NWX-HHS-AOA-1 

Moderator: Lauren Solkowski

02-24-16/1:00 pm CT

Confirmation # 6612094

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NWX-HHS-AOA-1 

Moderator: Lauren Solkowski

February 24, 2016 

1:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a 

listen-only mode. During the question and answer session please press star 1 if 

you’d like to ask a question. Today’s conference is being recorded. If you 

have any objections you may disconnect at this time. 

I will now turn the meeting over to Lauren Solkowski. Ma’am you may begin. 

Lauren Solkowski: Great. Thank you so much. And good afternoon and welcome everyone. 

Thank you for joining us today for the Administration for Community Living 

Business Acumen Webinar on Network Development.

Again this is Lauren Solkowski with ACL and I will be facilitating our 

Webinar. For today’s Webinar we have invited representatives from ACL’s 

2013, 2014 Business Acumen Learning Collaborative. 

They are representatives of the Western New York Integrated Care 

Collaborative and are here to discuss a report that their collaborative has 

published entitled Community Based Integrated Care Networks. 
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So they will be looking at some key pieces from the report and some of the 

decision making processes that they used to begin defining their network 

structure.

So before we start with their presentations I have a few housekeeping 

announcements to run through. First of which if you have not done so please 

use the link included in your calendar appointment to get on to the WebEx so 

that you can follow along with the slides but also so that you can ask your 

questions when you have them through the chat function.

If you don’t have access to the link you can also go to www.webex.com. Click 

on the Attend a Meeting button that’s at the top of the page.

And then from there you can enter the meeting number. So today’s meeting 

number is 661512633 again that meeting number is 661512633.

If you have any other problems getting into the WebEx please call the 

technical support number at 1-866-569-3239 again that number is 1-866-569-

3239.

As our operator mentioned all of our participants are in a listen-only mode,

however we do welcome your questions throughout the course of our 

Webinar.

There are two ways that you can ask your questions. The first is which - is 

using the chat function in WebEx - so you can enter your questions that’s 

located on the right-hand side of your screen in the WebEx.

So once you enter your question we will sort through them through all the 

questions and answer them after the speakers have presented.
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The second way to ask a question is through the audio line. So when that time 

comes the operator will give us instructions as to how to queue up to ask your 

question.

If there are any questions that we do not answer or don’t get to during the 

course of this Webinar please feel free to email them to me.

And I will actually during the Webinar I will put my email address up in a 

post that you all will see on the right-hand side of the screen.

As the operator mentioned we are recording the Webinar. And we will be 

posting the recording copy of the slides and a transcript on the ACL Web site

as well as on the AML TSS Network Web site.

So again I will enter this Web site and the email AML TSS Web site address 

in that chat box located in the right-hand side of the screen throughout the 

Webinar and you’ll be able to access it there.

Okay so with that I would like to introduce our speaker. First is Ken

Genewick. Ken has been the Director for the Niagara County Office for the 

Aging for the past four years leading his organization mission to promote 

independence and quality of life through directly and collaboratively provided 

community based services to older adults and caregivers living in Niagara 

County.

Ken’s diverse private and public sector professional health and long term care 

experience and education background including a Masters of Business 

Administration degree with a concentration in health systems administration 
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from the University of Buffalo allows him to bring a unique perspective on 

aging and its dual impact on both the system and the individual.

Our next presenter is Diane Oyler. Diane is the Coordinator of Neighborhood 

Services for the Erie County Department of Senior services.

Her key responsibilities include collaborating with public sector agencies and 

community based organizations to coordinate, evaluate and improve services 

for older adults and the disabled including identifying new resources to 

expand services.

And lastly we have Randy Hoak. Randy serves as the Commissioner of Senior 

Services for Erie County, New York.

Commissioner Hoak’s demonstrated leadership in long term care at home and 

community based services brings a professional perspective informed by front 

line experience working with frail, elders, caregivers and people of all ages in 

need of assistance.

Randy has previously held positions at the Erie County Medical Center 

Corporation and the town of Hamburg Senior Services department.

So welcome to all of our speakers again and thank you so much for joining us 

today. Ken I will turn it over to you.

Ken Genewick: Thank you Lauren. And it’s a pleasure to be presenting here today with my 

colleagues and I’d like to welcome all of you that are a part of the Webinar.

Lauren if you can go to the next slide please it would be great. So really the, 

you know, the discussion that we’re going to have today and what’s ahead is 
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we’re going to discuss with all of you the aging network in Western New 

York.

And certainly not only the network but we are looking to accomplish as a 

collaborative with the backdrop of all the changes that are taking place in New 

York State.

And we also want to talk about community based integrated care networks, 

what these networks are, what we’ve learned about these networks and I think 

more importantly their value and the utility that we’re seeing here in New 

York State and in Western New York.

We also want to talk about the state of our network, you know, where we are 

at in the phases that we presented in our report. And then of course at the end

we’ll have time for questions and answers.

So next please. New York State known as the Empire State and New York 

State is aging like all other states across the country.

Right now there’s almost 20 million people that are 60 or older which is about 

20% of the I’m sorry almost 20 million people in the state 20% of which are 

60 and older sorry I couldn’t read my own slide.

Most live in densely populated downstate area. For those of you who aren’t 

aware of New York State you basically have, you know, New York City,

downstate and then what else is- the rest is considered upstate.

We think New York State is aging though as we mentioned there’s, you know, 

approximately 20% are 60 or older.
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Also we need to include in there for purpose of our discussion is that there’s 

over 3 million caregivers that live in New York State to provide assistance for 

their loved ones as well.

Next please. Western New York is obviously on the Western end of New 

York State. And you can see that there are eight counties that make up 

Western New York with Erie, Niagara in the top left.

