Department of Health and
Administration on Aging
Integrated Care Management Grant Program
As new options for older people are emerging in health and long-term care, managed care is playing an increasingly important role. AoA’s Integrated Care Management grant program is designed to identify and support innovations in aging services that involve the use of partnerships with managed care organizations or Medicare Modernization Act Demonstrations and/or the creation and use of capitated financing arrangements that improve older people’s access to social and preventive services. This program is part of a strategic effort AoA has undertaken to strengthen the role of community aging services programs in promoting a more balanced and integrated system of health and long-term care for older people.
Projects include either program enhancements that build on existing approaches or new models that support the design and/or implementation of new approaches in managed care. Grantees include Area Agencies on Aging (AAAs) and Community Aging Services Providers (CASPs). A broad mix of partnerships between area agencies on aging, community organizations, managed care organizations, universities, and health care providers are represented in the programs.
Ten grants were awarded to the following organizations in FY2005:
- Alzheimer’s Disease & Related Disorders Association, Los Angeles, CA
The Alzheimer’s Association will partner with HealthCare Partners Medical Group, a mixed staff/PPO model Medicare managed care organization, to create an evaluation-based intervention to reduce expenses while improving quality of care given to people with dementia and their caregivers. The project will replicate and adapt an evidence-based model of care outlined in a replication manual the Alzheimer’s Association produced in partnership with Kaiser Permanente under a FY2004 Integrated Care Management grant. The partners will develop a plan and materials for implementing a care management intervention for people with dementia being served in a managed care organization and their caregivers.
- Area Agency on Aging 10B, Inc., Uniontown, OH
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, AAA 10B partnered with SummaCare to develop and implement a High Risk Screening Tool and Risk Score Calculation Model to identify dual-eligible clients at high risk for permanent nursing home placement. FY2005 funding will be used to measure the predictive power and accuracy of the High Risk Screening Tool, implement the risk-based protocols and a high risk care model integrating both organizations’ previously separate care plans via a web-based system, and develop a geriatrician led interdisciplinary care management team.
- Atlanta Regional Commission, Atlanta, GA
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, the Atlanta Regional Commission established a partnership with Evercare Assist Managed Care Programs, the Visiting Nurse Health Systems, and Project Open Hand/Atlanta to provide integrated case management to persons with End Stage Renal Disease. During FY2005, the partners will expand the project to provide integrated case management to older patients with chronic illnesses. The project will focus largely on home monitoring of patients, communication between partners for status updates and referrals, and promotion of chronic disease self-management.
- Benjamin Rose Institute, Cleveland, OH
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, a partnership was developed among the Benjamin Rose Institute, Anthem Blue Cross and Blue Shield, the MetroHealth Medical System, and the Western Reserve Area Agency on Aging to establish an intervention linking managed health care services and community-based services. During FY2005, the partners will expand a “care consultation” intervention to include an additional 153 MetroHealth patients who are also members of Anthem Senior Advantage. The intervention will include participants from diverse backgrounds with various chronic health conditions. A randomized control design will be used to test the overall efficacy and sustainability of care consultation as well as the feasibility of partnerships among the three participating service providers.
- Chinese American Service League, Chicago, IL
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, the Chinese American Service League partnered with Humana to increase access to Medicare managed care benefits among ethnic Chinese elderly. The current project will expand the Managed Care Initiative to include health education and fitness components. • City of Inglewood, Inglewood, CA
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, the City of Inglewood partnered with Kaiser Permanente to provide the “Be Well” fitness and nutrition program to seniors. FY2005 funding will be used to formalize the partnership and provide the “Be Well” program to 50 seniors.
- Gulf Coast Jewish Family Services, Inc., Clearwater, FL
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. The goal of the project is to help the aging services network develop the organizational structure and tools needed to assume or share risk in a capitated managed care system and to partner with a for profit HMO or managed care organization. Specifically, Gulf Coast Jewish Family Services, CARES, the Suncoast Center, and the Area Agency on Aging of Pasco-Pinellas will determine an organizational structure for and develop a corporate entity that could partner with a managed care organization or become its own MCO to provide integrated long-term care services for elders.
- Kenosha County Department of Human Services, Kenosha, WI
Kenosha County will hire consultants to define rate-based services for inclusion of two evidence-based prevention programs, the Multi-Factorial Falls Intervention and the Chronic Disease Self-Management Program, in the benefit packages of Wisconsin Medicare and Medicaid managed care programs. A variety of Medicare and Medicaid payers/providers will be approached to partner in providing these interventions to their members as covered benefits.
- San Mateo County, San Mateo, CA
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, San Mateo County Aging and Adult Services established the Integrated Information Project, a component of the effort to achieve a fully capitated Medicare/Medicaid long-term care system. The Integrated Information Project involves implementation of a uniform assessment tool using a single automated case management system for all members of the target population entering home and community-based long-term care services in the county. FY2005 funding will be used to continue implementation and testing of the uniform assessment tool.
- Senior Services of Seattle/King County, Seattle, WA
This project is a Program Enhancement of a project funded by a FY2004 AoA Integrated Care Management grant. Under year 1 funding, Senior Services of Seattle/King County partnered with the Group Health Cooperative (GHC) Burien and Northgate Medical Centers to offer the health centers’ senior population the Health Enhancement Program. FY2005 funding will be used to expand the services offered to include a health and wellness package of community services to be offered at 4 senior centers. Ultimately, the partners will determine a prepaid cost per individual for access to a set of agreed upon services within the health and wellness package.