INSIDE OKDHS FEATURE STORY, JANUARY 2014 - 20 YEARS OF ADVANTAGE

(MUSIC PLAYS) 

No Audio: Lance Robertson - Aging Services Division Director

Lance Robertson: The ADvantage Program is actually the name of a program that provides in-home services for those with care needs. And it's a program that's funded in part through Medicaid dollars, and it enables us to serve a participant in their community most often in their home rather than them have to go into an institutional setting like a nursing home. The same types of services are rendered and a lot more choice is available, and of course, for all of us it's the setting of choice. You really would most often find people who wanted to be served in-home versus in a facility. 

I always think it's good to pause and to reflect back and then celebrate some of the hard work that's been done, particularly in programs like the ADvantage Program. Just given the hectic-ness of that program and all that we serve and do, it's easy to just keep moving forward. But we realized that we were, about a year ago, approaching that 20-year benchmark. 

Again, when the program was founded it started off as a small pilot project out in the Tulsa area, and of course since, had expanded and grown. Now, it's really become kind of the flagship program for this division and for what we do for those we serve. So, what we decided to do was in November to pause and to again, have a celebration and recognize all that the program has done for the state. And we held that celebration in Tulsa at the large Asbury Church, a good partner of ours, and had several sponsors including the Oklahoma Public Employees Association, amongst others. 

And we invited legislative staff and legislators, and of course those who had been involved with the program from the beginning. We recognized providers, members, just a variety of folks all of whom have contributed to the success of the program. We had a number of attendees who participated in the celebration from various parts of the agency, and again, it just reminded me of how fortunate we are to have within the Department of Human Services so many different entities and groups that are committed to the success of ADvantage and of serving people in the community. 

Whether it's the Advocate General's Office or even the Field Operations Staff who do the financial eligibility, it takes a team, and we get to have the fortune of kind of being the tip of that spear. But the agency has a lot of different folks, even not within Aging Services, who are part of the vested success of the ADvantage Program. 

It was so delightful to have some of the original pioneers of the ADvantage Program at the celebration. You know, these are folks that sat around a table 20 years ago and had a vision. Whenever they put the paperwork together and sent it up to the federal government through CMS for approval, and it was approved, out launched the pilot. Fast forward 20 years and it was really neat to see their expression, just the look in their eye, to see how this program has matured, and I think in some respects has probably exceeded their expectations in what they thought the ADvantage Program could do for our state. So, that was really neat to see. 

The program really best serves the needs of individuals because it is so customizable. We can actually develop a service plan that will specifically and clearly meet the current needs of that member. Of course, like most facilities, care is fairly generalized. You feed people at a certain time, you take care of their needs at a certain time, all of which is appropriate. But again, the positives of ADvantage include being able to actually serve your specific needs. So again, that service plan customization is so important and kind of the benchmark behind the value of a waiver program like that. 

A secondary advantage of course is being able to be served in your own home, which for so many of the members that we serve, you know, this is a place that they are very comfortable obviously in staying and being in. Their informal supports are around there: loved ones, friends, church members, etc. And it just feels more of a natural progression as you age and as you need that type of care. So, those are really two of the better benefits to the program. 

The third of course, is the economics of it all because it costs a whole lot less to serve someone in their home than the cost that you're going to experience in a facility. Naturally, the overhead is less. You know, when you're in a facility you're paying for all sorts of additional costs that you're incurring as an organization or a company, versus in-home, when you simply pay the direct care staff person who goes in and provides that care. 

In round numbers, a daily rate right now for a nursing facility is around $110 a day, and for the ADvantage Program the average is around $35 a day. So again, for the same type of care given to a person with the same medical level of need, for again, a third of the cost is a real winner for the state's budget and just overall economically. 

It of course, provides jobs for a lot of the different providers that we employ. We have about 400 different provider agencies that we work with, and of course, they have a cadre of staff who come in and provide acute and non-acute care. And then, again, just the relationships that are often built between that member and the consistency that's provided by typically one staff person or a small group of staff people who come in nearly every day to provide those needs. It's just a real wrap-around win for everybody involved. 

Since the creation or the launching of the program in 1993, we have served roughly about 73-74,000 Oklahomans, unduplicate account, of course. Some people stay on the program for many years, and right now we serve overall about 22,000 people annually. The economic savings tied to the program really has been derived by saying, if you serve 22,000 people in the ADvantage Program, all of whom are nursing-home-level of care, and they had to then have their services provided to them in a nursing home, and then you factor in what that would cost, deduct out, of course, the cost to serve people through ADvantage; we save about $300 million a year. 

Again, my hope is that as the Legislature inevitably has these conversations about how to better manage and control Medicaid costs, that the ADvantage Program isn't kind of caught up or sucked into that because through ADvantage we are very efficiently and very effectively managing care. I cannot imagine there would be any more appropriate way to serve the long-term care needs of Oklahoma than the way needs are currently being addressed through the ADvantage Program. 

I'm just very honored to be part of an Aging Services Team - nearly 200 strong - who are very dedicated to the success of the ADvantage Program. We have a large cadre of nurses who do the level of care determinations. We also have a number of administrative staff who really pay attention to the smallest of details, all of which is necessary to make sure that that flow of care happens in an uninterrupted and efficient manner. So I couldn't be more proud of the team we have. And again their - over the last six, seven years - their commitment to the success of the ADvantage Program. 

Another beautiful thing about ADvantage is how specifically that program does tie into the mission of our overall agency. Two key words that come to my mind: one is "independence" which is part of the overall mission of the agency and is part of our strategic plan. How do we enable Oklahomans to remain independent? Certainly, the ADvantage Program does that. Another word that really comes to mind is "dignity" because as I mentioned, for so many of us who haven't yet gone through that end-of-life care situation, one of the more humiliating aspects of all of that would be having no say in your care: what's provided, when and where, just having that dignity stripped from you. And really, at the culmination of a lifetime spent doing great work, which really is indicative of so many of those that we serve, I believe you are entitled to that dignity, and the ADvantage Program provides that. 

So, both independence and dignity, I think, are two key words that I think of when I think of the ADvantage Program and how beautifully that ties into the overall mission of the Department of Human Services.