We mention that roughly 20% of New York State is 60 or older. Western New 

York itself is above the state average. About 22% are 60 and older about 1.6 

million people that are served across these eight counties.

And really Western York is considered the Buffalo, Niagara metropolitan 

area. And so as we are, you know, really responsible for our local counties it’s 

important to point out the functionally Western New York is really considered 

the metropolis.

So when you think of the way consumers, media outlets and companies view

this area they really consider Western New York to be really one big region.

There are a few cities most notably Buffalo and Niagara Falls but largely 

suburban and very rural as well. And as I mentioned is served by eight county 

governments and really eight different area agencies on aging.

Next please. So the aging network in Western New York, as I mentioned is 

really county-based area agencies on aging.

Really just to take a step back when you think of New York State unlike a lot 

of other states we are by far have more AAA than any other state. There are 

57 counties. And there are 59 area agencies on aging.
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So when you think of your states and how AAAs are set up in New York State 

we are by far have the most. We have 59 different across New York State.

Also when we think of the aging and disability resource centers ours are also 

county based. And all of these ADRCs or Aging Disability Resource Centers 

are housed within the AAAs. So therefore you have 59 AAAs that are also act 

as dual ADRCs.

We have some regional community based organizations that span, you know, 

across several counties or across the entire region of Western New York but 

we have many community based organizations that serve smaller geographic 

areas.

And next please. So the changing landscape -- and I told Diane I wouldn’t 

sing David Bowie’s song Changes -- but you can see that there is obviously 

changes are happening rapidly in New York State as they really are across the 

country.

And across the country of course is, you know, really the Center for Medicare 

Medicaid aim at triple aim driven healthcare which is, you know, better health 

by addressing the root causes of poor health, providing better quality care and 

lowering per capita costs.

So that is something that obviously is an aim across the country. New York 

State is embracing that which we’ll talk about as part of their Medicaid 

redesign team efforts.
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Also that is integrating the medical and social models of care where I think it

was described in our report that there’s thinning lines between the medical 

models and social models of care.

And of course the payment reform that is part of that. And we certainly see 

that in our networks, you know, where you’re moving from your more 

traditional grant based type of funding where, you know, people are paid to, 

you know, perform work and paid the same amount consistently. And even 

fee for service to your performance based models that emphasize shared risk.

Next please. What that change means for the aging network is that, you know, 

a lot of these changes and opportunities are really placing increased value on 

traditional services that our aging networks offers.

And, you know, when you think of the Older Americans Act total three 

dollars of being, you know, home based services, community based social 

model wellness, education, prevention services in the home.

There’s increased value on those services which are great opportunities for 

our network as well as emerging services that play to those traditional 

strengths as well like improving health outcomes, reducing hospital 

readmissions as well as books on health promotion and wellness activities.

Also as part of all these changes it’s bringing new partners to the table to work 

with the aging network as well as new expectations and rules to govern our 

work and our reimbursements.

Next please. Opportunities under the health care reform and aging networks 

that we’re seeing nationally of course is improving population health by 

focusing on things such as chronic disease, self-management, fall prevention, 
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nutrition and exercise also hospital utilization to drive down those costs of 

hospitalization re-hospitalization by focusing on care transitions, short term 

supportive services, and follow-up referrals to preventive services and then 

long term care driving down costs through care coordination, long term 

supportive services, and as mentioned earlier caregiver support all with 

obviously improving health outcomes.

Next please. So what changes look like in New York is as we mentioned 

earlier with the triple aim New York State has in - since 2011 has engaged in

Medicaid redesign through a Medicaid redesign team.

And just looking at why this is being done really is to curtail a significant 

amount of cost so just research has shown that the US has spent 16% of its 

GDP on healthcare nearly two times as much as any other nation.

New York State’s Medicaid the nation’s largest. At one point we’re spending 

$53 billion to serve 5 million people which is twice the national average. And 

so, you know, obviously it’s an initiative at the state level to reduce those 

costs significantly.

And so Medicaid redesign, you know, by initiating a global Medicaid 

spending cap has looked at reforming both, you know, their long term care but 

also instituting several initiatives.

One being the Balance Incentive Program or what we refer to as BIP which 

was a state award in New York State from the Center for Medicaid and 

Medicare Services to expand under your Connects Programs but also try to 

help provide greater access to non-institutional or long term support and 

services.
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And then of course a huge initiative of the Delivery System Reform Incentive 

Program which is really the goal of reducing avoidable hospital use by 25% 

over five years.

This is an up to $6.42 billion allocated to New York State based upon 

achieving predefined results. And so obviously there’s a lot of change 

happening in New York State and happening as we speak as it is I’m sure in 

all of your states as well.

What we’ve seen though is there are new partners that are emerging to be able 

to move ahead with which the New York department of - State Department of 

Health, hospital systems, performing providers systems through DSRIP as 

well as Medicaid long term care plans.

Next please. So what’s needed and expected that we’ve identified, you know, 

over our time being part of this collaborative is to really increase our local 

capacity to deliver services.

Also have the ability to deliver services consistently and inexpensively. And I 

think when you talk about, you know, local governments particularly county 

governments that are trying to work as a region the terms, you know, 

consistently and inexpensively really are the goal.

But, you know, it can be difficult, you know, when you’re looking at scaling 

up if you will as a collaborative entity.

And then of course the ability to serve a large geographic area in a 

collaborative manner really to better meet the needs of customers and engage 

and work with partners that are looking to work in a regional capacity.
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Next please. And up next is how are we going to do that? And I’m going to 

pass along to Diane to talk about, you know, our involvement in the Targeted 

Technical Assistance Initiative beginning in the spring of 2013 (sic) who’s

going to talk about lessons that we’ve learned.

Diane Oyler: Yes, thank you Ken. Absolutely like all of you we were lucky to be a part of 

the Business Acumen Learning Collaborative. We were part of cohort one.

