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Welcome

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Agenda

7:30 Check-in and breakfast

8:00 Welcome to the day

8:30 Exploring the Nexus of AAAs and MyCare Conversion: Advancements in Integrated Health and Social Care Systems

10:00 BREAK

10:15 Transforming Health Systems through Social Care and Health Equity

11:45 LUNCH

1:00 Personhood-Centered Practice and Policy and the I/DD Dementia Experience

2:30 BREAK

2:45 Sustaining Care: Addressing Workforce Shortages with Ethical Technological Integration

4:15 Close

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Please go to https://www.dhad.org/blog-news to view today’s slides.

Scan the QR codes on today’s slides or in your program to complete the session evaluations!

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Thank you to our

level sponsors

Peer

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Thank you to our

level sponsors

Scholar

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Thank you to our

level sponsors

Leader

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Welcome

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Agenda

7:30 Check-in and breakfast

8:00 Welcome to the day

8:30 Exploring the Nexus of AAAs and MyCare Conversion: Advancements in Integrated Health and Social Care Systems

10:00 BREAK

10:15 Transforming Health Systems through Social Care and Health Equity

11:45 LUNCH

1:00 Personhood-Centered Practice and Policy and the I/DD Dementia Experience

2:30 BREAK

2:45 Sustaining Care: Addressing Workforce Shortages with Ethical Technological Integration

4:15 Close

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Thank you to our

level sponsors

Neighborhood

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Thank you to our

level sponsors

Visionary

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Please go to https://www.dhad.org/blog-news to view today’s slides.

Scan the QR codes on today’s slides or in your program to complete the session evaluations!

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We will begin �at 8:00

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Welcome

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Thank you to our sponsors!

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Please go to https://www.dhad.org/blog-news to view today’s slides.

Scan the QR codes on today’s slides or in your program to complete the session evaluations!

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Advancements in Integrated Health and Social Care Systems:

Exploring the Nexus of AAA's and MyCare Conversion:

Beth Kowalczyk, JD

o4a CEO

Larke Recchie, MA.

o4a Strategic Advisor

Direction Home Akron Canton Presentation

August 8, 2024��

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Looking closer at:

Why focus on HRSN and SDOH? Why Focus on those dually eligible for Medicare and Medicaid?

What is the U.S. Playbook to Address Social Determinants of Health? What are recent federal initiatives to connect health and social care?

What does all this mean for Ohio? What is a FIDE SNP?

What does this mean for Ohio’s AAAs?

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What are SDOH and HRSNs?

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HHS defines SDOH as:

“…the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

These community-level social factors influence a variety of individual health-related social needs (HRSNs) such as:

Financial strain
Housing stability
Food security
Access to transportation
Educational opportunities

First—I think it’s important to level-set on what we’re talking about when we say “align health and social care”. That sounds good. But what does it really mean?

We’re still figuring that out at the individual, community, state, and national levels.

However, when we say that we are inherently referring to addressing SDOH and HRSNs—what are they?

HHS defines SDOH as community conditions which affect individual circumstances. Those individual circumstances are HRSNs…The U.S. Department of Health & Human Services defines SDOH as the conditions in environments where people are born, live, learn, work, and age. These conditions affect health outcomes and risks. Addressing SDOH involves understanding individual health-related social needs, such as financial strain, housing stability, food security, and access to transportation

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Why Is This Important?

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Building the Evidence-Base

“Social determinants of health (SDOH) account for about half of the variation in health outcomes in the nation.”

HHS Call to Action: Addressing HRSNs in Communities Across the Nation

“A sizable proportion of health care costs is associated with social determinants of health. …Our results suggest that reducing health care costs in the Medicaid population will require cross‐sectoral collaborations and multilevel interventions aimed at eliminating the structural inequities that contribute to large health disparities in the United States.”

2022 study funded by the National Institute for Minority Health and Health Disparities (NIMHD)

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Why Is This Important?

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Building the Evidence-Base

“In studies of programs that use multiple types of providers, such as social workers, nurses, physicians, and case managers, to offer services that coordinate care across provider types and assist individuals with managing their health care conditions and HRSNs some studies have found reductions in total health care spending and health care utilization, and improved health outcomes, while in other cases results have been mixed…. Evidence suggests when partnerships are coordinated and well-funded, they are more likely to be successful.

2022 HHS Report, Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts

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Why focus on people dually eligible for Medicare and Medicaid?

Dual-eligible as compared to Medicare only beneficiaries:

are usually more economically disadvantaged and
have a higher prevalence of chronic conditions, disabilities, and mental health issues and
face more significant barriers to accessing care, including fewer provider options, transportation issues, and more substantial financial constraints despite having Medicaid coverage.
experience worse health outcomes and
have higher rates of hospitalizations and emergency room visits and
have higher mortality rates and
are more likely to experience adverse social determinants of health, such as poverty, unstable housing, and food insecurity.
A Profile of Medicare-Medicaid Enrollees (Dual Eligibles) | KFF

Health Status:

Medicare-Only: Typically, Medicare-only beneficiaries are older adults (65+), who may have varying health statuses but generally have higher income and assets compared to dual-eligible individuals. Their health conditions can range from manageable chronic diseases to severe disabilities, but overall, they often have better health outcomes.
Dual-Eligible: Individuals eligible for both Medicare and Medicaid (dual-eligibles) are usually more economically disadvantaged and have a higher prevalence of chronic conditions, disabilities, and mental health issues. They often experience worse health outcomes and have higher rates of hospitalizations and emergency room visits.

Chronic Conditions:

Dual-eligible individuals tend to have higher rates of chronic conditions such as diabetes, heart disease, and hypertension. This group is also more likely to suffer from multiple chronic conditions simultaneously, which can complicate treatment and management.

Mental Health:

Mental health conditions, including depression and anxiety, are more prevalent among dual-eligible beneficiaries. This population also has a higher incidence of substance use disorders.

Access to Care:

Medicare-Only: Beneficiaries generally have better access to healthcare services and are more likely to have supplemental insurance to cover additional costs, leading to fewer financial barriers in accessing care.
Dual-Eligible: These individuals often face more significant barriers to accessing care, including fewer provider options, transportation issues, and more substantial financial constraints despite having Medicaid coverage.

Healthcare Utilization:

Dual-eligible individuals tend to use healthcare services more frequently, including higher rates of hospitalizations, emergency room visits, and long-term care services. They also have higher rates of preventable hospitalizations, indicating potential gaps in primary and preventive care.

