Innovations of virginias aaa bay aging 2016 governors conference on aging

Designing Our FutureImproving Health Outcomes:

Innovations of Virginia’s Area Agencies on Aging

May 2, 2016

Governor’s Conference on Aging

Kathy Vesley-Massey

President/CEO

William MasseyCEO

Aging Facts – Around the World• Between 2000 and 2050:

• the proportion of the world’s population over 60 years will double from about 11% to 22%

• the absolute increase – 605 million to 2 billion• the world will have more people who live to see

their 80s or 90s than ever before• the number of people aged 80 and older will

have almost quadrupled to 395 million

World vs United StatesProportion estimates of people aged 65 and older for 2010 and 2050

65+ by 2050WORLD:

65+ in 201015.6%

7.7%

65+ by 2050UNITED STATES:

65+ in 201021.4%

13.1%

2050 2010

• Countries with the largest growth: Japan, S. Korea, Spain, Italy and France

• Countries with the least growth: Nigeria, Kenya, Pakistan, S. Africa, Egypt

• United States ranks 11th highest growth in the world

The Changing Age Structure• Overall age structure is projected to change greatly from 2010 –

2050• Boomers are driving the change• Who are these Boomers?

Baby Boomers were born

between the years 1946 and 1964

Today, 40 million people in

the U. S. are 65 and older

which will more than

double to 89 million by

2050

The “oldest old” – those people ages

85 and older will

number 19 million by

2050

In other words, by

2050 1in every 5 Americans

will be 65 and older

• Seniors have a new definition of aging, attitude toward aging and interest in aging

• People are living longer thanks to changes in lifestyle and technology • A man reaching age 65 today can expect to live,

on average, until age 84.3• A woman turning age 65 today can expect to

live, on average, until age 86.6• One out of every four 65-year-olds today will

live past age 90, and one out of 10 will live past age 95

• More older adults will be living with disabilities

• Disease in old age is less likely to mean death or loss of physical and mental function

Seniors are Redefining Aging

Life Expectancy at Age 65Sex and calendar year, based on period life tables. Example: Life expectancy at age 65 for males increased from 11.3 years in 1900 to 15.72 years in 2001

ANNUAL COST OF CHRONIC DISEASES

Data Source: CDC Cost Calculator for Virginia 2015. Includes costs only for diseases that are selected and have cost values available. The projections: 1) are medical costs only, including nursing home costs but excluding absenteeism costs; 2) are based on default inputs; 3) are reported in 2010 $ and do not project inflation; and 4) assume no changes in policy or technology and exclude changes due to the Affordable Care Act. Virginia Department of Health.

Impact of the Aging Population:Area Agencies on Aging (AAAs) Expertise• 90% of people ages 65 and older want to stay in

their home for as long as possible• 80% believe their current residence is where they

will always live• Physical and service environments

must be accommodating for older adults to age in place

• Village communities• Alternative housing

AARP, National Conference of State Legislatures, In Brief 190, December 2011

Eastern Virginia Care Transitions Partnership

Centers for Medicare and Medicaid Services (CMS) demonstration for Care Transitions Intervention (CTI) –

• to lower healthcare costs by lowering unnecessary Medicare readmissions

• to improve the care experience• to improve health outcomes

What is CTI? • Hospital to home social / coaching model • Empowers patient to take charge of their

health care

• Successful coalition of 11 hospitals and 5 AAAs

• Proven collaboration for CTI and other pre & post acute “prevention” interventions

• Measureable outcomes• Foundation for additional contracts and

partnerships• Launching point for statewide initiatives

Eastern Virginia Care Transitions Partnership

Innovations on SteroidsVirginia Center for Health Innovation Partnership

• EVCTP recognized as statewide model for care transitions

• Funding in State Innovation Model (SIM) grant for Virginia to develop statewide AAA collaborative – a one-stop shop

• AAA state model for better care and lower cost for Medicare, Medicaid, emergency department diversion and more

Senator Warner Roundtable Discussion

Public Policy Framework for Improving Population Health

From: the healthy living Center of Excellence

AAA Solution: Address Social Determinants• AAAs, already in the home, are equipped to address the social needs that

directly contribute to poor health and unnecessary health care utilization• AAAs = Aging & Disability Resource Centers and No Wrong Door• Arrange long-term care supports and services

• Meals on Wheels• Transportation• Home and Personal Care• Medication Management• Respite/Caregiver Support• Housing• Falls/Home Risk Assessments• Options Counseling, Information and Assistance• Senior Medicare Patrol to prevent fraud, waste and abuse

Other AAA Evidence-Based InnovationsValue Proposition: Bring Evidence-Based Innovations into the Home -

• Healthy IDEAS (Behavioral Health)• Chronic Disease Self-Management• Advance Care Planning• Matter of Balance: Fall Prevention• Patient Activation Measure (PAM)• Telehealth Pilots • Chronic Pain Management• HomeMeds and more

AAAs Promote Informed and Active Lifestylevs

Passive and Sedentary Lifestyle

Summarizing the Value PropositionVirginia AAAs have a very strong plan and portfolio –

• Diverse menu of traditional services (meals, transportation …) blended with a repertoire of innovative evidence-based solutions

Key takeaways –• Right care, at the right time, in the right place• Appropriate and timely prevention and post-acute interventions• Home-based care delivery• Social determinants of health assessment and intervention

Virginia AAAs● Unique! 25 AAAs consolidated goals and capacity● Each has specialized capabilities, but there is a core

set of competencies that can be delivered statewide

● There is a one-stop shop mechanism for statewide contracting and performance monitoring

"We have come to “medicalize” aging, chronic illness, frailty and death, treating them as if they were just one more clinical problem to overcome.  However, it is not only medicine that is needed... but life, a life with meaning, a life as rich and full as possible under the circumstances."                                                          Quote from Dr. Oliver Sacks

Being Mortal, Medicine and What Matters in the End Atul Gawande, MD, MPH

• The Next Four Decades. The Older Population in the United States: 2010 to 2050. U.S. Census Bureau.

• Pew Research. Global Attitudes Project. 2014.• Projections of the Size and Composition of the U.S. Population. Population Estimates and

Projections. U.S. Department of Commerce, Economics and Statistics Organization, U.S. Census Bureau.

• Aging in Place: A State Survey of Livability Policies and Practices. AARP. National Conference of State Legislatures

• America’s Aging Population. Population Reference Bureau.• Institute of Gerontology. A Growing Demand for Careers in Aging• Virginia State Police: Report on the Impact of the Aging Population.• Department of Homeland Security. Impact of an Aging Population on Fire and Emergency

Medical Services. 2013 Report to Congress.• National Association of Area Agencies on Aging. Trends and New Directions: Area Agencies on

Aging Survey 2014.• Virginia Employment Commission. Demographic Profiles.• Center for Housing Policy. Housing an Aging Population. Are we Prepared?• World Wide Learn. Five Biggest Trends Impacting the Job Market• The Healthy Living Center of Excellence. Public Policy Framework for Improving Population

Health• The Social Determinants of Health. Healthy People 2020 Approach. Department of Health.• Aging and Life-Course. World Health Organization.• Life Tables for the United States. Social Security.1900-2100. Actuarial Study No. 120.• Kaiser Family Foundation

Resources