As Ken just walked through we were facing a lot of change here in New York 

State that was driven by health care reform on the national level.

So our state unit on aging was calling for us to do a lot of the work that 

emerging. And we really did know how to do that.

So when this opportunity came out with the National Learning Collaborative 

it was - we jumped on it. And we were lucky to be invited to participate.

So if you’ll go to the next slide please Lauren. So in terms of the early lessons 

I guess the good news was that we definitely have services that are 

increasingly valued by the healthcare system.

Now we need to direct our energy to scaling up our local programs and 

learning the new rules of the road.

So during our time in the learning collaborative we learned a couple of things 

related to that. The first thing is you really need to build up capacity pretty 

quickly.

If you normally deliver four DSME classes a year and reach about 40 people 

that’s probably not going to be enough for you to secure partnerships with 
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physicians to refer to you on a regular basis. So you really need to be able to 

build up capacity to offer classes regularly and reliably for example.

You also need to be prepared to work under different payment models which 

will require some infrastructure that you may not already have in place right?

For instance in the collaborative we learned you’re probably going to need to 

get a Medicare billing number to take advantage of some of these new 

opportunities. To bill for DSME you’re going to need to get accreditation for 

your program.

You’re likely to need to build new systems to monitor quality, do reporting, 

undergo audits all of those sorts of things that go along with that new 

business.

So we understood that that was a lot for any one organization to do on its own. 

So one of the biggest takeaways from the learning collaborative was rather 

than try to do that and go it alone as a standalone organization AAAs and their 

community based partners should really work together to do these things as a 

formal network.

Next slide please. So the ACL has been encouraging all of us to look 

specifically at what they call community based integrated care networks.

As they explained in their original request for application for the first learning 

collaborative those networks are very similar to Independent Physician 

Associations or IPAs.
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And IPA serves as a vehicle for private practice physicians to get together. It 

allows the physicians to address issues together without losing their 

independence.

The signature characteristic of course of an IPA is that it serves as a vehicle 

for physicians to negotiate and contract with payers.

Next slide please. In the time that we’ve been looking at community based 

integrated care networks we found that they’re even more similar to rural 

health networks here in New York State.

And rural health networks are across the country. I don’t know how many of 

you are familiar with them or not. I know a lot of people haven’t heard of 

them before.

But like an IPA they also bring providers together to pursue common goals. 

Where they’re a little different is that they bring different provider types 

together.

For instance they’ll bring together a hospital and ambulance service

physicians. And here in New York those can also include county government 

such as county health departments.

So they’re very similar to where we want to go. And they can look very 

different from one another depending on the needs of the communities they’re 

serving. Their form follows the functions they’re going to have to perform.

So as we’ve been working through our own network building we’ve definitely 

been keeping an eye towards those rural health networks and we also have a 
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partner agency at the table that is part of a rural health network that’s been 

helping us quite a bit.

Next slide please. So in terms of how they can help while in the learning 

collaborative we learned a lot about the different ways that they can do that.

For us here in New York State where services are very county based they can 

absolutely increase your geographic reach.

They certainly help to provide economies of scale so that labor intensive 

activities like going through an accreditation process can benefit more than 

one organization.

They can provide a single contracting point so it’s easier for buyers to do 

business with providers. And they can perform a lot of the common business 

functions that are needed such as billing and doing data analytics.

Next slide please. So all of that sounded good to us, when we were in DC and 

we were learning more about these networks it sounded good to us.

But when we brought these lessons back to New York State and to our 

partners, our partners wanted to know if these kinds of networks made sense 

here in New York. And if they do what kind of network should we build? 

What should that network look like?

If we were going to build something we wanted to make sure it made sense 

for our community and was a fit for our needs.
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Next slide please. So every state’s regulatory system is a little different. So we 

really needed to look at the situation here in our state and map out the best 

course of action.

To do that we needed a little bit of help. So we secured some help from a local 

foundation partner. And we certainly would encourage everybody to seek out 

such partners themselves.

Our partner is the Health Foundation of Western and Central New York. They 

have been supporting our learning collaborative experience in a number of 

ways already.

For example they had funded several of our network partners to attend the 

2013 n4a conference to kick off our learning collaborative experience.

So when we came back with these questions about network building they were 

very receptive to sponsoring our work as we took a closer look a systematic 

look at integrated care networks and building them here.

So with their help we’ve been working through a three phased process. During 

the first phase we set up a steering committee and developed a work plan for 

taking a really deep look at networks during Phase 2.

Phase 2 or the study phase the fact finding phase resulted in the report that the 

ACL shared with you. It included our recommendations for moving forward 

with our network building.

And now we’re in Phase 3 which is the implementation phase which we’re 

going to describe to you in a moment.
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Before we do that though we just want to give you a better sense of what we 

looked at when we were developing that proposal.

Next slide please. So what we felt we had to look at were four big questions 

okay? First what does the regulatory landscape look like here in New York 

State?

That’s - as we’re going through this Medicaid redesign has been unfolding in 

New York State. So every time we think we have one thing figured out the 

state has thrown something new at us. So it really took time for us to get our 

arms wrapped around all of that regulatory change.

So we had to look at what the landscape looks like in New York State. We 

had to look at what kind of network structure could help us maneuver in that 

landscape and position us to be stronger partners.

We - once we identified the type of network that could help us we had to 

address whether or not that network was achievable in New York State in 

terms of dealing with personality types, and politics and just the reality on the 

ground.

And the last question we had to answer when we took stock of all those things 

is what would we need to make this network happen?

Next slide please. So when we looked at the regulatory landscape just to give 

you a sense of that we found that the emerging needs of New York State are 

very similar to what others are reporting across the country.