Mortality Rates:

Dual-eligible individuals often have higher mortality rates compared to Medicare-only beneficiaries. This is partly due to the greater burden of chronic diseases, mental health issues, and social determinants of health that negatively impact their overall health.

Social Determinants of Health:

Dual-eligible beneficiaries are more likely to experience adverse social determinants of health, such as poverty, unstable housing, and food insecurity, all of which contribute to poorer health outcomes.

In summary, dual-eligible individuals generally experience worse health outcomes and higher healthcare utilization compared to Medicare-only beneficiaries, driven by a combination of poorer health status, higher prevalence of chronic and mental health conditions, and more significant barriers to accessing care. Addressing these disparities requires targeted interventions that focus on improving care coordination, enhancing access to services, and addressing social determinants of health.

4o

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What are the MA/SNP Plan �Business Model Assumptions?

Health Plans are paid on a Per Beneficiary Per Month Basis

The Health Plans are paid a risk-adjusted PBPM payment based on health risk of the individual member. Member demographics contribute to the risk-adjusted payment

Dual-Eligible Enrollment Status
Low-Income Subsidy Enrollment Status

STAR Ratings also impact Health Plan profitability https://www.ncqa.org/hedis/health-plan-ratings/

Members that lose their Dual Eligible or LIS enrollment or if they never complete enrollment besides being eligible directly impacts the risk adjusted payment to the health plan.

Millions have lost their enrollment status of failed to re-enroll after the Pandemic unwinding.

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Medical Loss Ratio (MLR) requirements

Medical Loss Ratio (MLR) requirements are standards set to ensure that health plans spend a minimum percentage of premium revenues on clinical services and quality improvement, rather than administrative costs and profits. Federal Requirements:
Affordable Care Act (ACA) Requirements:

Under the ACA, health plans in the individual and small group markets must have an MLR of at least 80%. Health plans in the large group market must have an MLR of at least 85%.If insurers do not meet these MLR requirements, they must provide rebates to policyholders.

Medicare Advantage and Part D Plans:

Medicare Advantage plans and Medicare Part D prescription drug plans must meet an MLR of at least 85%. Plans that fail to meet this requirement must provide rebates to CMS and face potential penalties, including termination of the contract if they fail to meet the requirement for three consecutive years.

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Ohio Medicaid MLR Requirements:�

Ohio Medicaid also has specific MLR requirements for managed care plans, which align with federal guidelines but may have additional state-specific stipulations:
Ohio Medicaid Managed Care:

Ohio Medicaid managed care plans are required to meet an MLR of at least 85%. This means that at least 85% of the premiums received must be spent on medical care and quality improvement activities.
The MLR calculation for Ohio Medicaid includes all managed care plans' revenues and expenses, ensuring transparency and accountability.
If a managed care plan fails to meet the MLR requirement, it must refund the excess premium amounts to the state.

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U.S. Playbook to Address Social Determinants of Health

Purpose: Highlight a set of exemplary actions under three main pillars that federal agencies are undertaking to support health by improving the social circumstances of individuals and communities.

Pillar 1: Expand Data Gathering and Sharing. The Administration is advancing data collection and interoperability among health care, public health, social care services, and other data systems to better address SDOH with federal, state, local, tribal, and territorial support.

Pillar 2: Support Flexible Funding to Address Social Needs. The Administration has been working to identify how flexible use of funds could align investments across sectors to finance community infrastructure, offer grants to empower communities to address HRSNs, and encourage coordinated use of resources to improve health outcomes.

Pillar 3: Support Community Backbone Organizations. The Administration is supporting the development of community backbone organizations and other infrastructure to link health care systems to community-based organizations. The Administration will distribute new grants to enhance emerging and existing backbone organizations and continue ongoing programs that bolster entities providing housing assistance, food access, free or low-cost legal resources, environmental justice resources, and more.

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Recent CMS Actions To Address Health-Related Social Needs

Community Health Integration and Principal Illness Navigation services
Social determinants of health risk assessments add-on payment
Telehealth flexibilities for health and well-being coaching services (temporary) and SDOH Risk Assessment (permanent)

Medicaid flexibilities to address HRSN:

Section 1115 demonstrations in certain states (Arizona, Arkansas, California, Massachusetts, New Jersey, New York, Oregon, Washington)
Medicaid managed care programs through “in lieu of” services

Housing and nutrition supports provided under home and community-based services (HCBS) authorities

Medicare Shared Savings Program Advance Investment Payments to build infrastructure and capacity to address SDOH, particularly in underserved and rural areas.

Pillar 2: Support Flexible Funding to Address Social Needs

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HHS Call to Action: �Addressing Health-Related Social Needs in Communities Across the Nation

Example Actions

Community-Based Organizations: Develop and/or expand capacity to serve as a Community Care Hub and/or participate as a partner organization in a CBO network led by a Hub organization.
Health Systems and Clinicians: Engage community partners on needs assessments and in shared decision making, enlist the expertise of backbone organizations such as Community Care Hubs, and consistently identify patients with HRSNs and connect them with community resources.
Payers: Consider covering and paying for allowable services, incentivize health care providers to screen and refer patients for HRSNs, and establish partnerships with backbone organizations.
Public Health Departments: Leverage community health assessments and multi-sector partnerships, forge relationships with backbone organizations, and support the health care sector’s work on SDOH and HRSNs through public health’s population health expertise.
Health Information Technology: Partner with other sectors in planning and implementing interoperable, community- and person-centric approaches to electronic social care referrals and care coordination, and adopt and advance the use of open data standards.

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Two Great Resources for CBOs/AAAs

USAging and the Aging and Disability Business Institute :

The Aging and Disability Business Institute provides community-based organizations (CBOs) with the tools to successfully adapt to a changing health care environment. CBOs can use these resources to enhance their organizational capacity and capitalize on new opportunities.

Partnership to Align Social Care:

The Partnership through collaboration and co-design among senior leaders from CBOs, health plans, health systems, national associations, and federal agencies acts to enable and support efficient and sustainable ecosystems needed to provide individuals with holistic, equitable, community-focused, and person-centered care.

