Chronic Disease Self Management
Education
Wellness/Risk Assessment and
Chronic Care Management
Falls Prevention
Depression Counseling
Surfing with the Board to Catch the Age Wave Steven E. Marcus, President and CEO
Health Foundation of South Florida/Florida Heath Networks
Carol Nohelia Montoya, Network Director
Florida Health Networks
Health Foundation of South Florida
Not-for-profit grantmaking organization established in 1993, dedicated to health in South Florida.
• Our support fuels:
– Programs – Policies – Systems changes
Engaging a broad network of effective partnerships, including elected officials, government agencies, business leaders, other funders, and communities, while finding and integrating smart, lasting solutions to key health issues.
Why Healthy Aging?
• The population age 65 and older represents 14.5% of Americans.
• Florida has the highest percentage of older adults in the United States with 25.7% of its population being 65 and older (US Census 2016 estimates) – 51.7% have arthritis – 23% have diabetes – 21.5% had reported coronary heart disease, heart
attack, or stroke
Florida Department of Health, 2016
Toward an age-friendly world…
Age-Friendly Communities
Housing
Social Participation
Respect and Social Inclusion
Civic Participation
and Employment
Communication and Information
Community Support &
Health Services
Outdoor Spaces and Buildings
Health Foundation of South Florida Response
• Healthy Aging Regional Collaboration (2008-2016) supported learning collaborative and evidence-based program in the following areas:
– Fall prevention
– Physical activity
– Self-management education and support (Stanford menu of Chronic Disease Self Management Education Programs)
– Depression
Healthy Aging Regional Collaborative
• Six year implementation, 29 agencies offered one or more of the following evidence-based programs: – EnhanceFitness (EF): physical fitness – Living Healthy (LHP): chronic disease self-management – Tomando Control de su Salud (TCS): chronic disease self-
management – Diabetes Self-Management in English (DSMP-E): diabetes self-
management – Diabetes Self-Management in Spanish (DSMP-S): diabetes self-
management – A Matter of Balance (MOB): increase mobility through reduced
fear of falling – Asunto de Equilibrio (ADE): increase mobility through reduced
fear of falling – Healthy IDEAS (HI): depression case management – Walk With Ease (WWE): self-directed walking program
Reach in Six Years
Total number of workshop attendees from all programs over all six years was 40,365 persons. On average 30% of participants participated in two or more programs yearly.
Percent of
Participants
By Age Group
Healthy Aging Regional Collaborative Outcomes…
• Created a collaborative atmosphere among the
community-based agencies who have participated as members in HARC
• Member agencies show a commitment and dedication to continue to offer the evidence-based programs chosen by HARC to older adults in South Florida
Develop a system that would allow for the continued and long-term maintenance of evidence-based programs in South Florida by community-based agencies
Current
• Right now catching a major wave is near! (additional story telling)
• Decision making two major umbrellas external branding and marketing and internal
Decision Making Process to create a Statewide Network
• HFSF and Board commitment to support and expand health and wellness services throughout the state
• Board decided to create a separate FHN committee
• Obtaining and securing additional funding
• Identify network partners
• Selecting evidence-based programs
Decision Making Team: Board of Director CEO and President Finance Director Project Director
Florida Health Networks
• Created in 2014, upon success of HARC
• FHN through Falls Prevention and CDSME projects has provided network partners the following services: – Evidence-based program trainings – Statewide evidence-based licenses – Data management – Quality assurance – Technical assistance – Additional funding to expand the delivery of health
and wellness programs
Provider Network
Each AAA/ADRC has a network that includes:
• Senior Centers • Elder Housing • Nutrition Sites • Parks • Community
Centers • YMCA • Adult Day Care • Public Libraries • Centers for
Independent Living
Resources/Challenges
Internal Operations
• Staff
• Administrative
Board Members
• HFSF Board
• FHN Committee
Network Partners
• Statewide Delivery Organizations
• Readiness/Needs
Healthcare Providers
• Referral
• Sustainability
Additional Resources
• Financial
• Data Management System
• Billing
The Undertow
• Finance
• Operation
• Board
• Network Partners
• Healthcare Providers
Internal Operations
• Brief Staff History
• Defining staff roles based on needs and administrative changes
• Establishing Fiscal/Financial roles and responsibilities between FHN and HFSF staff
• Contract Monitoring (HFSF/FHN)
• Integration of FHN into Board Meetings
Getting on and off the Board
Continuous Education of Board Members on Statewide Network
• FHN Committee is created
• In 2014, HFSF awards FHN
a $300,000 grant
• May 2015 HFSF approved a
$425,000 line of credit
• Contracting with a Specialty Care Company
• Successes of FHN in
securing ACL grants and other Foundations program grants
• In 2017, Board approved
line of credit increase to $1.2 million for FHN
Surfing through the Waves
• Early stages of FHN we thought we were about to catch some big waves
• HARC outcomes and that the programs were already acknowledged by major Universities for having evidence based outcomes.
