems for CDSME programs

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Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 3

About the Learning Collaborative

• Intensive, targeted technical assistance over 12

months

• A rich, dynamic, and interactive learning

environment

• Learning is a shared responsibility

• Learning is tested and applied in real-world

settings

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Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 4

Focused on Medicare Part B Benefits

• Chronic Care Management (CCM) - Care coordination and care management for individuals with multiple (two or more) chronic conditions

• Diabetes Self-Management Training (DSMT) - Outpatient diabetes education and training services

• Health and Behavior Assessment and Intervention (HBAI) - Services to address psychosocial barriers that affect management of one or more physical health conditions

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Achieving Medicare Reimbursement to Sustain CDSME Programs: A Road Worth Traveling

Chronic Care Management: One CBO’s Journey

Yuliya Gaydayenko, MA, LMSW

Senior Director of Older Adult Services

Jewish Family Service of Metropolitan Detroit

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CBO: Jewish Family Service of Metropolitan Detroit

•Budget: Over $11 mln

•Staffing: • 120 staff• 2 locations

•3 Main Areas of Services:•Older adults •Outreach/education•Mental health counseling

•Community Partnerships: A major strategy

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Sustaining Core Services and Innovation

•Current funding

•Incorporating evidence-based and research-based interventions (CDSME, Mind University, AIMS, BRI Consultations, SHARE)

•Specialized population services

•Sustainability

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Chronic Care Management

•Population: Underserved communities

•Goal: The project will deliver an integrated service addressing health management and social determinants of health with improved population health outcomes and increased patient satisfaction at no additional cost to physician while creating a sustainable model of care

•Service Model:•Partnership with a primary care provider•Adding HBAI and DSMT billable interventions•Clinical support

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Moving Forward: Network Development

•Senior Regional Collaborative: A partnership of 30 member agencies

•Capacity Building

•Applying to participate in the NCOA’s National Learning Collaborative for Network Development

• Identifying additional local partners and champions

•Designing a new strategic plan

•Engaging local funders

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Resources

•Southeast Michigan Senior Regional Collaborative

http://www.semisrc.orgJewish Family Service of Metropolitan Detroit

http://www.jfsdetroit.org

•Yuliya [email protected]

http://www.semisrc.org/
mailto:[email protected]
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Kristin Overton, MBA, Spectrum Generations

www.healthylivingforme.org

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About Us

•Spectrum Generations•Area Agency on Aging

•2016 CDSME Grant Awardee• 2016 Falls Prevention partner

•Revised Goals•Create a network of providers•Develop financial sustainability

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Developing Our Business Model

•Operational Concept Developed• Systems use document•Operational concept paper•Marketing & advertising plan

•Break-Even Analysis • 96 classes per year

• Joint-Venture Begun• Spectrum Generations & SeniorsPlus

• Investing in Infrastructure•www.healthylivingforme.org

http://www.healthylivingforme.org/
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Building Referrals and Marketing Our Services

•Creating a Value Proposition •Understanding 4 Different Target

Markets:• Leaders• Participants• Potential Delivery Partners• Funders

•Marketing and Advertising Plan•Multi-Prong Strategy:

• Social Media• Online• Print• Advocacy

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Clinical Wrap-Around

•Medicare Advantage v. Original Medicare• LCSW v. psychologist or nurse practitioner

•Per Diem Staff•Preparing for staff

•Building Relationships•Physicians – Chronic care management focused•Health plans – Start with who you know

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What’s Next: Growing and Expanding Our Services

•Gradual Process• Expecting first billable class in 12 months

•Original Medicare for HBAI (2019-2020)•Medicare provider enrollment• 3rd party billing agent•Medicare consultant

•DSMT (2020-2021)•Registered Dietician on staff as Assistant Nutrition Director

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Achieving Medicare Reimbursement to Sustain CDSME Programs: A Road Worth Traveling

DSMT

CENTRALINA AREA AGENCY ON AGING

Annette Demeny, DTR

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Centralina AAA

About Us

There are 16 Area Agencies on Aging in North Carolina

Centralina AAA is the 2nd largest AAA in NC

Serves the nine county region surrounding Charlotte

Demographic area is both urban and rural

Offer a variety of services from planning services, training and education and direct services

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The AAA Approach

Business Acumen Framework, Strategy & Implementation

Know True Cost of Delivery

Understanding Population & Need Utilizing Existing Programs

Partnership

Sustainability & Growth

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Marketing & Referral

Understanding Marketing Ecosystem

Recruitment of Leaders

Recruitment of Stakeholders

Recruitment of Class Participants

Marketing / Advertising Staff In the Field

Social Media

Community Outlets

Referrals Know Your Clients

Elevator Speech

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Billing and Documentation

Eligible Beneficiaries

Navigating Medicare

Client Information Tracking

Claims Processing

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Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 22

Learn More! Log On to NCOA’s Roadmap to CIHC

www.ncoa.org/cha/roadmap

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Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 23

Contact Information

• Yuliya Gaydayenko, MA, LMSW

Jewish Family Service of

Metropolitan Detroit

6555 W Maple Road

West Bloomfield Township, MI 48322

(248) 592-3962

[email protected]

• Kristin Overton, MBA

Spectrum Generations

1 Weston Court, Suite 109

Augusta, ME 04330

(207) 620-1673

[email protected]

• Annette Demeny, DTR

Centralina Area Agency on Aging

9815 David Taylor Drive, Suite 100

Charlotte, NC 28262

(704) 348-2736

[email protected]

• Karol Matson, RD, CDE

Partners in Care Foundation

732 Mott Street, Suite 150

San Fernando, CA 91340

(818) 837-3775, Ext. 114

[email protected]

mailto:[email protected]
mailto:[email protected]
mailto:[email protected]
mailto:[email protected]

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