Notes |
September 19, 2019
Innovative Financing Mechanisms to Address
Vulnerable Populations: Lessons from a Medical
Respite Intervention
2019 Medicaid Health Plans of America Conference
Quantified Ventures is an
outcomes-based capital firm
that drives transformational health,
social, and environmental impact.
Our Solutions
▪ We cultivate trusted partnerships across sectors and
involve agencies, investors, private and nonprofit
institutions, philanthropies and community groups that
share our vision to be at the forefront of creating
healthy people and planet.
▪ To make positive health, social, and environmental
outcomes both financeable AND profitable, we
leverage the strengths of all sectors.
▪ We help to build robust, accountable, and sustained
structures that bring needed resources to solve stuck
problems.
Benefits of Outcomes Based Financing
▪ Transfer performance risk of innovative projects to investors
▪ Access new sources of flexible investment capital
▪ Showcase partners and their projects, attracting internal and
external support
▪ Engage diverse and new stakeholders benefiting from
projects
▪ Measure and track outcomes through embedded
performance evaluation
▪ Establish external accountability structures that foster
commitment and support sustained partnerships
Courtesy of WEF
We commit to:
Driving positive impact
Linking financial results
to proven outcomes
Expanding access to
capital
Building a sustainable
outcomes-based
financing marketplace
Investor Repayment Option: Performance Contracting
▪ Limits contracting complication, with
familiar performance contract between
payor and service provider
▪ Fewer regulatory or compliance risks (real
or perceived) for payors
▪ Intervention sustainability by not having
termed contract with payors
▪ Solves double capitalization issue by
removing need for escrow
Expansion of Medical Respite Can Help Break Homeless-to-Hospital Cycle
▪ For the first night after hospital
discharge:
▪ In these settings, individuals can’t heal
(i.e. simple cuts become infected) and
get sick enough to require further
hospitalization
…Without a safe place to recuperate, they are
more likely to return.
75%
11%
go to a shelter
end up on the street
Individuals experiencing homelessness are more
likely to be hospitalized and…
Individuals experiencing homeless are:
4x
5x
more likely to present in the
emergency department
more likely to be hospitalized
Expanding Medical Respite Capacity in the District of Columbia
▪ Project Goal: To increase the number of beds in the District for
AmeriHealth Caritas DC members experiencing homelessness and
housing insecurity
▪ Outcomes:
▪ Address DC Medicaid’s top priorities related to acute care utilization
(3 P4P Measures)
▪ Reduce total cost of care to AmeriHealth Caritas DC
▪ Connect individuals experiencing homelessness to permanent
supportive and other (non-shelter/street) housing solutions
▪ Program Model:
Health and Human Services Case Study
Respite services include:
▪ Clinical care
▪ Case management
Permanent
supportive
housing
▪ Room and board
▪ Peer support
Temporary
housing, other
social services
Hospital/ED Medical Respite Housing Support
States are Increasingly Demanding More of Medicaid Managed Care
Sample State Managed
Medicaid RFP
“…Meet health related needs
of members, including :
• Housing instability
• Homelessness
• Nutrition
• Other social services…”
States are Struggling With:
• Affordable housing crises
• High rates of homelessness
and housing insecurity
• Chronic shortage of funding available
to support many human
and social services
The Envisioned Medical Respite program will be comprised of 3 phases, each
with distinct levels of medical, behavioral health, and social support services
Phase 1: Temporary for
Medical Necessity
Phase 2: Temporary for
Transition
Phase 3:
Permanent
Medical
Behavioral
Health
Socialization
Hospital Discharge
Medical Necessity 90 Days
Transition of Case Management
Maintenance
Assessment
Engagement
Active Care
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Phase 1 – Hospital Discharge until End of Medical Necessity
Facility
• Temporary Housing – Medical Respite Facility
• Meals – Catering Service
Medical Care
• Active Medical Treatment including screening & assessment
Behavioral Health Care
• Behavioral Health Engagement including MAT
Social Supports
