Building Community-Based 


Integrated Care Networks 


Lessons learned by the Western New York 


Integrated Care Collaborative
 

Ken Genewick 

Director, Niagara County Office for the Aging 

Randy Hoak 

Commissioner, Erie County Department of Senior Services 

Diane Oyler, Ph.D. 

Coordinator of Neighborhood Services, Erie County Department of Senior Services
 
What’s !head?
	

The Aging Network in WNY and Change in NYS 

Community-based integrated care networks—what 

they are and how they can help 

The state of the network 

Question & Answer 
New 

York 

State
 

• Almost 20 million people 

20% are 60 or older 

Most live in the densely populated “downstate” area 

•

•
Western New York
 

• 1.6 million people 

21.6% 60 or older 

Buffalo-Niagara 

Metropolitan Area 

Most of the area is rural 

Served by 8 county 

governments 

•

•

•

•

5 
The Aging Network in WNY 

• County-based Area Agencies on Aging (AAA) 

County-based Aging & Disability Resource 

Centers (ADRCs) 

Some regional Community Based 

Organizations (CBOs) 

Many CBOs serving smaller geographic areas 

•

•

•
The Changing Landscape
 

• Triple Aim-driven health car e 

reform (Better health, better 

care, lower costs) 

Integrating the medical and 

social models of care 

Payment reform 

•

•
What Change Means for the Aging 

Network 

•	 Increased value placed on our traditional

services

•	 Emerging services that play to our

traditional strengths
 

• New partners, expectations, and rules
OPPORTUNITIES UNDER HEALTH CARE REFORM AND 

AGING NETWORK SERVICES
 
What Change Looks Like in NY 

• Medicaid Redesign 

• Medicaid long term care reform 

• Balancing Incentive Program (BIP) 

• Delivery System Reform Incentive Program (DSRIP) 

New partners 

• NY Department of Health 

• Hospital systems 

• Performing Provider Systems 

• Medicaid Long Term Care plans 

•
What’s Needed and Expected
 

Local capacity to deliver services 

Ability to deliver services consistently and 

inexpensively 

Ability to serve a large geographic area 
How Are We Going To Do That?
 

Targeted Technical Assistance 

to Build the Business Capacity 

of Aging and Disability Community-Based 

Organizations for Integrated Care Partnerships 

RFA Spring 2013 

THE ADMINISTRATION FOR 

COMMUNITY LIVING 

12 
Early Lessons Learned From the Business
 

Acumen Learning Collaborative
 

We need to be able to scale up quickly. 

Payment models are changing and we need 

to change with them. 

Networks may be better suited to do this. 
Community-based Integrated Care Networks
 

Similar to Independent Physician Associations 

(IPA) 

a legal entity organized and directed by physicians in 

private practice to negotiate contracts with insurance 

companies on their behalf. 
Community-based Integrated Care Networks
 

Even more similar to Rural Health Networks 

• A collaboration among rural health care providers that 

pool resources and identify means to achieve common 

goals and objectives. 

• Cross-sector public-private partnerships 

• The characteristics of the network in terms of governance, 

complexity, and scope of objectives differ among networks 

(form follows function). 
How Do they Help?
 

• Regional reach 

• Economies of scale 

• Single contracting point 

• Perform common business functions 
Questions that came out of our time in the 

Learning Collaborative 

• Do integrated care networks make 

sense in New York State? 

• If so, what should that network look 

like? 
 

Help Answering Those Questions
 

ACL National Learning 

Collaborative begins 

2013 

HFWCNY funds WNYICC to 

attend n4a 2013 to kick off 

Learning Collaborative 

HFWCNY funds 3-phase 

network development 

process 

2014 

• Strategic Partnership with the Health Foundation of Western 

and Central NY 

• Sponsored a 3-phase process to guide our work as we 

explored integrated care networks 
Fact Finding: Opportunities and Constraints for 

Integrated Care Networks in New York 

4 key questions that emerged from participation in the Business 

Acumen Learning collaborative: 

What are the regulatory and payment-system demands that 

buyers must meet? 

What network structure can best meet those demands? 

Is such a network feasible in our current healthcare and LTSS 

marketplace? 

What additional resources, including new partners, will be 

required for implementation? 