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National Trends Driving Alignment�Health and Social Services

Increased attention on social drivers of health (SDOH)

Need to ensure capacity exists within communities to partner with health care to address HRSNs, respond to increase in referral volume

CBOs are increasingly contracting with health care organizations to address health-related social needs—specifically among networks of CBOs

2023 ADBI Update out soon - 48% of CBOs contracting!

From a broader perspective, this work aligns with ongoing federal and state efforts advancing aligning health and social care

1. Increased attention on social drivers of health

Medicaid 1115 Waivers in AR, AZ, CA, MA, NJ, NY, OR, RI, WA supporting state investments to address health-related social needs (HRSNs)
CMS “In Lieu of” Services Guidance to address HRSNs in Medicaid Managed Care
CMS rules: New screening measures for SDOH for hospitals, physicians and Special Needs Plans + new Advanced Payment Incentives for Medicare ACOs
2024 Medicare Physician Fee Schedule Proposed Rule – Services Addressing Health-Related Social Needs (Community Health Integration, SDOH Risk Assessment, and Principal Illness Navigation)

2. Need to ensure capacity exists within communities to effectively partner with health care

30% of human services CBOs have cash reserves that cover less than 1-month expenses.* Not enough funding to meet the demand and be sustainable. Need to attract new funding.

3. Overall, we are seeing increased contracting with health care organizations—specifically among networks of CBOs

Leverages CBO core competencies and services
General contracting between health and cbos rose from 38 to 44 percent btw. 17 and 21 & 90 percent of CBOs contracting said that they have had contracts renewed by health care partner
Percentage of CBOs contracting as part of a network doubled between 2017 and 2021, from 20% to 40%

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Partnership to Align Social Care

Mission:

To enable successful partnerships and contracts between health care and community care networks to create efficient and sustainable ecosystems needed to provide individuals with holistic, person-centered social care that demonstrates cultural humility.

Vision:

A sustainably resourced, community-centered social care delivery system that is inclusive of all populations and empowered by shared governance and financing, multistakeholder accountability, and federal/state/local policy levers.

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Philanthropy

Health Plans, Systems, & Providers

CBOs and CBO Networks

Federal Agency Partners

National Associations

Academics & SMEs

Co-Designing a Social Care Delivery System

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Define & Enable Community Care Hubs

Streamline Contracting

Facilitate Expanded Social Care Billing

Promote Health Equity

Implementing �Co-Designed Social Care Delivery System Changes

As part of this work, the Partnership to Align Social Care has developed and is disseminating numerous resources for multi-sector stakeholders aimed at improving alignment between the health and social care ecosystems (HSCE). These include, but are not limited to, resources to help:

Define & Enable Community Care Hubs by developing shared expectations of CCH functions and capacities and enable emerging CCHs to identify strengths and gaps in capacity;
Streamline Contracting by leveraging and augmenting existing CBO resources to provide tools for health care payers to identify and pursue contracts with CBOs and CCHs;
Facilitate Expanded Social Care Billing by analyzing and building upon existing leading practices to expand the landscape of opportunities for CBOs and CCHs to efficiently code and bill for social care labor and services; and
Promote Health Equity by Use the ECHO® learning framework to deploy community-driven models of care to achieve agreed-upon health equity goals.
Implement the CHI HCPCS codes through Multi-Payer Alignment models.
GOING TO FOCUS ON CCHS – both within the partnership and beyond
Coffee and contracts monthly

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Non-Clinical Service Delivery Investment Timeline

2012: �Community Care Transitions Program (CCTP)

2014: �CMMI Demonstrations: MyCare Ohio

2017: Accountable Health Communities Model

2018 - 2024: �CHRONIC Care Act – Special Supplemental Benefits/ Medicare Rule changes

For more on the evolution and development of CCHs visit, Community Care Hubs: Making Social Care Happen

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Bringing More CBO/Health Care Innovation �Linking Social Needs to Health Care

Medicare Rule Changes: 2025

In Lieu of Services

Z codes

Community Care Hubs

The Ohio Department of Medicaid – MyCare Conversion to FIDE SNP program

"In Lieu of Services" allows Medicaid health plans to pay for alternative services that may be less costly than traditional options while still meeting beneficiaries' needs. Plans receive the same capitated payments but have flexibility in how they use these funds to cover alternatives. This can lead to savings by preventing more expensive medical interventions and improving health outcomes. The savings and improved outcomes can create a more sustainable model for both Medicaid and the health plans.

Z codes are a set of ICD-10 codes used to indicate factors that influence health status and contact with health services, but are not necessarily a current illness or injury. These codes are used to capture a wide range of social determinants of health, including demographic factors, socioeconomic status, and environmental factors

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Medicare Managed Care 2025 Rule Changes�

Supplemental Benefits

Mid-year notifications for unused benefits.
Emphasis on evidence-based benefits for chronically ill (Medicare & Medicaid Services) (Health Management Associates).

Health Equity Analysis

Annual assessments of utilization management for underserved populations (Medicare & Medicaid Services) (Health Management Associates).

Integrated Care for Dual Eligibles

Increased enrollment in integrated Medicare-Medicaid plans (Medicare & Medicaid Services) (Health Management Associates).

Enhanced Appeal Rights

Improved appeal processes for non-hospital services (Medicare & Medicaid Services) (Health Management Associates).

Star Rating System Updates

Revised measures to align with CMS quality strategies (Health Management Associates).

The Centers for Medicare & Medicaid Services (CMS) has finalized several significant changes for the Medicare Advantage and Part D programs effective in 2025. Here are some of the key rule changes:

Supplemental Benefits: Medicare Advantage (MA) plans are required to engage in outreach to beneficiaries regarding supplemental benefits, such as dental, vision, and hearing coverage. MA plans must send mid-year notifications to enrollees about unused benefits, aiming to increase awareness and utilization of these benefits .
Special Supplemental Benefits for the Chronically Ill (SSBCI): New standards require MA plans to demonstrate the value of SSBCI services by submitting evidence that they improve or maintain the health of chronically ill beneficiaries. This change ensures that SSBCI benefits are evidence-based and meaningful .
Health Equity Analysis: MA plans must now conduct an annual health equity analysis of their utilization management policies. This analysis aims to identify any disproportionate impacts on low-income, dually eligible, or disabled beneficiaries (Medicare & Medicaid Services) (Health Management Associates).
Dually Eligible Beneficiaries: CMS has revised policies to increase the percentage of dually eligible individuals receiving integrated Medicare and Medicaid services from the same organization. This includes changes to Dual Eligible Special Needs Plans (D-SNPs) and the introduction of a new special enrollment period for integrated care
Appeal Rights: Enrollees in MA plans will have enhanced rights to appeal decisions related to the termination of services, aligning more closely with the appeal processes available in traditional Medicare .
Star Rating System Changes: CMS is updating the MA Star Rating system, including removing certain measures and adding others to align with broader CMS quality strategies .

