Consolidating Data Sources to
Improve Public Access to Benefits
and Public Accountability
Tom Snedden
Director
Pharmaceutical Assistance
Pennsylvania Department of Aging
717-787-7313
tsnedden@pa.gov
September 19, 2013
Pennsylvania Department of Aging-Mission
“Enhancing the quality of life of all older
Pennsylvanians by empowering diverse
communities, the family and the individual.”
2
Pennsylvania Department of Aging-Priority Areas
Two main goals of Pennsylvania Department of Aging
are prevention and protection.
3
Pennsylvania Department of Aging-Priority Areas
Prevention
Prevention from instability in health and wellbeing through
• assessment and service care coordination
• nutrition programs
• transportation
• PACE and PACENET and pharmaceutical assistance
• health and wellness programs:
PrimeTime Health, Healthy Steps,
Chronic Disease Self Management
Promote advocacy for consumers of long-term care
Encourage partnerships among communities and agencies
4
Pennsylvania Department of Aging-Priority Areas
Protection
Ensure vulnerable Pennsylvanians are protected from
abuse
Safeguard rights of residents in facilities
Continually monitor services provided
5
Pennsylvania Department of Aging-Constituent Growth
PENNSYLVANIA BABY BOOMERS AS PERCENT OF
TOTAL POPULATION, 2010
TOTAL = 12,700,000
0 TO 44 YEARS,
7.5 MILLION
57%
BABY BOOMERS,
45 TO 64 YEARS,
3.6 MILLION
28%
65+ YEARS,
2.0 MILLION
15%
Pennsylvania State Data Center, Penn State Harrisburg, 2012
6
Pennsylvania Department of Aging-Constituent Growth
1,000,000
PENNSYLVANIA POPULATION PROJECTIONS
BY AGE GROUPS
2000 - 2030
900,000
55-59
800,000
60-64
700,000
65-69
600,000
70-74
500,000
75-79
80-84
400,000
85+
300,000
200,000
100,000
0
2000
2005
2010
2015
2020
2025
2030
Pennsylvania State Data Center, Penn State Harrisburg, 2012
7
Pennsylvania’s Aging Population
In Pennsylvania, there are more than 300,000
residents who are over the age of 85 (2.4%); PA ranks
4th among states in percentage of population age
85.
Additionally, 22% of PA population is age 60 and
over; PA ranks 4th in percentage of population age
65 and over.
Source: US Census Bureau
8
Pennsylvania’s Aging Population
Pennsylvania’s age 60+ population is projected to
increase by 1.045 million from 2010 to 2030
Race/
Ethnicity
2000
2005
2010
2015
2020
2025
2030
White
2,239,096
2,269,508
2,429,895
2,669,720
2,967,029
3,197,529
3,285,204
Black
164,850
171,133
188,076
213,748
247,495
279,267
301,064
23,083
30,812
41,970
56,188
76,136
101,105
128,851
2,430,821
2,479,546
2,671,969
2,953,938
3,302,970
3,585,310
3,716,975
Hispanic
Total
Source: US Census Bureau
9
County % of Population Age 60 Years and
Over
Rural counties (green) have highest
percentages of population age 60+ (tan
and brown).
Source: US Census Bureau
10
u
The Aging Population
Americans are living longer with more complex conditions and
disabilities.
One in five Americans will be eligible for Medicare by 2030
More than 20% of older adults have at least five chronic
conditions
Heart disease
Diabetes
Arthritis
Osteoporosis
Dementia
This group of 20% accounts for 80% of all Medicare spending
http://www.americangeriatrics.org
11
u
The Aging Population
Americans are living longer with more complex conditions and
disabilities.
Older adults access healthcare more than younger adults and
children
26% of all physician office visits
35% of all hospital stay
34% of all prescriptions
38% of emergency medical services and responses
90% of all nursing home use
http://www.americangeriatrics.org
12
Pennsylvania Department of Aging-Funding
The Pennsylvania Department of Aging funding sources do not
include any general fund revenue.
13
u and Access
The Aging Population
Older adults need access to benefits and resources to
reach and maintain economic security and a healthful
life.