19 
Regulatory and Payment-System Demands in 

New York State 

20 

Consistent with the national dialogue 

• Regional reach is essential

•	 Integrated care entities must be able to demonstrate

that they have local capacity
 

•	 Integrated care entities need access to a wide range of

new services

•	 They need partners that can deliver client outcomes

and work within new payment models
 
Network Features to Meet Demands
 

To address the changing health care environment, a 

network should be able to do several things: 

• Get partners to the table with potential buyers quickly. 

• Serve as a vehicle for collective action on a regional level. 

• Help build and manage relationships with funders and buyers. 

• Perform needed business functions. 

• Insulate the collaboration from political dynamics and overreliance on personal relationships. 

21 
Network Models
 

• MOU-based Coalition 

• Super Messenger Model 

• Clinical Integration Model 

• Financial Integration Model 

• Primary Provider Model 

From “The Future Is Now—Preparing for the New World of Medicaid Managed 

Care, Contracting with Private Health Plans and Development of Community 

Care Networks” Center for Disability and !ging Policy !dministration for 

Community Living Webinar Series. March 11, 2014. 
 Less Integrated More Integrated 

MOU Based Super Messenger Clinical Integration Financial Primary 

Coalition Model Model Integration Model Provider Model 

Get Partners to Table Quickly X x X 

Regional Reach X x x x x

Relationship Management x x x x 

IT Infrastructure x x X 

Quality Improvement x x x x x 

Marketing x x x x x 

Billing (Medicaid/Medicare) x x x 

Contract Negotiation x x x x 

Contract Monitoring X 

Credentialing x x X 

Utilization Review x x X 

Shared Financial Risk x 

Common Pricing x 

Network Models —Functions and Availability 

X = Local examples currently performing function x = possible network model feature 

Network Models—Functions and 

Availability 
What Works Here?
 

MOU-based Coalitions 

• Been used successfully to secure a regional 

contract with the NY Department of Health to 

deliver caregiver services 

• Pro: Helping us to go after opportunities NOW 

• Con: Drain resources away from the day to 

day operations of the organizations involved 
What Works Here?
 

Primary Provider Model 

• AAAs are already perform several key network 

functions for buyers and sub-contractors including 

providing IT infrastructure, credentialing, contracting 

and contract monitoring, and utilization review 

• Pro: Leveraging existing infrastructure and 

relationships allows us to be cost-effective partners 

• Cons: Limited geographic reach of county-based 

AAAs; CBO partners concerns with political dynamics 

in government-based environment 
 

What We Need
 

Incremental Network Needs
 

Immediate Need: 

Geographic Reach

Short-term Need: 

QI, RelationshipManagement 

Long-term Need: 

Take on Financial 

Risk 
A low-cost, quick set up solution that 

can grow with us. 

A legal structure that allows AAAs and CBOs 

across Western New York to contract as a 

single entity. 

• Regional 

• Low Cost 

• Able to Grow 
Learning from others 

Safety Net Association of Primary Care 

Affiliated Providers of WNY (SNAPCAP) 

• employed an incremental strategy to network 

development. 

• the nucleus of that group evolved from what 

organizers would describe as a “coffee club” to 

a Limited Liability Corporation (LLC), before 

finally going on to become a 501(c)(3) that is 

now a central part of a Performing Provider 

System 
Seeking legal advice
 

• Wanted something expedient 

• Relatively easy to understand for both 

public sector county managers and nonprofit board members 
Making it legal 

Finding the right vehicle took time 

Found one that will grow with our network: A 

taxable not-for-profit corporation 

– As quick to set up as an LLC 

– Can be converted to a 501 (c)(3) 

– NYS statutory law allow it to function while by-laws, 

etc. are being hammered out 
Where We Are Now
 

Strategy—Build It As We Go 

• Funding from the HFWCNY being used to 

covered costs of incorporation 

• Minimum requirements—3 board members 

• Allow form to follow function as WNYICC 

programming develops 
The Next Phase
 

• What is the ownership and governance 

structure? 

• How does an organization become a 

member? 

• How and under what circumstances can a 

membership be revoked? 

• How will the ICN cover start-up and 

ongoing administrative costs? 
Questions?
 

For more information: 

Ken Genewick 

Randall.Hoak@erie.gov 

Diane.oyler@erie.gov 

Randy Hoak 

Diane Oyler 

Kenneth.Genewick@niagaracounty.com