ManagedCareSupplement3

GENERATIONS – Journal of the American Society on Aging

As of November 2018, the PCHP was operating in seven states, and n4a had agreed to invest as an equity partner in its operation. PCHP fully expects to expand to other states. In its launch, PCHP is contracting with Anthem plans serving individuals with commercial insurance, and the MSO has entered the Medicaid managed long- term services and supports market in one state. Ultimately, PCHP aims to contract with MA plans. The n4a views the equity stake in PCHP as centrally important in supporting AAAs to position their services for older adults through an entity that is based in the aging network and knows the community and its elders. PCHP was established to deal proactively with common problems and challenges that AAAs have experienced when contracting with managed care plans. Managed care plans would like services on a bigger scale than many sin- gle AAAs can easily organize and provide, and they prefer to avoid multiple contracts with individual AAAs. Accordingly, PCHP provides a streamlined, standardized infrastructure for statewide networks of AAAs and CBOs in the following areas: contract management, financial oversight, standard agreements with states, stan- dardized intervention across states, billing and claims support, protocols for tracking outcomes, and IT communication and analytics, including calculations of Return on Investment. PCHP’s development took twenty-six months and an investment of nearly $500,000 to estab- lish initial legal agreements, secure Master Ser- vices Agreements (MSA), achieve certification of the health information technology (IT) plat- form, and structure an operating delivery system framework. The MSA is negotiated and executed at the corporate level and allows for work nation- wide under one agreement. When starting in a new state, PCHP initi- ates a contract with a managed care plan and commits to arranging for specific services pack- ages to be provided to their members on the ground. The MSO simultaneously recruits AAAs and CBOs interested in delivering those

services. One significant advantage to work- ing with PHCP, Jim Vandagrifft, CEO of Pre- ferred Population Health Management, notes that most AAAs still lack access to the IT that allows programs to share data about their shared clients—e.g., data on services use, such as for home-delivered meals and transportation, are in separate systems and do not share informa- tion about participants. AAAs also are unable to share data usefully with clinical providers. The PCHP circumvents these shortcomings. Looking ahead, AIHS’s President and CEO Connie Benton Wolfe believes that contin- CBOs also may work with “age- friendly” and “dementia-friendly” health systems that are based in communities they serve. ued growth for the aging network is linked to shifts toward capitation and other value- based systems that increasingly hold providers financially accountable for providing cost- effective care, and for delivering high-qual- ity services that meet an expanding array of performance metrics. The healthcare system, she said, still has substantial opportunities to reduce use of high-cost services through first—and preferentially—employing the most cost-effective interventions. Another opportunity on the horizon is a role for AAAs in providing supplemental services paid for by MA plans for their complex care members. Most likely, nutrition and transpor- tation will be the first types of services in this arrangement (Super, Kaschak, and Blair, 2018). As of late 2018, no AAAs had MA contracts, but n4a expects this area to grow quickly. For example, PCHP has been working to secure a MA contract that would use the established infrastructure for service delivery to MA mem- bers. Another area for possible development is working with “age-friendly” and “dementia- friendly” health systems that are based in com-

52 | Spring 2019

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