• Socialization Assessment including Adult Needs & Strengths Assessment and Service Prioritization Decision Assistance Tool (SPDAT) or Vulnerability Index (VI-SPDAT)
• Applications for disability and other benefits as needed
On-site staff Staff : Client Ratio FTEs Needed (per facility)
Day Shift - Monday – Friday (9am – 5pm)
APRN 1:24 1/3
RN 1:8 1
LICSW 1:8 1
Behavioral Health Staff PRN Paid by CSA
Weekday Evening (after 5pm) & Weekend (24hrs)
LPN 1:8 3-4
Security 1:8 3-4
Visiting staff
As per medical necessity (dental, OT, PT) PRN PRN
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Phase 2 – Transitional for up to ~90 Days
Facility
• Temporary Housing – Step Down Unit
• Meals
1. Communal with staff support
2. Catered
Medical Care
• Medical Monitoring
Behavioral Health Care
• Active Behavioral Health Treatment
Social Supports
• Socialization Engagement including follow-up Adult Needs & Strengths Assessment
Staff : Client Ratio FTEs Needed (per facility)
Day Shift - Monday – Friday (9am – 5pm)
Community Support Worker 1:8 1
Behavioral Health Staff PRN Paid by CSA
Weekday Evening (after 5pm) & Weekend (24hrs)
Community Support Worker 1:8 3-4
Security 1:8 3-4
Individuals will transition to Phase 2 if their treatment plan includes moving towards Permanent Supportive Housing.
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Phase 3 - Permanent Housing
Facility
• Permanent Housing
• Flex funding to assist with household essentials
Medical Care
• Medical Monitoring
Behavioral Health Care
• Behavioral Health Monitoring
Social Supports
• Active Socialization including follow-up Adult Needs & Strengths Assessment
Staff : Client Ratio FTEs Needed
Day Shift - Monday – Friday (9am – 5pm)
Community Support Worker 1:8 Paid by CSA
Behavioral Health Staff PRN Paid by CSA
AmeriHealth Case Manager/Care Coordination For Discussion
Anticipated Partnerships
Pilot
Pay for Success
HOMELESS MEN
Pay for Success
HOMELESS WOMEN
Pay for Success
PREGNANT WOMEN
Volunteers of America Unity Health Pathways to Housing
Volunteers of America Unity Health Pathways to Housing
Volunteers of America Unity Health Pathways to Housing
Volunteers of America Mary’s Center Pathways to Housing
Patients who enter the Medical Respite program after an inpatient admission will
flow through the program in different pathways depending on their medical acuity
and treatment plan.
Partnership with hospital partners will be essential to the correct identification and
referral of homeless individuals to the medical respite program.
Considerations: When Does This Work?
▪ Is there a new intervention or partnership model perceived as too risky? Or a proven
intervention that should to be scaled?
▪ Do stakeholders have aligned interests / value the same outcomes but need
incentives to work together?
▪ Can these outcomes at least partially be achieved within 3-7 years?
▪ Are there easier, cheaper, or faster ways to finance this work?
▪ Is the potential deal size big enough to warrant this form of financing?
▪ Are any stakeholders driven by regulatory requirements and/or policy pressures?
Considerations: Stakeholders and Measurement
▪ Stakeholder Buy-in Questions:
▪ Is there a champion willing to fight for innovation?
▪ Is there a revenue source that can be allocated to repayment?
▪ Is there at least one clear outcome that will interest investors?
▪ Measurement & Monitoring Questions:
▪ Can the desired outcomes be measured quantitatively?
▪ With what data sources and over what time period?
▪ Can those outcomes be valued financially? To which parties does that value accrue?
Key Data and Evaluation Questions
▪ Where is the best starting point to determine the right target population(s)?
▪ What other factors inform site selection?
▪ How big are you trying to scale?
▪ What data are available to assess eligibility / impact potential of the population?
▪ Who can contribute resources to that analysis? Or provide data for 3rd party?
▪ What data use or other agreements would need to be established or modified?
▪ At an institutional level, what data are contractually prohibited to share?
▪ What, if any, IRB considerations need to be addressed (i.e., is it TPO, QI, “Big R”
Research?)
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The Envisioned Medical Respite program will be comprised of
3 phases, each with distinct levels of medical, behavioral
health, and social support services |