Webinar: Unleashing the Capabilities of MAOs to Deliver Health Inno...

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Unleashing the Capabilities of MAOs to Deliver Health
Innovation for Older Adults in Underserved Settings
In partnership w...

Disclaimer
This presentation is offered only for general informational and educational purposes.
As always, the agency’s p...

Agenda
• Welcome, Jason Petroski Ph.D., Director Division of Delivery System Demonstrations
• VBID’s Role in Advancing Car...

Health Equity – Building a Foundation in HPI
Models
Executive Order on Advancing Racial Equity and Support for Underserved...

Significant Growth in Model Adoption and Partnerships
2017
• VBID: 9 MAOs; 45 PBPs;
3 States
2020
• VBID: 14 MAOs;
157 PBP...

CY 2022 VBID Model Components Began in 2021
Tests Complementary MA Health Plan Innovations
Targeted Benefits
by Condition,...

Importance of VBID in Promotion of Health Equity
MA Enrollment Is Dramatically
Increasing
With overall enrollment in the M...

VBID Health Equity Business Case
INCREASE MEMBER
ENGAGEMENT &
RETENTION
Plans that offer
supplemental benefits like
meals ...

The U.S. Administration for Community Living:
Mission, Values, and Impact
Vijeth Iyengar, PhD
Brain Health Lead & Technica...

Administration for Community Living (ACL)
ACL was initially established in April 2012 by bringing together the
Administrat...

The Older Americans Act, Administered by the Administration on Aging (AoA),
Help Seniors Remain at Home through Low-Cost, ...

Who Do We Serve?
 Poor and Near Poor (below 150% Poverty)
 Frail and Vulnerable
 Lives Alone; Diabetes; Heart Condition...

Thank you + Feel free to get in touch!
vijeth.iyengar@acl.hhs.gov

Unleashing the Capabilities of MAOs to
Deliver Health Innovation for Older
Adults in Underserved Settings
RFI Lessons Lear...

Road Map
 Background
 RFI Development
 Emerging Themes
 Outputs to Date
 Next Steps

Background
• >65 projected to be ~95
million by 2060
• Ages >65 at greatest risk
from COVID-19
hospitalization and mortali...

RFI Development
A Collaboration of Many Federal Agency Partners

RFI Development
Publishing and Descriptive Stats
Organization Type # submissions
Trade Association 4
Academia 4
Insurer 4
...

Emerging Themes from RFI Respondents
 Care Plans and Models
 Policy Considerations
Reimbursement structure needs to con...

Emerging Themes from RFI Respondents
 Remote Healthcare Delivery
 Policy Considerations
Medicare's bifurcation of remot...

Deliverables to Date
Initial Focus on Knowledge Dissemination and
Thought Leadership
Sources: https://www.hhs.gov/blog/202...

Next Steps
Collaboration and Follow Through
 Continued collaboration with HHS partners to identify
opportunities to syner...

Thank You!
Leith J States, MD MPH
Acting Director, Office of Science and Medicine
Chief Medical Officer
leith.states@hhs.g...

John Wiecha MD, MPH
Dr. John Wiecha is currently Medical Director of Senior Products for
Point32Health, the combined organ...

Confidential. Please do not distribute.
Improving
Dementia Care
Through Caregiver Support
25

26 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Agenda
Point32Health
Overview
Ceresti
Ove...

27 Confidential. Please do not distribute.
Our Family
All Results are Draft and Preliminary

28 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Point32Health: We Guide and Empower Healt...

29 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Serving 2.2 Million Members Across 5 Stat...

30 Confidential. Please do not distribute.
All Results are Draft and Preliminary
All Data Presented Today are
Preliminary
...

31 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Agenda
Point32Health
Overview
Ceresti
Ove...

32 Confidential. Please do not distribute.
All Results are Draft and Preliminary
32
The Problem:
Certain Conditions Requir...

33 Confidential. Please do not distribute.
All Results are Draft and Preliminary
33
The Problem:
Dementia has Disproportio...

34 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Goals of Digital Caregiver Support with C...

35 Confidential. Please do not distribute.
All Results are Draft and Preliminary
35
6-Month Digital Caregiver Empowerment ...

36 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Ceresti Provides Single-Purpose Tablet wi...

37 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Daily Plan Automatically Includes Curated...

38 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Simple Daily Assessment Tool For Caregiver

39 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Risk Assessments Provide Actionable Alert...

40 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Caregiver Can Message with Their Coaches ...

41 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Point32Health
Overview
Ceresti
Overview
C...

42 Confidential. Please do not distribute.
All Results are Draft and Preliminary
High Caregiver Engagement with Ceresti
*
...

43 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Distribution of Caregiver Engagement Time...

44 Confidential. Please do not distribute.
All Results are Draft and Preliminary
The Number of Mental Unhealthy Days (MUHD...

45 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Significant Program Satisfaction
Among 16...

46 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Caregiver Voices Reveal Pilot Program Rel...

47 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Point32Health
Overview
Ceresti
Overview
C...

48 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Dementia Patient Medical Costs Decreased
...

Caesar A. DeLeo, MD MHSA
Dr. Dr. Caesar A. DeLeo is vice president and executive medical director
of strategic initiatives...

Multi-Product Insurer and Vertically
Integrated Delivery System:
Pandemic Telemedicine Experience with SUD
Impact of Opioi...

Highmark Health is a national
blended health organization
• Highmark is a Pittsburgh-based national
blended health organiz...