• We were wrong!
• Needed to gain trust and respect
• Demonstrate a reduction in claims, current cost saving benefits, and
health metrics for the Health Plans to use our services
• Value of our services related to HEDIS, Star ratings, MIPS, CAHPS measures
Surfing through the Waves
What we needed to become a champion surfer:
– Better slicker faster surf
board to surf out the health plan waves
– Specialty care company (SCC) that had a long standing relationship with some of the biggest Medicare advantage plans and could be a value added partner to increase our credibility.
• Recently signed an agreement
– Develop the relationship to
create an administrative services agreement
– fill the service gap
– Relationship with designated SCCs representatives
– Included data, training, help develop contract, training of their own staff
Challenges
• Network Partners: – Large number of partners, diverse,
accustomed to working independently, governed by different priorities
• Healthcare Providers – Cultural issues: for profit vs non for profit
cultures
– Community vs clinical interventions: trust issues
Network Partners
• Uneven Network Partner’s
readiness • Uneven availability of
Human and Financial Resources
• Uneven Organizational Capacity
• Recruitment of leaders/coaches
• Program Trainings • Quality Improvement
Processes • Billing and Data Services
Healthcare Providers
• Engaging multi-sectorial healthcare providers
• Securing contracts with healthcare providers
• Education on Evidence-Based programs
• Benefits of outsourcing the delivery of the programs to community based organizations
• Marketing and Branding • Hedis, Star Rating, and CAHPS
benefits for Health Plans • Proving concept and providing
local data and/or ROI
Outreach
Knowledge Exchange
Community Involvement
Self-Management
Resources
• Financial
– HFSF continuous backing and support
– Grants
– Contracts
• Data Management System
• Billing
Financial
Grants • 2014:
– ACL Falls Prevention Grant $400,000
– HFSF $300,000
• 2015: ACL CDSME Grant
$900,000
• 2017: – ACL CDSME Grant
$757, 590 – Humana Foundation
$118,500 – Weinberg Foundation
$272,870
HFSF In-Kind Support Services Provided by HFSF staff:
– President and CEO – CFO – VP of Communications
• CMS consultant (Tim McNeil)
has provided guidance on billing codes for specific programs and through ACL CDSME grant.
FHN funding: - Grants - Health Foundation Line of Credit - HFSF In-Kind Support
HFSF Line of Credit
Line of credit covers annual expenses (office rent, staff salary, telephone, office utilities, etc.)
– 2015: $425,000
– 2016: $1.2 million
Data Management System
Operations staff responsible for data analysis and for managing multiple data bases for different uses:
– Centralized Database created for programs
– HIPAA compliant system with capacity to provide reporting to healthcare partners
– System able to provide data for ROI and for billing
Billing Services
FHN requires the capacity to provide billing services to partners. Board decided not to pursue own Medicare number instead FHN:
• March 2015: FHN signed a contract with Comprehensive Care Alliance to provide billing service to statewide network. CCA would receive a percentage of the total amount billed by FHN.
• January 2018: FHN signed a contract with Provider Network Solutions to provide administrative services including billing.
Why FHN Works?....
• Existing Relationship of Network Partners with sustainability partners and/or healthcare providers
• Network partners experience in providing health and wellness services to older adults
• Success of evidence-based programs
• Ability to work with health plans/ healthcare partners and provide behavior change programs
Questions?