14
·
Pennsylvania Department of Aging-Current Service Delivery
Serves over 960,000 older adults annually
52 Area Agencies on Aging, serving all 67 counties
Prescription medications for 350,000 older adults
In home and community services to over 520,000
older adults
12.1 million meals served annually
Average person served by PDA is a woman age 78
who is widowed
15
PENNCARE and PACE
To address prevention and protection, PDA administers:
Home and Community Based Services
Pharmaceutical Assistance (PACE)
Health and Wellness Programs
Protective Services
Advocacy (Ombudsman)
Persons Served in PENNCARE and PACE
Program Area
Lives Served
(unduplicated count)
Community Services
In Home Services
342,000
82,000
Assessments
108,000
PACE/PACENET
343,000
16
Protective Services--Increasing
Total Reports of Need (RON)
Total Investigations
Statewide Investigations Substantiated
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
FY 2007-08
FY 2008-09
FY 2009-10
FY 2010-11
17
Pre-Admission Assessment--Increasing
Assessments/recertifications
Referrals to community services
Referrals to nursing home
120,000
100,000
80,000
60,000
40,000
20,000
2006-07
2007-08
2008-09
2009-10
2010-11 2011-12* 2012-13
2013-14
2014-15
18
2015-16
2016-17
Nursing Home Population--Decreasing
Nursing Home Population Trend
19
Nursing Facility Bed Trends--Decreasing
Nursing Facility Bed Trends
94,000
92,000
90,000
88,000
86,000
84,000
82,000
80,000
78,000
2000
2001
2002
2003
2004
2005
Total MA Certified Beds
2006
2007
2008
2009
Total Licensed Beds
20
2010
2011
Pennsylvania Department of Aging-Direction
Ensure Pennsylvanians will age and live well and our
communities are places to age and live well
Provide Pennsylvanians with access to care in the
right setting, with the right intensity and at the right
time
Bring the best of Pennsylvania to Pennsylvanians
21
Our Direction with Data Technology
Using technology in a person-centered approach to
improve benefit access by identifying and contacting
unenrolled eligible seniors
Using technology to overcome barriers to successful
enrollment
Using technology to be accountable
22
Multiple Barriers to Benefit Access
Lack of awareness
Complicated
applications
Fear
Stigma
No transportation
23
Multiple Barriers to Benefit Access
Estimated rates of unenrolled eligible individuals for government
benefits are in the 30 to 90% range, depending on the program.
Pathways to Success: Meeting the Challenge of Enrolling Medicare
Beneficiaries with Limited Incomes, NCOA, 2005
24
The PACE Application Center
Department of Aging
outreaches to eligible
seniors using multiple,
measurable databases.
Model developed by
Benefits Data Trust
(BDT) for outreach,
assistance,
enrollment,
evaluation.
25
The PACE Application Center
Key components of data-sourced outreach
Benefits specialists reach people “where they are” by
tracking multiple attempts and formats
Allows for analysis of key metrics
Provides trained outreach staff with tools that
emphasize respect, patience, and empathy
Support is refined, as needed, immediately
26
The PACE Application Center
Key components of data-sourced outreach
Customized databases manage eligible senior contacts
and response information
Mail, telephone calls, and post cards coming from an
identifiable, trusted source
Person-centered management system is two-way:
Outreach to seniors and
Seniors as incoming callers who ask for support
27
The PACE Application Center
Key components of data-sourced outreach
Person-centered management system securely
stores documentation to fulfill verification
requirements of benefit programs
System manages documentation follow-up tasks for
benefits specialists
Benefits specialists submit documentation on behalf
of senior applicants
28
The PACE Application Center
Elements of person-centered application
management and documentation
Age
Residency
Household size
Household income and assets
Household expenses
Medical expenses
Medical coverage
Enrollment status in benefits programs
29
Overcoming the Barriers to Benefit Access
Increasing awareness—by contacting enrollees in
other programs to identify eligible individuals
Reducing stigma—by training call center staff to
educate targeted eligibles, one-on-one
Eliminating complicated application processing—by
streamlining and supplementing the process with the
use of current data
30
Overcoming the Barriers to Benefit Access