We have suspected that New York State was different. Some of you may be 

suspecting the same thing about your own home state.
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We’re - it’s not that different. It may look different on the surface but once 

you dig in deeply the dynamics are unfolding are nationally driven so what 

we’re seeing is very consistent.

There’s definitely a need for our services whether that be health promotion, or 

care transitions, or care diverse services that’s definitely there.

There is definitely a need for a local capacity. You’ve probably been hearing a 

lot about our value for having feet on the street right?

So they definitely need our local capacity. Services need to be delivered 

consistently and reliably wherever people in need of services are.

But there are some new expectations as well. The most important one that we 

have to address here in New York State again is that need for regional reach 

which may seem easy for you guys because a lot of you are organized

regionally already.

But New York State has traditionally had a very strong county based delivery 

system for many services and that’s changing now.

New opportunities are opening up. But to take advantage of them 

organizations are expected to have reach beyond one county.

There’s also very - this is very different from our traditional system which 

really has emphasized neighborhood based services within one county.
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And then looking on the horizon payment reform is also going to be impacting 

us. Right now we’re still finding that grant dollars are still slowing just for 

program development.

But things are starting to change. Grant funders are increasingly asking us 

about our sustainability plan. They are increasingly encouraging us to talk to 

the performing provider systems that were set up by DSRIP or accountable 

care organizations.

So they want - there is definitely an emphasis for switching from grant based 

business to negotiated contract based business.

Next slide please. So given what’s happening in New York State we definitely 

felt that an integrated care network could definitely be helpful.

Our appreciation for that grows every day. I think Randy will tell you little bit 

more about that soon. But the question is if we’re going to set that network up 

what did we need it to look like?

We identified a couple of big things. Number one the opportunities are 

coming up all the time. We were telling Lauren before we got started 

sometimes our network development work has been slowed because while 

we’re developing the network we’re also responding to program development 

opportunities.

So because opportunities are coming up all the time we need to be able to 

establish this network easily and quickly.
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The second thing is we need the number of funders and buyers in the system 

are increasing. We’re not just working with the state unit on aging anymore. 

We’re seeing a lot of different types of buyers and funders.

So we need something that can help us to build and manage relationships with 

those funders, and buyers and the people that will refer business to us.

We need something that can perform key business functions. The most 

important ones include going after the new business in the first place but then 

also taking care of all of the administrative work that comes along with that 

from managing the contract, to reporting and so on and so forth.

And the last one which really comes primarily from our CBO partners 

whatever we build has to help insulate the collaboration from political 

dynamics.

AAAs here are county based. So they want to make sure that whatever we 

build if the cast of characters changes this work can still continue.

Next slide please. So with that menu of things in front of us we turn to looking 

at several of the network models that we were introduced to while in the 

learning collaborative.

Some of you may have already been introduced to some of these things like 

the super messenger model, clinical integration model, provider primary 

provider model which we learned more about on Webinars like this.

So all of those models can kind of blend together when you’re first learning 

about them so we wanted to really take stock with what each one entails and 

then compare those to what we (need).
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Next slide please. So if you take time to read the report in this section this 

table basically summarizes how we went about doing that model by model 

comparison.

We looked at five different models and about a dozen different network 

functions that we identified that we would need going forward.

For each of those functions we identified if it was something that a particular 

network type could perform.

We also identified whether there were local examples of that function already

being performed by an organization.

So if we had it locally it’s a large X. If it’s something the model could do but 

it’s not available right now it’s a small X.

This helped us to take stock of what we already had here in place in Western 

New York and what we would need to move forward.

So for example you can see we have a large X indicating that we have MOU

based coalitions that are helping partners to get to the table and are providing 

regional reach beyond one county. They don’t provide much more than that 

though. That’s the model in the first column.

At the other end of the table you see that we do have local examples of 

primary providers performing network functions on behalf of the CBO

partners.
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All of the AAAs in New York State for example are primary providers that

perform key network functions for their local aging network already providing 

IT services for example but they don’t have regional reach because they’re 

limited to the county.

So in all cases with the models that we looked at we were missing something 

that we needed moving forward okay?

So on that note I’m going to hand it over to Randy and he’s going to tell you a 

little bit more about what we’ve been doing here locally, what’s working and 

then where we’re heading with filling in this network model.

Randy Hoak: Thanks Diane. Good afternoon everyone. Yes as Diane said I’m going to talk 

about what was currently working what’s been working for a little bit - a little 

while here what we need, and what we are doing about it and what we plan on 

doing about it.

So Diane mentioned this MOU based coalition. And that’s working here. That 

has been working here. And we have an example of success where we’ve been 

able to partner with - I’m sorry next slide. I’m going to forget to do that. So 

you’re going to hear Diane and Ken saying next slide.

So these MOU base coalitions we’ve been successful. And we have a definite 

example recently where we were able to secure some funds from the New 

York State Department of Health to deliver caregiver services.

And this has been great. We’ve been - it’s been a very positive experience. 

We’ve engaged some of the partners that have been on board with this

collaborative all long as well as some new partners.
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What’s been nice about it is it’s really highlighted and reinforced some of the 

needs that we’ve identified in the earlier part of this presentation.

And it helps us to do something right now. And that was one thing that we 

identified we need to do something. Our partners were looking for some 

tangible results.

However it’s a little clunky to work under this arrangement especially if 

you’re going after funding for a program that’s going to be delivered in eight 

counties.

So were talking a lot of MOUs, a lot of time that could be saved if there was a 

different type of network available to execute some of this work.

The other thing that works - next slide thank you. The other thing that has 

been working here is the primary provider model.

And this is a model that’s very familiar to AAAs in Western New York and 

I’m sure across the country. A lot of this work we do already.

And they’re really network functions. We perhaps didn’t think of them as 

network functions before we had the opportunity to join the Tiger Technical 

Assistance but we’ve been able to identify these as resources that can be 

helpful.