These changes are part of CMS's broader efforts to improve access, equity, and the overall experience for Medicare beneficiaries, especially those with complex needs (Medicare & Medicaid Services) (Medicare & Medicaid Services) (

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Background

Overall effort to better align social care delivery with healthcare delivery and payment
Health plans and systems are partnering with CBOs, particularly through Community Care Hubs and the Community Care Networks they organize
CCHs offer administrative economies of scale and broad range of services over a larger geography than provided by a single CBO

CCH Features

Developing and maintaining a network of CBOs
Advancing a collective vision for CBO-health care partnerships, SDOH initiatives and health equity
Centralizing administrative and operational infrastructure
Managing financial resources

Community Care Hub

A community care network is a coordinated group of visible, trusted CBOs led by a community care hub that has entered a formal partnership with a health care organization

Term/definition developed through a multi-stakeholder process

A community-focused entity that organizes and supports a network of community-based organizations providing services to address health-related social needs.
A community care hub centralizes administrative functions and operational infrastructure, including but not limited to:

contracting with health care organizations
payment operations
management of referrals
service delivery fidelity and compliance
technology, information security, data collection, and reporting.

A community care hub has trusted relationships with and understands the capacities of local community-based and healthcare organization and fosters cross-sector collaborations that practice community governance with authentic local voices.

Networks have the capacity to:

Deliver a broad scope of services

Expand and evolve populations served

Build stronger administrative infrastructures

Capitalize on economies of scale

Provide expanded geographic coverage

Offer “one-stop” contracting for variety of services/payers

Expand quality improvement initiatives

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ACL CCH National Learning Community

Purpose - Bring together organizations serving as community care hubs (CCHs) …with the goal of building the strength and preparedness of the CCH to address health-related social needs and public health needs through contracts with health care entities.

Network Development

Curriculum focuses on foundational building blocks of establishing a community care hub
Capacity assessment to inform strengths and areas to focus technical assistance efforts

Network Expansion

Co-led and facilitated by peers and subject matter experts
Curriculum focuses on:

Enabling health/housing partnerships (co-developed w/ HSRC)
Billing, coding, and payment

58 Organizations

32 States

Learning Tracks

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What does this mean for Ohio?

More requirements for hospitals and health care providers to assess social care needs (HRA Health Risk Assessments) = more opportunities to address social needs to improve individual and population health.

Innovations for Medicaid and Medicare will continue.

CMS ending Financial Alignment Demonstrations – MyCare Ohio is changing starting January 2026 - ODM in procurement process to pick 4 health plans.

Statewide Fully Aligned Dual Eligible Special Needs Plans will be started.

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Ohio AAAs and Integrated Care: MyCare Ohio and the Future�

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Ohio Association of Area Agencies on Aging

Statewide Network of Agencies

Coordinates Advocacy

Provides Training

Creates Collective Voice

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1

Council on Aging of Southwestern Ohio

2

Area Agency on Aging PSA 2

3

Area Agency on Aging 3, Inc.

4

Area Office on Aging of Northwestern Ohio

5

Ohio District 5 Area Agency on Aging

6

Central Ohio Area Agency on Aging

7

Area Agency on Aging District 7

9

Area Agency on Aging Region 9

Direction Home of Eastern Ohio

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8

Buckeye Hills Regional Council Aging and Disabilities

10a

Western Reserve Area Agency on Aging

10b

Direction Home Akron Canton Area Agency on Aging

Ohio AAA Network

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What is MyCare Ohio?�

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What is MyCare Ohio?

CMS financial alignment demonstration – 10 states

integrates Medicaid (long-term services and supports) and Medicare (health care) for people dually eligible into managed care
Brings long term services and supports to managed care - includes HCBS waivers (DD is optional) and nursing homes

In Ohio: 5 managed care plans in 7 regions (29 counties)

Began in 2014
Individuals can opt out of Medicare but not Medicaid
Serving 100,000+ Ohioans age 18 and over

Goals of MyCare Ohio:

One point of accountability and contact for enrollees
Person-centered care, seamless across services and care settings
Easy to navigate for enrollees and providers
Focus on wellness, prevention and coordination of services
Integrated approach to care coordination to integrate services into one benefit package
Every member has a care manager

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https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families%2C%20Individuals/Programs/MyCareOhio/Next_Generation_MyCare_RFA_pre-application_conference_presentation.pdf

To be eligible for MyCare Ohio, you must be

-Eligible for the full benefit of both Medicare and Medicaid services.

-Age 18 and older (Note: In the Next Generation program, eligibility age is 21 or older); and

-Reside in one of the 29 counties where MyCare Ohio is currently available, until statewide

expansion occurs.

You will receive a letter from Ohio Medicaid asking you to choose from at least two MyCare

Ohio plans.

You do not have to receive your Medicare benefits from your MyCare Ohio plan. You may

choose to continue to receive your Medicare benefits in the way you do today. However, your

Medicaid benefits will only be available through your chosen MyCare Ohio plan.

Choosing to receive both your Medicaid and Medicare benefits through your MyCare Ohio

plan will provide you the following benefits:

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MyCare Ohio Regions

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NORTHWEST

NORTHEAST

EAST CENTRAL

NORTHEAST

CENTRAL

WEST CENTRAL

SOUTHWEST

RE REGIONGION	MYCARE PLANS
NORTHWEST	AETNA BUCKEYE
NORTHEAST	BUCKEYE CARESOURCE UNITED
EAST CENTRAL	CARESOURCE UNITED
NORTHEAST CENTRAL	CARESOURCE UNITED
WEST CENTRAL	BUCKEYE MOLINA
SOUTHWEST	AETNA MOLINA
CENTRAL	AETNA MOLINA

AAAs serve as WSC coordinator for members age 60 and old, and also serve as the care manager for waiver members of all ages for plans Aetna and CareSource.

AAA 10b

AAA 10 A

AAA 4

AAA 11

AAA 6

AAA 2

AAA 1

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Area Agencies on Aging Roles in MyCare

Waiver Service Coordination for members 60 and older (PASSPORT-like services)

In MyCare Ohio, AAAs do not give final authorization of services or pay providers; that is the responsibility of the managed care organizations, who receive a PMPM for each beneficiary enrolled.