Removing fear—by providing application assistance
together with information management
No transportation—Obviate the need for applicant
travel
31
Overcoming the Barriers to Benefit Access
Increasing awareness—by identifying eligible seniors
in benefit databases who are not enrolled in other
public benefits for which they are eligible:
PACE and PACENET prescription coverage
Part D Extra Help program for Medicare
prescription assistance
Property Tax and Rent Rebates
SNAP enrollment for nutritional assistance
LIHEAP heating assistance
PennDOT low-income registration
32
Identifying Unenrolled and Determining
Eligibility—Data Sources
Federal
Center for
Medicare and
Medicaid Services
Social Security
Administration
(MIPPA)
Railroad
Retirement
Administration
State
Health Insurance
Companies
Other
sources
Department of
Aging
Geisinger Health
Insurance
Penn Medicine
Department of
Public Welfare
UPMC Health Insurance
Jewish Federation
of Greater
Philadelphia
Department of
Revenue
SilverScript Medicare
Prescription Drug Plan
Acxiom
Department of
Labor and Industry
Department of
Transportation
Department of
Insurance
Highmark
33
Identifying Unenrolled and Determining
Eligibility
Federal Lists:
State Lists:
• Extra Help Recipients (MIPPA)
• LIS Redeemed, Medicare
• LIHEAP Recipients
• SNAP Recipients
• Property Tax/Rent Rebate Recipients
• PACE/PACENET Enrollees
• Medicare Savings Program Recipients
• Meals on Wheels / Congregate Meals Program
• Family Caregiver Program
• Shared Ride Program
• DomCare Program
• Unemployment Compensation Program
• Medicaid Waiver Program Lists
• Vital Statistics Age Verification
• Revenue Income Verification
• AdultBasic
34
Identifying Unenrolled and Determining
Eligibility
Outreach cover letter for PACE
enrollment application mailing
35
The PACE Application Center
Results of Targeted, Coordinated Benefits Access
Higher response rates
Better quality responses
Reduced outreach costs
Reduced time with screening ineligible persons
Higher enrollments
Healthcare savings
36
The PACE Application Center
Results of Targeted, Coordinated Benefits
2005-2012 STATEWIDE APPLICATION SUBMISSIONS
PACE AND PACENET APPLICATIONS, RX COVERAGE
153,000
PART D EXTRA HELP, LOW INCOME SUBSIDY, RX COVERAGE
109,000
SUPPLEMENTAL NUTRITION, SNAP
27,000
HEATING ASSISTANCE, LIHEAP
900
PROPERTY TAX & RENT REBATE
8,900
TOTAL APPLICATIONS
298,800
37
The PACE Application Center
Results of Targeted, Coordinated Benefits Access—PACE
FY 2011-12 STATEWIDE PACE PROGRAM OUTREACH
MAILINGS
713,642
OUTBOUND CALLS
19,461
TOTAL OUTREACH
733,108
UNDUPLICATED
548,379
OUTREACH CONTACT 31,813
APPLICATIONS
10,806
75% OF TOTAL OUTREACH
6% OF UNDUPLICATED
34% OF OUTREACH CONTACT
38
The PACE Program—Access
AVERAGE PACE BENEFICIARY
• WIDOWED FEMALE, 78 YEARS OLD,
• LIVING ALONE IN HER OWN HOME,
• MANAGING 3-4 CHRONIC DISEASES,
• USING 4 OR 5 MAINTENANCE DRUGS,
• TO TREAT CARDIOVASCULAR DISEASE, ARTHRITIS,
DIABETES, OR GASTROINTESTINAL PROBLEMS.
39
The PACE Program—Access
40
The PACE Program—Accountability
41
The PACE Program—Accountability
PROTECTING A VULNERABLE POPULATION
Outreach Program to Seniors, a statewide direct outreach, outbound call activity, targets unenrolled
eligibles to screen for enrollment into PACE, Medicare Part D, the Low-Income Subsidy, and Property
Tax and Rent Rebate Program.
Drug Utilization Review checks for harmful therapy before the pharmacist dispenses the drug by
reviewing for interactions, duplicate therapies, and over- or under-utilization. For exceptional
circumstances, a medical exception allows the prescriber to indicate the diagnosis and medical rationale
to explain use of the drug.
The Independent Drug Information Service brings non-commercial, evidence-based drug information
directly into the physician office. Visits include data about comparative effectiveness, safety and costs.
Improving the Health of Seniors with Mental Health Problems delivers counseling and care
management to cardholders newly prescribed an antidepressant, anxiolytic, or antipsychotic. This
patient-centered care program promotes patient involvement by providing timely assessment and access
to mental health services. There is also a component for caregiver support.
42
The PACE Program—Accountability
2011 STUDY—THE PACE IMPACT ON MEDICAID
PACE supports many seniors prior to Medicaid enrollment
.