So these - this model will help us to leverage existing infrastructure and 

maximize our existing relationships.
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So it gives us the opportunity to be cost effective partners. And as Diane had 

mentioned it insulates or one of the concerns that we have is the political 

dynamics of a government based environment.

So that is very prevalent in the primary provider models. There’s political 

turnover. There’s turnover in staff. There’s changes in policy and direction of 

the governmental entities.

So what -- next slide please -- so we have been able to identify some needs 

that we’ve looked to address incrementally over time.

Certainly the geographic reach is a need that we’ve been able to convey. But 

also a short term need for quality improvement and relationship management. 

That was certainly lacking in the two models that we had experience with 

locally.

And also this continues to be a learning experience for us the need to take on 

financial risk as we move forward with these partners.

So working under the -- next slide please -- working under the constraints that 

we’ve kind of set forth with a better idea of what the needs are locally we 

started to identify what we can do next. What do we need to do immediately 

and what are the things some of the low hanging fruit that we can address?

So those priorities are regional reach certainly, low cost and the ability to 

grow and change over time because as we were able to stress early in the 

presentation we are in an environment that is under a great deal of change and

pressure to change.
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Next slide. What was very a valuable experience for us probably about half 

way through this process was to sit down with some folks that worked in a 

clinical setting but had gone through a similar process and similar evaluation 

years previous to us.

And this was a group of the Safety Net Association of Primary Care Affiliated 

Providers of Western New York, they called themselves SNAPCAP.

But they were not a very formal entity at the outset. This was a group of 

primary care providers, leaders within those providers that really met on a 

very informal basis and would describe themselves as more of a coffee club.

They then transition into a Limited Liability Corporation when the needs that 

were impacting their sector became apparent to them.

And then eventually they went on to a 501(c)(3). And they are a central part of 

one of the DSRIP performing provider systems in Western New York. So they 

were able to point us in several directions of work that we needed to do right 

away.

Next slide. Probably first and foremost was seeking legal advice. And this was 

- this is where we really were able to get the ball rolling.

And I think it’s very important that if you find yourself at this stage in 

network development to make sure that you have the appropriate legal advice.

And our partners at SNAPCAP were able to refer us to an attorney who really 

is considered an expert by many on not for profit law, governance and the 

like.
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So he was able to put a lot of these terms answer a lot of these questions for us 

for our partners, for our county leadership in relatively easy to understand 

terms that we could bring back to our leadership and we can - our partners 

could bring back to their not for profit board members.

Next slide please. This was not as easy as we thought it would be. We - when 

we participated in our TTA cohort we heard a lot about LLCs.

And there was a number of regions within the country that were looking to go 

in that direction or had been successful in developing networks through the -

an LLC model.

And after a couple meetings with the attorney that we’re now working with 

we decided that wasn’t going to work well in New York State.

So he - and we decided against it because of the very difficult transition in 

New York City - New York State to go from an LLC to a 501(c)(3).

Unless you structure that LLC in the state of Delaware which was a loophole 

that the attorney provided for us to - if we wanted to do an LLC we could. It 

would be relatively easy and quick. But it would have to be in the state of 

Delaware and then we could down the road convert it to a 501(c)(3).

As we stress in this presentation we are local government entities. And we 

thought that, that would be a little awkward to propose to our county based 

and state leaders to establish an LLC in the state of Delaware.

So I just stress this point because this is an example of the political concerns 

that often need to be considered in this work.
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It certainly was an interesting conversation. And eventually we were able to 

identify the vehicle that we needed a taxable not for profit corporation.

And that’s where we are focusing our efforts on right now. So New York 

State law allows this entity to begin, to become incorporated, and to begin to 

function while the bylaws and other governance issues are being hammered 

out.

Next slide. So where we are right now, we’re continuing to build this as we 

go. The Health Foundation of Western and Central New York is continuing to 

be a great partner and they’re covering costs of incorporation while we work 

with this attorney and our partners.

We are looking at identifying the three members that are going to start off this 

process. We’re really looking at leadership and discussing with the leadership 

from our counties what our role is going to be, what that’s going to look like,

what the implications are within county government. And we’re also engaging 

our steering committee in that conversation as well.

We are really making sure that we allow this - the form to follow the function 

as programming develops.

So we’re giving you a few examples of what we’re looking at programming 

wise some of the health promotion activities, the diabetes self-management,

care transitions this caregivers grant that’s been a regional application.

So as those needs arise we are looking to make sure that the function of this 

network is going to address those as they come up.
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Next slide please. What’s been very important for us to remember is that as 

we get moving we will find the answers to - we found the answers too many 

of these questions as we worked through some of the issues.

We learned from some of our - the other organizations the other participants 

of our cohort that it can be very easy to get stuck on answering a question 

before you move along. And what we have found is a lot of this work needs to 

be done in parallel tracks.

So some of the work that remains that we are looking to address in this next 

phase is what’s the ownership and governance structure?

As we mentioned we have some ideas as far as the direction that we’re headed 

there but there’s a great deal to be hammered out yet.

What does membership mean? How does an organization become a member? 

What’s the value to that organization? What limitations may they have as a 

result of their membership? What circumstances can a membership be 

revoked? And how can we cover startup and ongoing administrative costs?

So there’s been several opportunities that we’ve worked on under this 

philosophy without putting a lot of the covering some of the legal questions

but looking forward the partners that we’ve had at the table and the newer 

partners due to some of the other initiatives that we’re working on they have 

been able to see the value in the concept and the model that we’ve discussed 

and that we’re moving towards.

So that’s all I have for right now. And we would - are really eager to hear 

what your questions may be.
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Moderator: Lauren Solkowski

02-24-16/1:00 pm CT

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Lauren Solkowski: Great, thank you. Ken, Randy and Diane thank you so much. So we will 

start the Q&A portion now. So operator if you could please provide 

instructions for asking a question through the phone that would be great.

