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Health Care Reform, Chronic Care Management, Care Transitions and the Future of Nursing

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Health Care Reform, Chronic Care Management, Care Transitions and the Future of Nursing Duke Carolina Visiting Professorship in Geriatric Nursing – PowerPoint PPT presentation

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Title: Health Care Reform, Chronic Care Management, Care Transitions and the Future of Nursing


1
Health Care Reform, Chronic Care Management, Care
Transitions and the Future of Nursing
  • Duke Carolina Visiting Professorship in Geriatric
    Nursing
  • Duke University School of Nursing
  • May 5, 2010
  • William A. Dombi
  • National Association for Home Care Hospice
  • wad_at_nahc.org

2
Health Care Reform What Happened
  • Health Insurance Reform
  • Expanded Coverage of the Uninsured
  • Medicare Spending Reductions
  • Health Care Cost Containment???
  • Health Care Delivery Reform???

3
Health Care Reform
  • There is much more of health care cost and care
    delivery reforms than mass media has focused on
  • Great attention paid to
  • The public option
  • death panels
  • States rights

4
Health Care Reform
  • Without public fanfare, the HCR legislation will
    revolutionize significant parts of health care
    delivery
  • Preventive care coverage expansion
  • Primary care supports
  • Accountable Care Organizations
  • Transitions in Care plans
  • Acute and post-acute care payment bundling
  • Long term care and chronic care management
  • Workforce supports
  • All these reforms involve nurses as central
    players

5
Health Care Reform
  • Long Term Care and Chronic Care Management
  • CLASS Act
  • Medicaid Home and Community Based Care Expansions
  • Federal Coordinated Care Office
  • Special Needs Plans
  • Medical (Health) Homes
  • Independence at Home pilot
  • HHA-based chronic care management demonstration

6
CLASS Act Long Term Care Returns to the Agenda
  • Community Living Assistance Services and Support
  • Payments made to cover individuals with ADL needs
    in home or nursing facility
  • Federal LTC insurance program
  • Premium withholding in wages
  • Opt-out of program authority
  • Participation begins 2010
  • Eligibility based on ADL needs
  • Benefit payments begin in 2016
  • Preset daily payment to insured
  • Boon to Private Pay home care starting in 2016

7
Medicaid Provisions HCBS Expansion
  • Major home care expansion/rebalancing through
    federal money (FMAP)
  • Community Free Choice Option
  • Removal of barriers to HCBS services
  • Money Follows the Person Demo extension
  • Spousal impoverishment protection

8
Chronic Care Management
  • Federal Coordinated Care Office
  • CMS based
  • Coordinate Medicare ad Medicaid dual eligible
    patients
  • Develop coordination tools
  • Special Needs Plans
  • Reauthorized through 2013
  • Refocus on enrollee characteristics

9
Chronic Care Management
  • Medical (Health) Homes
  • Grant programs and Medicaid supports
  • Interdisciplinary team approach
  • Required hospital referrals on Medicaid patients
  • Retains Medicare demo and includes authority for
    CMS Innovation Center creation of more models

10
Independence at Home
  • Pilot Program
  • Physician-centered interdisciplinary team
  • Focus on patients with
  • 2 or more chronic illnesses
  • Recent hospital, SNF or HHA admission
  • Shared savings based payment
  • Coordinates care across all settings
  • Specialized physician qualifications

11
HHA-based Chonic Care Management
  • CMS Innovation Center based demonstration
  • Nurse/care coach centered
  • Interdisciplinary team
  • Direct patient contact
  • Use of remote monitoring technologies
  • Shared savings reimbursement

12
Medicare/Medicaid Payment Bundling
  • Flexible authority for CMS
  • Many approaches to bndling available
  • Likely will include hospital, physician, and
    post-acute care
  • A community care-based bundling model possible

13
Community-Based Care Transitions Program
  • Medicare demonstration program
  • Competitively selected
  • Targets high readmission rates
  • Supports beyond routine discharge planning
  • Expansions possible by HHS authority

14
Workforce Supports
  • Primary Care physicians, NPs, Pas
  • Nurses
  • Direct care workers
  • Home care aides

15
Workforce Supports
  • Nurses
  • Student loan program
  • Loan repayment supports
  • Public health recruitment and retention programs
  • Nurse-managed health clinics
  • Advanced nursing education grants
  • Nurse education, practice, and retention grants
  • Geriatric education and training career awards

16
Direct Care Workers
  • Personal Care Workforce Advisory Panel (CLASS
    Act)
  • Demo grants to establish competency standards
  • Training and career ladder opportunities

17
REVOLUTION UNDERWAY
  • Broad recognition that chronic illness is a major
    factor in health care cost
  • Understanding that community-based care is an
    effective way to address needs of chronic care
    patients
  • Goals shifted to prevention and management, away
    from crisis intervention
  • Identification that workforce supports needed to
    staff the new care delivery models, with
    different skills

18
Who Will Be Crucial To Success
  • Nurses, nurses, nurses
  • Home care aides/personal care attendants
  • Primary care physicians
  • Committed/engaged patients and family members

19
What Will Be Crucial To Success
  • New skills
  • Coaches
  • Educators
  • Coordinators
  • communicators
  • Technological supports
  • Remote monitoring
  • Interoperable EHR
  • Financial supports/incentives
  • Medicare and Medicaid may need to lead

20
CONCLUSION
  • EXCITING TIMES!
  • Opportunities, but no guarantees
  • Taking the initiative essential
  • Teamwork prevails over silos
  • Dreams coming true
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