Some managed care organizations use AAA expertise for fully-delegated care management for members of all ages.
Area Agencies on Aging also conduct nursing facility level of care assessments for eligibility for long term services and supports.

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MyCare Next Gen MyCare (FIDE SNP)

April 2022: CMS ends financial alignment initiative (FAI), the duals demonstration program (MyCare in Ohio), and instead focus on expanding D-SNP model.
If states choose to transition to D-SNP, they must transition by end of 2025

Sept. 2022: Ohio Department of Medicaid (ODM) submitted to CMS the Ohio “MyCare Conversion Charter”.

MyCare Ohio will end December 31, 2025.
Intent to move to a FIDE SNP model by January 1, 2026.
Request for Proposals issued May 31, 2024. Applications Due by August 2, 2024. Award letters issued October 8, 2024.

https://medicaid.ohio.gov/about-us/notices/mycare-conversion-charter

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What is a FIDE-SNP?�

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MyCare Ohio

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What is a D-SNP?

SNP = Special Needs Plan - subset of Medicare Advantage. Tailored to meet the needs of members:

Low income
Certain medical conditions
Unique health care requirements

Must comply with federal Medicare Advantage regulations
Must have at least one enrollee advisory committee in each state

Three categories of SNP:

1. D-SNP (Dual Eligible) – 20% of Medicare Advantage enrollment

2. I-SNP (Institutional Needs),

3. C-SNP (Chronic Care)

State Medicaid Agency Contract (SMAC) - States can impose additional requirements regarding enrollee categories, details of how plans will manage care and benefit coordination with Medicaid, cost-sharing responsibilities of D-SNPs and other matters.

What is a Dual Eligible Special Needs Plan?

First, it helps to be familiar with a Medicare Special Needs Plan (SNP)—a type of Medicare Advantage (Part C) plan that offers broader Medicare coverage to a specific, limited population. SNPs are tailored to meet the needs of their members, which is typically people with:

Low income
Certain medical conditions
Unique health care requirements

A Dual Eligible Special Needs Plan is one type of SNP. It’s a managed care plan for people who qualify for both Medicare and state Medicaid assistance or Medicaid. A D-SNP combines multiple coverages and coordinates Medicare and Medicaid benefits to make them easy to access for people who have both. States decide which D-SNPs health plans can offer and may review the specific benefits provided.

Dual eligible people fall into several Medicaid eligibility categories. This determines the type of D-SNP plan you can enroll in, your access to Medicaid benefits, and the level of help you can receive for premiums and cost sharing. States may set up their eligibility categories differently, so be sure to check with your state before enrolling in a plan.

Fully-Integrated D-SNPs (FIDE-SNPs), currently serving 400,000 people in 13 states and D.C.

Highly-Integrated D-SNPs (HIDE-SNPs), currently serving 2.1 million people in 15 states and D.C.

Coordination-only D-SNPs (CO DSNPs), currently serving 3.3 million people in 38 states and D.C.

Applicable Integrated Plans (AIPs), which is a designation that can apply to FIDE-SNPs, HIDE-SNPs, and CO D-SNPs

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What is a FIDE-SNP?

Fully-Integrated D-SNPs (FIDE-SNPs): currently serving 400,000 people in 13 states and D.C. Includes coverage of primary, acute, and long-term services and supports benefits. Must also cover behavioral health benefits unless the state carves behavioral health out of the capitation rate.

Other D-SNPs:

Highly-Integrated D-SNPs (HIDE-SNPs), currently serving 2.1 million people in 15 states and D.C. Moderate level of coordination with Medicaid. includes requirement to provide LTSS or behavioral health or both
Coordination-only D-SNPs (CO DSNPs), currently serving 3.3 million people in 38 states and D.C. Provide varying levels of coordination, depending on state requirements. Provide Medicare-covered services and in most cases supplemental benefits. The state Medicaid agency or a Medicaid managed care plan provides Medicaid-covered services. Most D-SNPs fall into this category.

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Essential DSNP Care Coordination Requirements

All Medicare Advantage Special Needs Plans, including D-SNPs, must:

Have a Model of Care, approved by CMS, that is a plan for the following:

Assess members’ physical, psychosocial, and function needs through initial and annual health risk assessments (2024 – housing, transportation and food security)
Develop and implement individualized care plans for each member
Use interdisciplinary care teams (ICTs) to address member’s health and functional needs.
Also includes quality measurement, performance improvement plans and health outcome and beneficiary experience monitoring

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What is Next Generation MyCare Ohio?�

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State Budget: MyCare Expansion & AAA Role

2024-2025 Budget Bill HB 33�SECTION 333.320. MYCARE OHIO EXPANSION :

Requires Medicaid Director to seek CMS approval by July 1, 2024, for the MyCare program (or its successor) to go statewide
Requires plans to use the Area Agencies on Aging for waiver service coordination for 60+ unless otherwise requested by the individual
Allows for full delegation of care coordination to the Area Agencies on Aging
The Department may specify an alternative approach to care management and coordination of waiver services if the performance of the area agency on aging does not meet the requirements of the ICDS or if the Department determines that the needs of a defined group of individuals requires an alternative approach.

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MyCare Ohio: From Duals Demo to FIDE SNP

The benefit package will remain the same, recognizing that each of the Medicare-Medicaid Plans (MMPs) provides value-added benefits.
State anticipates no more than four plans, with statewide coverage.
The choice to opt in or opt out of Medicare managed care will remain.
QMB and SLMB beneficiaries are not eligible as is the case today.
Medicaid Managed Care component will align with changes in Next Generation Medicaid which started February 2023, particularly focused on centralization to promote consistency (single PBM, Provider Portal, fiscal intermediary, etc.).
Plans will be required to incorporate screenings for social determinants of health in their health risk assessments and partner with CBOs to address barriers.
Plans must donate percentage of profits to community-based organizations

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MyCare Ohio: From Duals Demo to FIDE SNP

AAAs continue role as waiver coordinators and in some cases fully delegated care managers.
Increased focus on behavioral health care coordination
Ombudsman funding will be maintained with state funding.
Streamline and expand self-direction option to give members more control over their waiver services
Eligibility changes from 18+ years old to 21+ years old
Adding additional member protections for transportation services
New comprehensive network adequacy requirements for home health providers

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All my care plans have dedicated behavioral health professionals to work with members

Community health partners are essential partners

Behavioral health

• Involvement of community behavioral health care coordination entities to meet member behavioral health needs. Almost half of MyCare Ohio members today have severe mental illness, depression, anxiety, or post traumatic stress disorder

Members must provide consent for use of group transportation
Shorter turnaround times for independent home health provider claim payments.
• New comprehensive network adequacy requirements for home health providers.
• MyCare Ohio plans will be required to dedicate time to help independent home health providers, including the creation of job aids to assist in tasks such as claims submissions.

