Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by the National Association of Area Agencies on Aging (n4a). The mission of The Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and n4a are collaborating on a series of articles and case studies in Generations Today that highlight community-based integrated care networks.
James Stowe is a gerontologist by training, who at one time worked in a medical school on older driver safety. Now he directs Aging and Adult Services at the Mid-America Regional Council (MARC), Missouri Association of Area Agencies on Aging in Kansas City, Mo. This AAA is one of 10 in the state. Perhaps it’s his training or it’s out of necessity, but Stowe takes a rather evidence-based approach to his work.
Originally, MARC provided typical Older Americans Act services such as home-delivered meals, transportation, evidence-supported programming around chronic disease, falls prevention and any other services that might allow older adults and adults with disabilities to live out happy, healthy lives in a community setting.
After entering into n4a network learning collaboratives, Stowe said, they now package those services differently and render them more quickly or flexibly and for different durations. The core feature offered is care management in the community, resulting in a co-developed care plan with the client and then wrapping services into those plans. This service works well for mapping recovery services after people return from the hospital.
“The fact of life is, that all of us will at some point need support in the community to be independent,” Stowe said. And an increased awareness across the aging services and healthcare sectors of the social determinants of health has also opened up regulatory opportunities to fund such services, Stowe added.
Once COVID-19 hit the Kansas City region hard, as it has so many regions, it compounded Stowe’s clients’ difficulties in accessing care, so the AAA quickly moved its services online where it could. “Within a few days care management activities had pivoted to virtual. Educational activities did the same a couple of months into the pandemic. And we instituted a new model for home-delivered meals that used frozen meals sourced from SeniorAge, a sister AAA in Missouri, and local nonprofits and city governments assisted with fulfillment to the client’s door, plus accelerated the new model two weeks after shutdown, as demand increased 50 percent,” said Stowe.
“There has been a profound, dramatic and sustained shift across all services [since COVID-19],” he added.
Joining the Network Operations Learning Collaborative
Having had previous experience with other learning collaboratives supported by the Administration on Community Living (ACL) and offered by the National Council on Aging (NCOA) and n4a, Stowe realized the new Network Operations Learning Collaborative would be an excellent opportunity for MARC.
“We were having growing pains (a lack of technological ability for one), while facing opportunities to expand across the state, especially in chronic disease self-management programs. And we needed national input from others who were doing it well,” said Stowe about joining the Collaborative.
MARC’s team also sought to learn about best practices around the contractual elements necessary for being a network lead entity, plus teaming with subcontractors, implementing quality assurance and service delivery and doing it all in a way that better met the needs of their customers.
'Landing an actual healthcare contract takes at least 24 months.'
“Really, the Learning Collaborative brings a focus to what you’re doing,” said Stowe. It helped his team identify top priorities and highlight which parts of the work are most important, and which to first implement. The Collaborative also honed where MARC was positioned to grow as a network.
“It resulted in fruitful changes, we signed contracts, were able to follow through on quality assurance plans, and at the end, after we had done some solid implementation work, we could identify next steps and future priorities. Essentially, I guess it was strategic planning,” said Stowe, chuckling.
Of course, no big changes happen without some snags. MARC encountered confusion with partners and barriers to building buy-in from community-based partners, as building such partnerships can take time.
“A lot of our challenges centered on this work being so new. We encountered naivete about what we were trying to achieve. Some people were unaware of the pathways we were trying to forge and facing the newness of networking proved to be a barrier,” said Stowe.
Lessons Learned, a Path Forward
Initially, MARC had been ambitious about partnerships and assumed it could cultivate a huge number of frontline service provider partnerships. They found in reality they only needed a few to help build capacity. “Next time we would right-size scaling,” said Stowe.
Another lesson was a need to learn more about technology requirements of partnerships and how long it takes to get such systems up and running. “It would be good to do better preparatory work to get those systems in place prior to trying to find partnerships,” said Stowe.
But the biggest challenge he found was that landing an actual healthcare contract takes at least 24 months, which he found others doing similar work agreed was a realistic time frame.
Currently MARC is engaged with commercial health plans, Medicare Advantage plans, the local VA Medical Center and is in final discussions with a Managed Care Organization through State Medicaid plans.
The sweet spot for AAAs has always been to serve members who are most socially and medically complex, to help them remain in the community for as long as possible. Health plans now realize this is a best practice, so AAAs can identify and triage people who are the most medically and socially complex, holistically track their needs, render services and move forward on the health plan’s end goal.
MARC is working on a COVID-19 initiative in which each health plan member receives a social determinants of health screen, and those who screen positive for COVID-19 receive a month of care management from MARC’s network of community-based organizations, which, as Stowe says, is a major community benefit.
Stowe has found the Network Operations Learning Collaborative to be of critical importance to MARC. “In our estimation, it will be crucial for any community-facing or -oriented organization to do this type of work if they want to be acknowledged as a critical component for a healthcare system. We have to move in this direction,” says Stowe, “mechanisms are opening at the federal level, the opportunity is immediate and taking action is urgent. I encourage folks on the edge to go into this work.
“We’re now at a place nationally where there are great examples of lessons learned, models to implement and structures to implement in your region.”