Compared who “had” and “did not have” PACE in a 5-year
period prior to long-term care or nursing waiver
PACE seniors remained in the community longer, with better
health
PACE delayed entry into and lessened the utilization of these
services
With early PACE drug coverage, PACE enrollees with later
Medicaid enrollment had lower costs due to deferred services
entry; savings estimated at $815.3 million annually.
43
The PACE Program—Accountability
44
The PACE Program—Accountability
The Survey on Health and Well-Being assesses
important aspects of providing a prescription benefit.
The voluntary and confidential survey, now in its 13th
year, measures health status, quality of life, attitudes,
health related behavior, activity limitations, and
satisfaction with the Program.
45
46
Questions?
tsnedden@pa.gov
THANK YOU
47
Information and data slides follow
Budget performance measures
PACE / PACENET Program
PACE / PACENET Enrollment and Claims
Dept. of Aging Organizational Chart
State Plan on Aging Goals
Benchmarking Reports
48
Budget Performance Measures
2009-10
2010-11
2011-12
2,644,175
309,255
2,702,605
305,675
2,705,875
315,545
13,125
12,275
12,275
Pre-Admission Assessment:
Assessments/recertifications
Referrals to nursing home
Referrals to community services
103,990
38,165
45,465
105,725
39,140
45,660
105,725
39,140
45,660
Persons receiving assistance:
Congregate meals
Personal assistance services
Attendant care services
Home delivered meals
Home support services
Personal care services
Protective services
Families receiving caregiver support
131,640
1,565
1,665
38,075
6,805
13,705
15,520
7,020
132,630
1,470
1,880
36,425
6,595
13,125
17,790
7,120
132,630
1,470
2,090
36,425
6,595
13,125
17,790
7,120
Pennsylvanians 60 years and older
Pennsylvanians 85 years and older
Persons served in community who are
clinically nursing home eligible
49
Budget Performance Measures
Comprehensive PACE Program
Older Pennsylvanians enrolled (average)
Total prescriptions per year
Average PACE cost per prescription
PACE Needs Enhancement Tier (PACENET)
Older Pennsylvanians enrolled (average)
Total prescriptions per year
Average PACENET cost per prescription
2009-10 2010-11 2011-12
133,560
125,105
120,175
4,930,610 4,398,280 4,233,835
$24.16
$24.30
$20.74
2009-10 2010-11 2011-12
175,770
182,480
183,955
5,843,355 5,942,900 6,097,700
$28.73
$28.02
50
$21.04
PACE / PACENET Program
PACE
Prescription drugs, including insulin, insulin syringes & needles
Generic medications:
$6 copay (30-day supply)
Brand name medications: $9 copay (30-day supply)
Can get 90-day supply with PACE & Part D
PACENET
Prescription drugs covered including insulin, insulin syringes & needles
Generic medications:
$8 copay (30-day supply)
Brand name medications: $15 copay (30-day supply)
Can get 90-day supply with Part D
Pay PACENET deductible or Part D monthly premium
Source: PACE 2010 Annual Report
For more details on PACE: www.aging.state.pa.us
51
Pharmaceutical Assistance Contract for
the Elderly (PACE)
PACE and PACENET Combined
FY
Enrollees
Total
Prescriptions
2001-02
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
263,761
263,780
321,507
341,892
347,016
356,977
358,824
359,533
349,696
343,406
10,168,800
10,419,634
11,384,660
12,037,387
12,528,807
12,410,451
12,145,267
11,598,878
10,831,072
10,341,179
Source: PACE 2010 Annual Report
For more details on PACE: www.aging.state.pa.us
52
Department
Aging
Organizational
Department of
of Aging
Organizational
Chart Chart
Office of General Counsel
------------------------------------Chief Counsel
SECRETARY
Governor’s Policy Office
------------------------------------Policy Office
Deputy Secretary
of Aging
Bureau of Advocacy
Divisions:
Housing and Community
Services
Older Americans Act
Services
Divisions:
Ombudsman
Protective Services
Divisions:
Quality and Compliance
Licensing
Metrics and Analytics
Aging and Disability
Resources Office
Legislative Liaison Office
Operations and
Management Office
Press Office
Bureau of Aging Services
Bureau of
Quality Assurance
Office of the Budget
-------------------------------------Comptroller
Education and
Outreach Office
PA Council on
Aging
Bureau of
Pharmaceutical
Assistance (PACE)
Human Resource
Office
Divisions:
PACE Cardholder and
Enrollment
Operations
Research and Evaluation
Intra-Governmental
Council on Long Term Care
Bureau of Finance
Divisions:
Budget
Procurement
Contracting
53
Goal
Goal11
•Goal 1: Improve access to care for older individuals at the right time, setting, and intensity.
