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Health Care Reform Gives Senior Living Funding for Innovative Care

By Alyssa Gerace for ALFA Update

While senior living companies have been concerned about how the Affordable Care Act (ACA) will impact them and how they provide health insurance to their workers, they may not realize that the comprehensive reform bill also contains funding for innovative methods of providing care–including for senior living residents.

Health care providers can access these opportunities by participating in a variety of initiatives and programs both new and old that seek to do several things, including increase the supply of geriatricians, develop managed care models, and promote community-based, non-institutional care. 

Last month, the nation’s largest provider of senior-related services, Brookdale Senior Living, was able to score more than $7 million in funding through an ACA initiative that made nearly $1 billion available to a variety of health care innovators—and more funding opportunities could be in store.

When Congress passed the health care reform law in 2010, one of the Obama Administration’s major objectives was to improve care quality while saving money.

“Many provisions of the Affordable Care Act work to improve access to long-term care and home- and community-based services and supports to seniors and people with disabilities,” said Emma Sandoe, a Department of Health and Human Services (HHS) spokeswoman. “New ways to deliver care will improve the quality of care individuals receive in medical and long-term care settings and will reduce unnecessary costs.”

To help achieve better care outcomes, the ACA launched the Health Care Innovation awards, the guidelines for which were fairly straightforward, according to Dr. Jose Pagan, Ph.D, chair and professor at the University of North Texas Health Science Center.

Organizations were called upon to pitch projects that could improve quality and reduce costs to the health care system by anywhere from $1 million to $30 million in the next few years. While about 3,000 organizations applied with their programs, only around a hundred were awarded the approximately $900 million of grant money made available through the health care law.

Brookdale Partnership with UNT Health Science Center

Brookdale was one of the few chosen recipients. It was awarded $7.3 million through its partnership with the University of North Texas Health Science Center (UNTHSC) to expand and test its BSL [Brookdale Senior Living] Transitions of Care program for residents in independent living, assisted living, and memory care communities.

Kathleen Sebelius, the HHS secretary, announced in May and June the 107 recipients of the Health Care Innovation awards, whose projects are expected to save the health care system an estimated $1.9 billion over the next three years.

The Brookdale/UNTHSC initiative had an edge over the competition, says Dr. Kevin O’Neil, Brookdale’s medical director, because the senior living provider had already been working on its BSL Transitions of Care program prior to the grant opportunity announcement and had been testing it in some of its skilled nursing communities.

“We thought, ‘If this is working in skilled nursing, can it also work in assisted living and home care environments?’” O’Neil says.

Armed with data and outcomes from the skilled nursing pilot, the partnership had already begun modifying goals and tools to adjust for other healthcare settings when HHS announced the innovation grants.

They decided to apply for the grant and focus initially on 23 communities in Texas and Florida, but the grant now increases the opportunity to eventually expand the model of care nationally, O’Neil says.

He says there are three important factors to bear in mind when developing a quality improvement program: have a clear aim or goal; make sure outcomes are measurable; and have a plan for making improvements based on acquired knowledge.

The University of North Texas Health Science Center will work with Brookdale communities to make sure staff are properly trained, and will also monitor and coordinate the overall project, says Pagan.

They’ll also be working with an analytics company that will provide information on hospitalizations and reasons for admission. If some communities aren’t as successful in the program as others, that information will be available, allowing the partnership to address and hopefully resolve issues, he says.

“There are a lot of moving parts in this,” Pagan notes.

Additional Funding Initiatives Under the ACA

There are a variety of other programs introduced by the ACA that could benefit the senior living industry. Many of them involve a transition away from institutional settings, and assisted living providers in particular have the opportunity to establish themselves as a community-based option.

Another initiative is a push to increase the limited supply of geriatricians. A number of geriatric experts have highlighted a growing concern: There are not nearly enough medical workers specializing in senior care in light of the growing number of older adults.

To that end, HHS is establishing a grant program to provide new training opportunities such as tuition and fee assistance for direct care workers employed in long-term care settings.

Anyone who receives this assistance is required to then work in the field of geriatrics, disability services, long-term care services and supports, or chronic care management for at least two years.

Long-term care entities that have partnerships with institutions of higher education are eligible for these grants, for which the ACA appropriated $10 million between fiscal years 2011 through 2013.

In another instance, the ACA authorized the Centers for Medicare & Medicaid Services (CMS) to make $275 million available to states for designing and testing coordinated care systems.

The awards will help states develop and pilot cost-effective multipayer systems, and senior care providers who are partnering with acute and post-acute care providers can benefit as these managed care models form and evolve thanks to the grants.

It’s possible CMS will announce future grant opportunities that could benefit the senior care industry, but the agency was not able to provide advance notice or specifics.

When applying for these grants, ultimately, it’s important to think big. Most initiatives that are underway aren’t meant to be confined to one health system, or one state—successes are supposed to be shared nationally, say O’Neil and Pagan.

“They want programs that are successful and can be replicated,” Pagan says, adding that the Brookdale/UNTHSC partnership “goes beyond” just one senior living chain. “If it works with Brookdale, others can learn from it and implement it in their settings. That’s what [HHS] wants to come out of this in the end.”

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