Ohio Medicaid Enterprise System – centralized provider enrollment, credentialling, securing authorizations, and billing

Single Pharmacy Benefit Manager

Fiscal intermediary- claims and prior authorization

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Where Are We Now?

Outreach Sessions: in-person meetings throughout the state with Ohioans who are dually eligible as well as virtual meetings with provider stakeholders over the coming months: March – September 2024
Request for Applications (RFA):

Issued May 31, 2024
Applications due August 2, 2024
Award letters issued October 8, 2024
Agreements, readiness reviews, etc. 2025
MyCare Ohio 29 counties converted January 2026
NonMyCare Ohio counties phased in by December 2026

https://medicaid.ohio.gov/families-and-individuals/citizen-programs-and-initiatives/mycareohio/mycare-ohio

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Changes for AAAs

Statewide Coverage – adding counties in some current AAAs and adding 5 of the 12 AAAs

Impact on provider network
Consumer education
AAA preparation
More plans means proposed different approach to exchanging data

Impact on existing waivers
Requirements in RFA

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o4a Training: www.ohioaging.org

o4a Annual Conference for Ohio’s Aging and Disability Network

October 23- 24 2024 Hilton Easton, Columbus

o4a Virtual Training Series

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Contact

Beth Kowalczyk, o4a CEO

kowalczyk@ohioaging.org
614-481-3511

Larke Recchie, o4a Strategic Advisor

recchie@ohioaging.org
614-557-6239

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Q&A

Scan the QR code to complete the evaluation

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Transforming Health Systems through Social Care and Health Equity

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�

Objectives:

Explore Social Drivers of Health: Understand the key factors influencing health outcomes and their impact on communities.
Differentiate SDOH and HRSN: Clarify the distinctions between Social Drivers of Health and Health-Related Social Needs.
Define and Utilize Z-codes: Learn about Z-codes and their significance in documenting and addressing social determinants of health.
Assess AAA Impact on SDOH Needs: Evaluate how AAAs address SDOH and contribute to improved health outcomes.
Identify Opportunities with Health Plans and Healthcare Systems: Discover collaborative opportunities to enhance care delivery and health equity through partnerships with health plans and healthcare systems.

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https://www.youtube.com/watch?v=dshh1JLO3ps

There’s No Such Thing as Small Stuff

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Mary Turner lives in a poor neighborhood of Louisville, Kentucky. With three teenage children, a husband on disability, and health complications that prevent her from working, Mary must budget carefully to keep her family fed and housed. In this video, she discusses the choices she faces every day, quickly but eloquently presenting a glimpse of one woman's life at the lower end of the U.S. socio-economic spectrum. This video is a Web-exclusive supplement to "In Sickness and In Wealth," Episode 1 of "UNNATURAL CAUSES: Is Inequality Making Us Sick?" This ground-breaking documentary series looks at how the social, economic and physical environments in which we are born, live, and work profoundly affect our longevity and health. The series broadcast nationally on PBS in spring 2008, and can be bought on DVD from California Newsreel, www.newsreel.org

What are your takeaways from this video?

Domino effect – constant juggling
Intense amount of stress on this mom
No fruits or veggies – almost all processed foods
Joy & happiness?
BH needs – depression/hopelessness/loneliness
Something is going to lose
She really wants to be positive and we see this at the end of the video
We cannot forget the “social” aspect of SDOH. Building and nurturing connections – need hope & joy

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Are They the Same?

HEALTH RELATED SOCIAL NEEDS

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https://www.youtube.com/watch?v=pbP1_qd5FHQ

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Interdisciplinary Team

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SDOHAP Goals

Health Equity & Closing Gaps in Care

Strengthen Partnerships

Social Care Clinicians

Future Contracting

Identify gaps in care through SDOH screenings, listening sessions, area plans and SAFE/I-Team data. Develop innovative interventions to close the gaps in care and pilot for at least a year.

AAAs are the “one stop shop”! SDOH, Care transitions and Chronic Conditions will be the focus for years to come. Data demonstrating ROI, innovative interventions and improved member outcomes. Physician 2024 Fee Schedule (CHI) and Z code assignment billing and referrals.

Develop a multi-disciplinary team of RNs, SWs and CHWs who are trained on tools and interventions to close gaps in care. Also provide a career ladder for current staff members (leadership, analytics, business development, CHW certification and tuition reimbursement.

Working with plans on pilot projects allows increased meetings and exposure to the AAAs and the interest and flexibility we have in meeting the needs of the community.

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Definition: Z codes

Z59.01 Sheltered Homelessness

Z59.81 Housing Instability – Housed

Z59.41 Food Insecurity

Z59.48 Other Specified Lack of Adequate Food

Z59.82 Transportation Insecurity

Z60.2 Problems Related to Living Alone

Z63.4 Death of a Family Member

Z63.79 Other Stressful Life Event Affecting Family or Household

Z63.8 Other Specified Problems Related to Primary Support Group

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COAAA Screening Tool

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Mr. Smith is a 67-year-old man who recently moved into his apartment after being homeless for five months. He owns a truck, but it is often unreliable, causing him to miss 2-3 medical appointments this year. He tried using transportation services through his insurance, but found them even less reliable than his truck. His electric bill is past due, and he hopes to obtain documentation from his doctor to get on a payment plan.

He does not feel safe in his apartment due to frequent sirens, yelling, and fighting in the area. He hasn't gotten to know his neighbors since he moved in a few months ago. He struggles to afford household necessities like toothpaste, paper towels, and cleaning supplies.

Although he can care for himself, he feels lonely and isolated, often feeling tense and agitated. His apartment is sparsely furnished, and he cannot afford a TV, so he listens to music and watches activities outside his window to pass the time.

He has an income of $1,030 per month, with housing expenses around $550 per month. He uses food banks and receives $100 in SNAP food benefits each month, trying to eat inexpensive foods like ramen noodles. While he prefers grocery stores, he often walks to Family Dollar or convenience stores for food due to convenience.

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What is a Social Driver of Health we should focus on for this member?