Coordinator: Thank you. If you’d like to ask a question please press Star 1. Please unmute 

your phone and record your name when prompted, it is required to introduce 

your question. Once again that’s Star 1 if you have a question.

Lauren Solkowski: Thank you. So while we wait for questions to come in I actually had a 

question for you - for you guys.

So - and I know this is something that we’ve heard from our current cohort in 

terms of, you know, getting your foot off the ground and, you know, making 

that initial step.

Diane you had mentioned you made a connection to your - the foundation the 

Health Foundation of Western and Central New York. So my question is how 

did you make that initial connection with them?

Diane Oyler: Well in the case of the Health Foundation of Western New York I think we 

are lucky in that they fund projects in two areas exclusively.

One is for children, you know, zero to five. The other is frail elders. So they 

had been - they’ve only been around I think for what about 15 years now. But 

since the beginning they’ve really been very good partners to the aging 

network in their territory.

So we happen to be involved in another capacity building grant effort that the 

foundation had underway at the time called Ready or Not.
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And so a lot of the work that we are planning on doing with our Ready or Not 

grant when this application - when this opportunity came forward with the 

learning collaborative it offered us a way to do a lot of that work and get the 

resources from the ACL for free.

So that was - that kind of gave us an automatic opening to talk to the 

foundation about this. They were excited from the beginning because it did 

complement their existing efforts so well.

But really I think that a lot of times people make the mistake of viewing 

grants in isolation. So when they, you know, they may a lot of your cohorts 

may have existing grants and regional partners already that are helping them 

to do work at point A.

And they need to make sure they’re connecting the dots. And that’s what we 

did with this. When we received this we automatically communicated that 

success to the Health Foundation of Western and Central New York.

One of the first things you guys did was encourage us to get our partners to 

the n4a preconference intensive in 2013.

We automatically said okay let’s ask the foundation to do that for us because 

we knew that this was consistent and in alignment with their own goals, and 

mission and vision.

And it starts with a phone call to your program officer your local program 

officer to see if there’s interest.

And then once that’s in place writing a pretty short proposal a two-page 

proposal outlining what it is that you want to do.
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And keeping them posted of your successes as you go. Don’t be shy about 

your successes. You’ve got to build up that excitement in your local 

foundation partners and always connect back your success to the things that 

they’re interested in so that’s all we’ve been able to leverage that relationship 

with the foundation.

And they’ve gone on to build new relationships themselves with you guys, 

with the Hartford Foundation, with SCAN.

So it’s been a win-win. So I think wherever you have a win-win you can 

certainly make the case with your local foundation.

Lauren Solkowski: Great. Thank you so much. Operator I’m checking back to see if we have 

questions come in on the phone.

Coordinator: Currently there are no questions. Once again that’s Star 1 if you’d like to ask a 

question.

Lauren Solkowski: Thank you. Checking we don’t have other questions on the chat but I did 

get a note from - it’s the California Association of Adult Day Services.

And sort of they - she mentioned that they’re just starting to build a network 

and would like to bring all of their adult day health care and adult day services 

together as one unit. So they’re just starting this work.

And so are just - she indicated an interest in connecting with you all maybe 

via through their executive director to talk, you know, more after this 

Webinar, you know, to learn more...
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02-24-16/1:00 pm CT

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Ken Genewick: Sure. We’d be happy to do that.

Randy Hoak: Yes.

Lauren Solkowski: ...that you talked about today. That would be great. So I’ll make that 

connection following the Webinar.

Okay I’m just checking my box here. Let’s see

Randy Hoak: I do think if I could just add Lauren I mean that’s a great - I’m glad to hear 

that there’s a group of adult day providers that are looking to organize in that 

way.

I believe that - and it was our experience in our work in our cohort the state 

associations or associations of specific agencies can be helpful in these.

I know that there’s a state association I believe in Pennsylvania that was a 

participant of our cohort. And if the willingness is there and if the capacity 

within the association that’s another place to look because they may be 

structured in such a way to have the regional reach and also, you know, the 

contracting, the QI there’s a great deal of potential there.

And what we found as we’ve had more conversations with medical providers 

that there’s associations that function in that way on the medical side that have 

been able to really model what we’re looking at in New York as well.

Lauren Solkowski: Oh great. A question that came in via chat is what was your timeline for 

the - for this network implementation?
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Diane Oyler: Well we’ve got overtime. I’ll tell you that much. I think that originally we 

were hoping to get something going before our cohort ended at the end of 

2014.

It’s been really difficult to maintain a timeline for several reasons. Number 

one during our fact-finding phase we secured consultants to help us unravel 

the regulatory picture here in New York - working with some consultants the, 

you know, it alters the timeline.

And new questions keep popping up. It was while we were in the early stages 

of building or looking at building this network that all of a sudden DSRIP hit

in New York State. And a lot of attention got diverted to that.

And so maintaining a timeline has been difficult. We originally had these 

conversations with the attorney early last fall I would say.

So at that point we were right in the in Erie County we were at a point where 

we were going through a county executive election. So we had to kind of wait 

for the - had to wait for the election calendar to catch up with us.

But in terms of once all that’s settles getting it done is very quick. The 

incorporation itself can take a matter of weeks according to the attorney.

And now we’re at the point where it will go as quickly as we are ready for to 

go. The incorporation papers are pretty much ready to go we just have to 

identify our three directors.

Just get the final okay from our county executives. We’re meeting our 

partners again tomorrow. We’re hoping to have this in place within the next 

what would you say guys a month or two?
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Randy Hoak: Yes hopefully.

Diane Oyler: Yes.

Ken Genewick: Yes. I think it’s important maybe just to talk about what Diane had mentioned 

as well is that, you know, we obviously came in with plans, and goals and 

timelines.

