Scaling Network Lead Entities Grantee Profile 

Network Name: Bay Aging Area Agency on Aging/VAAACares® 

Grant Goal: 

Bay Aging/VAAACares®, in partnership with the Virginia Center for Health Innovation, the Virginia Hospital and Healthcare 

Association, and other social services providers and health entities, will convene a group of stakeholders to undertake a two-year 

project to assess Virginia’s emerging Community Integrated Health Network (CIHN) and develop strategies to address needs. 

Grant Partners: 

• Virginia Association of Area Agencies on Aging 

• Virginia Center for Health Innovation (VCHI) 

• Virginia Hospital and Healthcare Association (VHHA) 

• UniteUs (Unite Virginia) 

• Riverside Health System 

• Telamon Corporation 

• Health Quality Innovators 

• The Planning Council 

• Virginia Community Action Partnership 

• AARP Virginia 

• VCUHealth 

Target Population: Award: 

Individuals 18+ with a focus on Older $291,564 

Adults and people with disabilities 

Grant Objectives: 

1) To develop a business/strategic plan; 

2) To develop consensus on new or bridged interoperable 

software platforms; 

3) To develop a financial model that ensures viability of 

CIHN; 

4) To assess staffing and leadership, and develop a plan to 

advance racial equity and perform outreach to 

underserved communities; 

5) To develop quality assurance and service delivery 

compliance standards. 

Expected deliverables include: 

1) Business/strategic plan; 

2) Interoperable software; 

3) Financial modeling system; 

4) Marketing and outreach materials; and 

5) Health worker training on a system capturing 

quantitative measures of success. 

Grant Summary: 

Bay Aging serves as the existing Network Lead Entity (NLE) and 

for VAAACares®, a collaboration of the 25 area agencies on 

aging (AAAs) in Virginia. They are the local lead agency for No 

Wrong Door Virginia, partnering with Virginia Department for 

Aging and Rehabilitative Services (DARS), centers for 

independent living (CILs), and behavioral health organizations to 

deliver several programs for people age 18+, with a focus on 

older adults and individuals with disabilities. 

It is anticipated that the primary social determinants of health 

(SDoH) services that their patients and clients need will include 

care coordination, care transitions, behavioral health, 

transportation, meals, housing, and emergency services. 

As NLE for VAAACares®, Bay Aging receives referrals from health 

systems and health plans, coordinates referrals to AAAs 

according to geography, coordinates billing, data management, 

reporting, and reimbursements. Bay Aging has expertise in care 

delivery and complex administration requirements. 

Bay Aging/VAAACares® has experience working with many 

payers, including Aetna, Anthem, Bon Secours, Magellan 

Complete Care, Mary Washington Healthcare, Optima Health, 

Sentara Healthcare, United Healthcare, Virginia Premier, Valley 

Health, VA Health Care, and private payers. Bay Aging will plan 

to co-convene with VCHI and VHHA to bring together multiple 

stakeholders, outlined above. 

Planned Activities for NLE enhancement will focus on: 

☒Leadership 

☒Finance 

☒Business Development 

☒Network Development and Support 

☒Network Administration 

Bay Aging recognizes that Network Administration was their 

weakest area or maturity. They will use this grant to develop a 

more robust information system to meet interoperability 

demands to expand their network. 

Grant Contact: 

Kathy Vesley, Bay Aging Area Agency on Aging, kvesley@bayaging.org