72 responses

Transportation (mentioned 36 times)
Housing (mentioned 15 times)
Food insecurity (mentioned 19 times)
Social isolation (mentioned 12 times)
Medical care/doctor appointments (mentioned 6 times)
Other: financial, mental health, safety, basic needs (mentioned 5 times)

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Innovation to Close Gaps in Care

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Findings & Impact

3,700 total referrals

2,400

800

560

Members Outreached

SDOH Screenings

SDOH Needs

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What is the data telling us?

48% Housing

46% Food

27% BH/Family Support

20% Transportation

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Opportunities & Partnerships

Relationships!!

Community Health Integration

Value Based Payment Models
Additional Resources/Providers
Advocacy

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What is our Call to Action?

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Contact information:

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�

References:

https://nam.edu/social-determinants-of-health-201-for-health-care-plan-do-study-act/

https://app.monami.io/admin/org/reports/332

https://www.cdc.gov/minorityhealthstrategies2016/

https://debeaumont.org/resources/infographic-social-determinants-and-social-needs/

https://news.datagen.info/2022/02/how-partnership-data-and-analytics-can.html

https://www.oaklandca.gov/news/oakland-launches-rental-subsidy-pilot-to-stop-displacement-prevent-homelessness

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Credit: Linkedin

What do you see?

Light

Dark

Shadow

When I look at this, I am reminded of the light we bring into each others’ lives, the shadows that sometimes make it hard to find clarity and empathy and understanding Most importantly, however, I am reminded, in contrast to this image, of the ways in which we are NOT all the same, but add to the richness of each other’s lives through our uniqueness of our story, our individual strengths and talents, and the way we move through our world (and the way the world can impact, both positively and negatively) that life journey.

Today at this conference, and every day, in your work and in your personal lives you build relationships and you cultivate understanding. And it is by centering personhood in serving and advocating for those you serve that we bring our best selves to this work, to the work of serving those living with dementia and their care partners, including those in the IDD community—our focus today.

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Honoring Personhood

Multi-Dimensionality

Strengths

Assets

Resources

Preferences

Autonomy

We make non-negotiable the honoring and the navigation of personhood. Unlike the cutouts we are not all the same, our stories are unique, our perspectives are unique, we are all just raising our arms and declaring, “Here I am. See me as me and not as the other.”

Multi-dimensional: thousands of gains and losses over a lifetime, all integrated into the person I am with preferences and a need to be empowered. ASK PARTICIPANTS: What are the assets, strengths, and resources your clients bring to your partnerships?

Acknowledge challenges introduced by differing abilities and a dementia diagnosis, but also acknowledge dignity, agency, hope, and possibility. Assume capacity to be a participant in their own life. Be aware of our own barriers to understanding, our own assumptions.

But we use our strengths and assets—our ingenuity and creativity and our commitment to personhood for every person—to ask the most important question we can in building our relationships…

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How Do You Want To Live?

Artist: Emily Catherine, Living with FTD

The question we all want to be asked and to answer for ourselves—I think we would answer that we want to live with purpose; we want to pursue the things that interest us; we want to feel and be a part of community (included, needed, asked for advice/opinion). A basic need—a self-affirming life defined according to personhood (ideas, beliefs, hopes, dreams). The right to forge and walk one’s own path.
What we’re really asking is—what gives your life meaning? How do you want to be connected to those people, things, experiences?
Alternatiives: “What is important to you?”, even something very concrete like, “When you think of what a good day looks like, what comes to mind?”.
For people who are not able to communicate with words “How do you want to live?” brainstorm how you can explore this question with them. What lights a person up? What makes them feel good? What does it mean to “focus on living” for this person?
Think about how we can connect this question of “How do you want to live?” with existing tools and strategies to honor a person’s daily preferences—visual, tech, environmental, etc.. More about this from Jen later.
And consider what local, state, and federal policies support the answers to this question, and what others may disregard, diminish, or deny this most important aspect of personhood for EVERY person.

How do YOU want to live?

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Personhood-Centered Dementia:

Advocacy & Public Policy

Camren J. Harris, M.A.

Public Policy Manager – Alzheimer’s Association

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Overview

Current Landscape of Alzheimer’s Disease

Recent History of ADRD Advocacy

Policy Recommendations

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Personhood-Centered Dementia:

Advocacy & Public Policy

Camren J. Harris, M.A.

Public Policy Manager – Alzheimer’s Association

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Ohio’s Recent ADRD Advocacy History

2019

ADRD Task Force

Examined Ohio’s needs of PLWD, services, facilities, providers and caregivers.

2023

Alzheimer’s Respite Line Item increase

490414 received a $1.8 Million Dollar Increase.

2023

Nursing Home Task Force

Examined the quality of Ohio’s nursing homes.

20XX

Policy Implementation(s)

Building a better tomorrow by implementing effective and comprehensive public policies to help support PLWD.

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Public Policy Goals For Personhood-Centered Dementia

Increase Public Awareness
Healthy Equity
Improve “Dementia Infrastructure”

LTC
Workforce retention & training
Resource Centers

Affordable Care and Supportive Funding

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Public Policy Recommendations

State Policy

Create Statewide public awareness campaign (Ohio House Bill 397)

Improving Care Coordination through Medicaid

Addressing systemic changes in LTC

Statewide Dementia Coordinator

Federal Policy

Federal Funding for:

PCP Training
Establish ADRD Public Health Centers
Support and expand Health Departments

Tailoring approaches for education

Written rule/policy changes for Federal Agencies

Comprehensive Care

Dementia care plan
Care coordination AND navigation
Caregiver education and support
Provider Reimbursement

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Personhood –Centered Practice and Policy: IDD and Dementia

Subtitle Goes Here

Jennifer Hudak, MPA,

Senior Manager

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Overview�

Defining person-hood centered practice
Myths and Misinformation-IDD Community
IDD and Dementia Inclusive policy
Role of Stigma

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The Role of Stigma in Policy Crafting for People with Intellectual and Developmental Disabilities (IDD)

Influence on Policy:

Stigma leads policymakers to have misconceptions about the abilities and potential of individuals with IDD,
Polices are underfunded leading to inadequate support services (Advances in Social Work) (Cambridge).

Barriers to Inclusion:

Stigma perpetuates a lack of inclusion in community life
Stigma leads to less access to essential services such as education, healthcare, and employment.
Stigma impacts overall quality of life. (SpringerLink).