But, you know, so much happens and it’s no - not like anyone else is 

experiencing in their work as you maybe your day to day operations that you 

run and the landscape changes.

But, you know, I think what’s been great about what we’ve done is that, you 

know, we’ve run into roadblocks here and there but we’ve kept the 

conversations going. And, you know, it gets discouraging at times if you 

aren’t meeting your self-imposed deadlines.

But just the fact that, you know, you keep it going and you don’t stop at a 

roadblock or a dead end, you know, Randy mentioned earlier this caregiver’s 

initiative that we were able to work with.

And frankly I mean we’ve got seven counties to collaborate with the regional 

not for profit to be able to apply for a grant that’s, you know, a 5 year grant to 

help provide caregiver relief for those caring for individuals with Alzheimer’s 

disease.

It’s an initiative that had we not started this targeted technical assistance in 

2013 we never would have been able to come together as quickly as we did.
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And even though we certainly - it’s been helpful to learn what, you know, 

what one of these not for profit corporations can do for us to make that 

quicker that effort would have never been put together had it not been for this 

initiative.

And so we found success in other arenas that would not have been built had 

we not have this relationship.

Diane Oyler: Right. And I think the only other thing I would add Lauren is that as our CBO

partners have been - the more seasoned ones who had experience in the rural 

health network sometimes when you’re doing the network building when 

you’re trying to justify go in from a coalition of partners to doing something 

more formal you really need to have a reason.

And I think that comes - so all of a sudden an opportunity will come your way 

that really requires you to make the change.

So to go back to the SNAPCAP example our primary care friends they were a 

coffee club until, you know, they had a - until Health Homes came along. And 

all of a sudden it made sense for them to become an LLC.

Then the transition from LLC to 501(3)(c) that only happened because they 

needed to be - have nonprofit status to make another move that they wanted to 

make with DSRIP.

So you’ve got to have a trigger to justify going from one step to the next with 

the network formation is what we’ve found here locally at least. People don’t 

want to just build something for the sake of building something.
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That’s why we chose this particular type of model where you can go - we can 

get the paperwork in place. We can be incorporated. We’re actually a thing, 

you know, it’s real and tangible.

And then as opportunities present themselves you can become more and more 

structured and flip from one from a taxable nonprofit to a 501(3)(c) as the 

need arises. So that’s what we mean form following function.

Lauren Solkowski: Right.

Diane Oyler: So yes so with this Alzheimer’s grant we’ve really found that yes we can get 

partners together with MOUs but as Randy said getting the contract in place 

we’re going - doing the work plan and has been a bear.

And I think every time one of these opportunities comes our way and we’re 

not prepared people realize the need for that network. And I think that’s you 

need to have that trigger.

Randy Hoak: Yes. The other thing when it comes to that specific issue is we are at the 

mercy of the regional partner that may or may not be available at the time.

So the mission could change, the leadership could change, we could have an 

established partner for years that we may look to in an opportunity that comes 

our way but things change. And folks that have worked in and among the not 

for profit world they know that well.

I’d also just like to echo the reason that is critical it - there’s a temptation. And 

this came up several times throughout the course of our interaction with some 

of our partners is a temptation to identify who this is going to be.
NWX-HHS-AOA-1

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02-24-16/1:00 pm CT

Confirmation # 6612094

Page 36

Diane Oyler: Yes.

Randy Hoak: Who’s going to be running this? How are we going to pay them? Where are

they going to work? Where is their office going to be or where is a building 

going to be?

And we have successfully dodged any of those commitments to this point 

because we want to protect that reason. I’m sure that many other communities 

can relate to, you know, seeing not for profits merge more and more a call for 

not for profits to merge.

So when you’re presenting your community with another not for profit that 

reason becomes all the more important.

Lauren Solkowski: That’s great. So I guess another question just - well actually let me check 

back with the operator before I go back to the chat. Are there any questions on 

the phone?

Coordinator: Yes. We do have a question from Kristin Jeffries. Your line is open.

Kristin Jeffries: Am I on?

Lauren Solkowski: Yes, hi Kristin.

Kristin Jeffries: Okay, hi. This is Kristin Jeffries with the Wisconsin Institute for Healthy 

Aging in Madison area.

And I had sent a question over the chat as well. And you may have answered 

this but could you comment on the proposed financial arrangements, the 

startup funding for the network, how will the network be funded to perform 
NWX-HHS-AOA-1

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02-24-16/1:00 pm CT

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Page 37

the administrative functions listed in the table? And Randy you were getting at 

this a little bit but if you could comment on where the startup funding is 

coming for this?

Randy Hoak: Sure.

Kristin Jeffries: Please.

Randy Hoak: The startup funding to date has been provided for by the foundation the Health 

Foundation of Western and Central New York.

So moving forward we are looking at several possibilities. I would say the 

primary possibility is through reimbursement for delivery of services as well 

as, you know, grant revenue through perhaps indirect costs that may be 

associated with different grant programs.

Kristin Jeffries: Okay. So taking a certain percent of the either the reimbursement revenue or 

the grant revenue and assigning that to the administrative and support 

functions of the network of corporation then okay.

Randy Hoak: Yes. That’s something that we’re looking at.

Diane Oyler: And I think...

Kristin Jeffries: And is it also possible that the network member organizations and grant it

most of them are county organizations or county governments perhaps private 

nonprofit CBOs.

Would they be also asked to contribute a certain amount to the - as a member 

to the network as an ongoing annual fee or anything like that?
NWX-HHS-AOA-1

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02-24-16/1:00 pm CT

Confirmation # 6612094

Page 38

Randy Hoak: Yes. That’s something that we’ve discussed. And it’s something that other 

organization SNAPCAP that I had mentioned that they had instituted at one 

point.