Three-
Pronged
Approach to
SUD
• Prevention: Education to schools, employers,
community, prescribers, social grants and an...

Pandemic Telemedicine
Experience with SUD

Telehealth
During the
Pandemic
• 2019 Vendor Telehealth (TH) = 50% of all TH
• 2020 TH grew 7100% organically through netw...

Tele-addiction
Service
Experiment
(100% Tele
Vendor)
Problem: 2019 WV:
8 of 55 counties
lacked a waivered
MOUD prescriber....

Opioid Risk Mitigation: Academic
Detailing and Academic Detailing

Reporting and
Interventions
and
Corrective
Action Plans
on Specific
Members
axialHealthcare
Opioid Risk Report
Generated f...

Highmark’s Impact on Opioids Through
Risk Mitigation (Profiling and Academic Detailing)
What
Risk Mitigation (opioid presc...

Pennsylvania Results
Members on Opioids
35.4% ↓
Multi-Prescriber
35.4% ↓
MEDD >50
19.1% ↓
Polydrug
22.56% ↓
Notes and Key ...

West Virginia Results
Members on Opioids
49.1% ↓
Multi-Prescriber
51.5% ↓
MEDD >50
25.1% ↓
Polydrug
28.2% ↓
Notes and Key ...

OUD Treatment (MAT %) Across Products
MAT % Com ACA MA Medicaid DSNP
PA 52% 49% 16% 68% 40%
WV 55% 55% 29% No data No data...

Mona Siddiqui MD, MPH, MSE
Mona Siddiqui, MD, MPH, MSE is Senior Vice President for Enterprise Clinical
Strategy and Quali...

Prioritizing Vulnerable
Populations through
Predictive Modeling

The health system is costly, complex, and poorly positioned
to meet customer needs
Medicare spending grew to ~$800B in 201...

Demographic trends point to an aging and
increasingly chronic population
Medicare eligibles have grown by
over a third sin...

Medicare Advantage has demonstrated the strength of holistic care
Medicare Advantage is a proven model to
address structur...

Technology and advances in value-based payment are enabling more
convenient, proactive care
Accelerating data and
analytic...

These trends create significant opportunity
1 The U.S. healthcare system is costly and complex
2
The U.S. population conti...

To holistically address the needs of our members, we are building our
contemporary technology stack and taking a platform ...

Proactive Care: We target the right members, at the right time,
with the right site of care
Our three pillars of effective...

Our platform approach to clinical interventions enables
continuous improvement and more precise care
Real-time member
info...

An important application is how we address social determinants
of health
Social determinants of health (SDOH) have an impa...

SDOH Insights | Condition Segments (MA only)

SDOH Insights | Member Demographic Segments (MA only)

SDOH data use cases
This information will help us do business differently by identifying members with reported or potentia...

SDOH Insights | MA Members with Diabetes
For MA members with diabetes, social needs have a negative compounding effect on ...

SDOH is evolving into a
sustainable model of care:
SDOH Care
Continuum
Prevention & Risk
Assessment
Clinical
Treatment
Soc...

MERs for SDOH domains and social risk index MVP
Leveraging SDOH screening results
MER* by SDOH Domain MER* by Social Risk ...

Key challenges with SDOH data
Population
Health
Lack of Data
Ontology
Lack of incentive
to collect SDOH
data
No single pla...

Steps to standardize SDOH data
Step 1:
Categorize SDOH
Data
Step 2:
Build SDOH Data
Ecosystem
Step 3:
Mapping SDOH
Screeni...

Data sources for SDOH predictive models
Machine Learning Platform
Lab Tests
History
Consumer
Data
CMS
Data
Credit
Data
SDO...

| 35
Model Development in MLP
Medicare
Members
• Demographics
• Clinical health
indicators
• Medical & Rx claims
• Lab tes...

Transportation challenges and financial strain predictive models built in
MLP
AUC = 0.79 *
Top Predictors
Total PartD Paym...

Ensure that when we have two clinically analogous members –
one with SDOH and one without—those with SDOH are prioritized
...

Scaling food insecurity
2015
Humana’s
Bold Goal
Launched
Focused on food
insecurity due to
high prevalence of
Unhealthy Da...

Humana’s Healthy Foods Card Program
The Healthy Foods Card (HFC) is a “direct-
spend” card ranging from $25-$75 to
purchas...

Our path to operational maturity
Our growth toward operational maturity
Ongoing
SDOH Screenings / Pilots & Tests
Pilot/tes...

Questions ?
Please enter your questions in the Q&A
(Please do not enter questions in the chat).

Thank you for joining us today
Please email us with questions or to discuss your interests at
VBID@cms.hhs.gov

Appendix

44 Confidential. Please do not distribute.
Appendix for Improving Dementia Care
Through Caregiver Support,
John Wiecha MD,...

45 Confidential. Please do not distribute.
All Results are Draft and Preliminary
45
Claims Analysis Methodology Overview
6...

46 Confidential. Please do not distribute.
All Results are Draft and Preliminary
30-Day Readmissions Decreased by 73%
N = ...

47 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Total Medical Costs Decreased by $666 PMP...

48 Confidential. Please do not distribute.
All Results are Draft and Preliminary
ED Visits Decreased by 424 EDK* (-42%)
N ...

49 Confidential. Please do not distribute.
All Results are Draft and Preliminary
Inpatient Admissions Decreased by 513 ADK...

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