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Opportunities to Defy Stigma and Embrace Personhood

Training and Awareness: Understanding biases and personhood in addition to the capabilities of people with IDD and Dementia fosters inclusivity, Ex) Dementia Friends,

Personhood-Centered Practice: Understand how to end stigma from both policymakers and service providers by fully embracing inclusive and person-centered approaches (Cambridge).

Cross Sector Collaboration: Include the IDD community in research, innovative practices, networks, volunteering and sharing of personal stories, Ex) KAER Toolkit for IDD, Music& Memory

Negative Perceptions: Stigma often manifests as negative perceptions and attitudes towards individuals with IDD, leading to their exclusion from policy discussions and decision-making processes. This exclusion perpetuates policies that do not reflect their needs or preferences (OU Joins SEC).

Barriers to Person-Centered Care: Stigma can create barriers to implementing person-centered care practices. Service providers may hold biased views, consciously or unconsciously, that influence their willingness to adopt inclusive practices that recognize the personhood of individuals with IDD (OU Joins SEC).

Training and Education: Addressing stigma requires comprehensive training for professionals in healthcare, education, and social services. Educating these professionals about the importance of personhood and the capabilities of individuals with IDD is crucial for fostering a more inclusive environment (OU Joins SEC).

Policy and Practice: Effective implementation of personhood-centered practices necessitates policies that explicitly address and mitigate stigma. This includes creating guidelines and standards that promote the dignity, autonomy, and preferences of individuals with IDD (OU Joins SEC).

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What’s In Your Advocacy Toolkit?

Knowledge and Understanding
Respect and Cultural Competency
Collaboration and Partnership
Reciprocity and Empowerment
VOICE!
ACTION!!

Knowledge—Living a life of ongoing participation is possible with IDD and with dementia; active listening and clear communication make the articulation of concerns, preferences, desires, and goals possible.

Respect: Maintain dignity of all; take into account spiritual beliefs, historical and social context (including trauma), ageism, ableism, past relationship with health care community, etc.

Collaboration and Partnership: You are in partnership with those you serve—empowering with their voices being included in decision-making and planning. Ensuring that they are the captain of their team through their active role. Recognizing your active role, too, in remaining engaged, responsive, and following through.

And, finally, exercising your voice, actively advocating for the policies and resources for every INDIVIDUAL you serve, to weave the strongest person-hood centered, inclusive communities possible.

How will you honor the personhood and power in your professional and personal lives? Where will your impact be felt? What will you do tomorrow, next week, and into the future?

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Let’s Continue The Conversation…

Camren Harris

cjharris@alz.org

Jen Hudak

jhudak@summitdd.org

Barb White

libdeputy@gmail.com

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Sustaining Care: Addressing Workforce Shortages with Ethical Technological Integration��Brandi Chrzanowski, Dr. Julie Aultman, �Julie Esack, Dale Wells, Eric Bloniarz

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What strategies are currently being used to mitigate the increased demand for services amid the shortage, how effective do you feel these strategies have been?

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Addressing Shortages through Health Profession Education

The college-age population is expected to shrink across the next five to 10 years by as much as 15 percent (Chronicle of Higher Education 2024); thus, fewer students going into nursing, medicine, dentistry, and allied healthcare.
Better recruitment strategies in secondary school and college are being developed.
New and emerging professions in healthcare are attracting competitive students (e.g., Certified Anesthesia Assistants).
Programs under development are seeking state endorsement (e.g., Certified Mental Health Professionals).
Hospitals are offering signing bonuses or hiring professional students while still in school to increase the workforce in resource-poor areas.
Higher education is lowering tuition costs since rising tuition has been the number one barrier to enrollment; states are scrutinizing wasted resources and requiring clearer budgeting strategies in higher education.

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What challenges have impacted the quality of care that patients receive and what actions do you feel are still needed to address the shortage?

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What we still need to do…

Fair and equitable wages are needed – the wage gap among women, persons of color, and persons coming from lower socioeconomic communities is significant. There are inequities within and among the healthcare fields as well that need to be addressed, which are preventing learners from enrolling.
Promoting work-life balance is critical to reduce burnout and improve retention among current workers and to encourage students to go into the health professions.
Employers and clinical organizations need to invest in healthcare education and advancement.
Workforce expansion requires governments (state and federal) to support new and emerging health professions.
Licensure and credentialing bodies need to update standards and assessments to account for diverse learners (e.g., reduce bias in licensure examinations).
Compensatory rather than punitive strategies need to be developed to retain healthcare workers and promote health profession education

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Can you provide examples of how telehealth, AI, and other technologies have been integrated into your organization and how effective have these technologies been in improving the efficiency and quality of care?

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Robots

in action

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Robots

in action

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What kind of training is required for workers to effectively utilize these technologies and what are the challenges associated (i.e. buy-in, cost, access) with implementing new technologies in your individual settings?

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How do we balance the need for human touch and empathy in home health care with the increasing reliance on technology? �

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Benefits of Robots and Artificial Intelligence �

Robots can help reduce health problems and associated health care costs caused by loneliness (e.g., heart disease).
With a shortage of 500k caregivers in the U.S., robots can contribute to unmet needs and fills the shortage gap.
Robots with AI technology can personalize human interactions and promote healthy living (e.g., reminding adults to take their medications).
Robotic technology use is on the rise with older adults (23% own Robotic vacuums and 35-40% have Alexa devices) and are user friendly.
With improved technology and increased demand, costs can be relatively low depending on the type of robot. For example: Paro (baby robot seal) is only robot currently approved by FDA as an insured cost for depression and anxiety.

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Barriers and Limitations of Robots and AI as Emotional Companions�

Research has shown that using technology as a stand-in for social interaction can actually increase loneliness depending on the technology.
Relying on robots and AI to fill caregiver shortages is not addressing the problem and fails to meet basic healthcare needs.
Issues of data protection and informed consent are of critical concern when personal data is being collected and tracked.
Detailed surveillance is an invasion of privacy and has not been fully addressed (and requires additional workforce to monitor these issues).
Even with low cost technology, robots and AI are not accessible or available to all persons.

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Recommendations

Use robots and AI technology to compliment healthcare delivery rather than use as a substitute.
Be transparent and develop clear informed consent guidelines for users to be aware of the benefits and risks of this technology (e.g., privacy issues).
Examine the accompanying resources that can increase costs and lower access (e.g., maintenance, data security).
Conduct extensive research on the benefits and burdens of this technology and develop ways to reduce risks of increased loneliness and other negative health effects.

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