I’m not sure if they still have that membership organization structure but it’s 

certainly something that we’d be willing to consider.

But it’s really not I wouldn’t say that it’s really the primary method of 

financing. We’re not looking at that becoming really the sustainable income 

for the network.

Diane Oyler: I think one of the most important things we’ve grappled with is this question. 

And, you know, there is a real hesitancy to build something that’s really large 

in the beginning that’s going to take a lot of capital to support because the 

idea of building this network is to be - help be a revenue generator for the 

member organization not a revenue consumer.

So we really are looking at low cost ways and really building it out as the need 

arises and the revenue for doing those services is coming in.

So we’re really trying to keep that in mind. And I think one of - an important 

indicator for us is that when we did sit down here in Erie County and talk to 

our county executives one of his first questions was is this going to be another 

nonprofit that we’re going to have to invest a lot of money in?

So locally, you know, we can - we have been invited to create another 

proposal write another proposal to cover, you know, more extensively these

startup costs.
NWX-HHS-AOA-1

Moderator: Lauren Solkowski

02-24-16/1:00 pm CT

Confirmation # 6612094

Page 39

But there’s not a lot of appetite locally for building a really expensive high

end organization. They’re going to have to earn their revenue as they go.

Randy Hoak: Which I think is why as we’re looking at this, you know, what models make 

most sense is the not for profit corporation is easy to set up which would 

allow you to develop the 501(c)(3).

But to Diane’s point, you know, to build, you know, a grand not for profit, 

you know, without having the revenue to go along with it would not be the 

right approach we want to take because the not for profit corporation can be 

small enough as your building and frankly not necessarily even realizing any 

profits, you know, that it will be easier to build small.

Diane Oyler: Right. And leverage the strengths of your partner organization. That’s the one 

- that’s what we have to do.

Right now I mean we have in terms of supporting our network efforts we’re 

using a part time consultant. So until resources are in place we’re keeping our 

- the cost for this as low as possible.

Kristin Jeffries: All right. Thank you very much.

Lauren Solkowski: Okay. Operator is there any other question on the phone?

Coordinator: Not at this time.

Lauren Solkowski: Thank you. We do have another question. So this one is asking about can 

you talk a little bit more about the type of healthcare partnerships that you 

have now and are you getting paid for the services as you more formally form 

your network?
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Diane Oyler: I think the most important one that we’re - partnership that we’re looking at 

right now is with our local performing provider system and our hospital 

systems.

The way we’re doing a lot of our program development work one of our first 

lessons we learned and it was from the folks in Merrimack Valley was you’ve 

got to demonstrate your value.

So we’ve had a pilot program in place with our local hospital called (Risa 

Home) that basically works on care transitions from hospital to home.

The grant funding for that is winding down. So those - and interestingly now 

they’re looking at us because they have experience with us. And looking at as 

being part of what their billing as rapid response teams to deal with hospital to 

home transitions.

We haven’t started talking about compensation yet but that would be an 

example of an emerging partnership.

Apart from that we’re aggressively working on building on building up our 

capacity to deliver reimbursable DSME.

And put that in place to get the Medicare reimbursement for that apart from 

any specific partnership.

Lauren Solkowski: Okay. Another question that just came in, are you still doing credentialing 

when organizations join?
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Diane Oyler: We haven’t filled out what the credentials would be. I mean as AAAs there’s 

provider credentials that we must have if it’s going to be for a social adult day 

or for a home care agency those sorts of things.

So to the extent that you’re dealing with existing services we fall back on our 

existing AAA credentialing.

But as we’re moving forward with accreditation whatever the accrediting 

body requires in terms of those credentials is something we would have to just 

as you do know with you in your AAA capacity you’re just going to have to 

make sure your partners - if you’re doing medical nutrition therapy they have 

to be a registered dietitian. If...

Lauren Solkowski: Right.

Diane Oyler: ...they’re going to be supervising DSME classes they have to be one of the 

acceptable clinical types. So that’s all part and parcel depending on what 

program you’re developing or pushing out.

Lauren Solkowski: Right. Okay just checking quickly. Okay operator any other questions on 

the phone?

Coordinator: No. There are no questions at this time.

Lauren Solkowski: Thank you. I will give it another minute or so just to see if we have any 

last minute thoughts from anyone. Sorry about that. So yes let’s just wait 

another minute and then.
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Page 42

Randy Hoak: And while we’re spending that minute I just want to say that our email 

addresses are up there. And we found that to be a very valuable interaction 

throughout our cohort as the Tiger Technical assistant.

And there was plenty of phone calls between folks in different parts of the 

country to just kind of clarify, you know, throw out the clarifying questions 

and seek their counsel as well.

So please we’d be more than happy to talk to you off line if you have 

questions that occur to you later on after digesting this, or after having a 

conversation with a colleague, or there’s something that comes up that you 

think we may be helpful with don’t hesitate to call or drop us an email.

Lauren Solkowski: Excellent. Thank you so much for that Randy. So I’m showing no other 

questions at this time. So I think we’ll get ready to conclude.

I just wanted to thank Ken, and Diane, and Randy again for joining us today 

and for such a wonderful comprehensive presentation.

Thank you so much. Thank you for all of our participants and for your 

questions for them. They were great.

Again if you think of any other questions once we hang up please feel free to 

email them to me. My email address is listed there in the chat box on the 

right-hand side of the screen. So just thank you again to everyone and enjoy 

the rest of your day.

Ken Genewick: Thank you.

Diane Oyler: Thank you Lauren.
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02-24-16/1:00 pm CT

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Lauren Solkowski: Thank you guys so much.

Randy Hoak: Bye-bye.

Lauren Solkowski: Bye-bye.

Coordinator: Thank you. That concludes today’s conference you may disconnect at this 

time.

Lauren Solkowski: Thank you.

END