•We have increased visibility of the state and regional staff at facilities and AAAs as well as
increased activities regarding community outreach.
•We have an increase in program activities between FY 10/11 and FY 11/12 in several key areas
such as resident/family councils, information and consultations to individuals, information and
consultations to facilities, and technical assistance to Ombudsman and Volunteers.
•The State Office is in the midst of implementing a newer version of the Ombudsmanager system,
which went live on March 18, and will allow for even better and more accurate data reporting.
54
Goal
Goal22
•Goal 2: Empower older individuals to remain in the setting of their choice by serving as a
catalyst in developing communities as places in which to age and live well.
•Collaborative undertakings were initiated with the medical schools and health systems of Temple University,
University of Pennsylvania, and University of Pittsburgh.
•These collaborations are aimed at identifying and enrolling eligible persons in PACE who are patients of the
hospitals and emergency rooms of these three institutions.
•Patients enrolled in PACE may then apply for other benefits, such as Medicare Part D, the Medicare Low
Income Subsidy (Extra Help), and Supplemental Nutritional Assistance (SNAP).
•Patients not eligible for PACE may be enrolled in other federal, state and pharmaceutical industry sponsored
pharmacy benefits.
•We have implemented additional reporting strategies to capture the data that is necessary to determine the
effectiveness of local Link partnership development activities and trainings.
•We are moving forward with various exit surveys and/or pro active follow-up to collect the type of data that
will provide some measure of their efforts.
•We are implementing Options Counseling with two pilots programs, classroom Options Counseling trainings
and on-line modules in partnership with P4A.
55
Goal
Goal33
•Goal 3: Direct older individuals to the supports necessary to maximize their health and
well-being.
•Financial Exploitation Recovery and Protection:
•By implementing an electronic background check process, we have reduced the time for employment
determination from 4-6 weeks to 2-4 days.
•In addition, the cost for background checks was reduced approximately 20% per applicant.
•The Department’s Institute in Protective Services at Temple University continues to provide expert
assistance in investigating and prosecuting financial exploitation which has led to eight arrests, $640,000 in
restitution/repayment agreements, over $100,000 in recovered assets, and over $761,000 assets have been
protected.
•APPRISE counselors discuss preventive benefits during counseling sessions.
•APPRISE volunteers conduct community presentations and include preventive benefit message.
56
Goal
Goal3,
3, continued
continued
•Goal 3: Direct older individuals to the supports necessary to maximize their health and
well-being.
•Endorsement through American Health / Silver & Fit Programs is in progress opening the door to Medicare
Advantage participants to attend Healthy Steps Programs.
•Four caregiver webinars have been offered.
•Obtained evidence-based status through US Administration on Aging for Healthy Steps for Older Adults (falls
prevention) program and transitioned counties to evidence-based programs.
•Healthy Steps for Older Adults expanded from 21 agencies in FY 2011-12 to 39 agencies currently.
•Chronic Disease Self-Management expanded to 17 counties and 28 Master Trainers in FY 2012-13 and 40
workshops will be held through June 2013.
57
Goal
Goal44
•Goal 4: Revitalize and redesign aging services to further enhance the lives of older individuals.
•Revisions to the Aging Service Policy & Procedure Manual are being made and the Administration and
Hearing & Appeals Chapter is close to finalization.
•An Area Agency on Aging (AAA) workgroup was convened to provide feedback on the Manual.
•The AAAs were surveyed regarding senior centers in preparation for the Senior Center Chapter.
•Cost sharing is being reviewed and revised.
•State Plan subgroups are meeting to identify and determine what reporting is needed.
58
Benchmarking Reports
Current Benchmarking Reports
Protective Services (PSDASHDB)
Aging Waiver Service Utilization Report (AWSUDB)
Options Service Utilization Report (OPSUDB)
Waiting List Report (WAITLTDB)
Assessment Report (ASMTDB)
Rebalance Report (REBALDB)
Aging Waiver Service Order Report (AWUPDDB)
Enrollment & Services Report (ENRSERDB)
Senior Center Report (SRCNTRDB)
Meals Report (MEALSDB)
59