Health care's role in the “Aging Our Way, PA” plan

In this episode, we learn about the Aging our Way, PA plan for healthy aging in Pennsylvania, and discuss how organizations like UPMC Health Plan are putting policy into practice when it comes to supporting the health and independence of members as they age.

Related to this episode:

• Aging our Way, PA: A Plan for Lifelong Independence
• UPMC Community HealthChoices
• Long-term Services and Supports
• Pennsylvania Department of Aging

Episode Transcript

Ellen

Stronger communities begin with good health—for everyone.

You’re listening to the “Good Health, Better World” podcast from UPMC Health Plan. This season, we’re exploring the joys, challenges, and opportunities associated with healthy aging. We’ll talk about what it means to age well; how to care for body, mind, and spirit as we get older; and the tools and programs available to ensure a good life, throughout life.

I’m your host, Dr. Ellen Beckjord. Let’s get started.

We're joined in this episode by the Pennsylvania Department of Aging Secretary Jason Kavulich to learn more about the Aging our Way, PA plan for older adults. We're also joined by the president of state programs at UPMC Health Plan, Brendan Harris, who will share how long-term services and supports for members relate to the Aging our Way, PA plan.

Secretary Kavulich, welcome to “Good Health, Better World.”

Jason

Thanks for having me. I really appreciate the opportunity to join you today and really talk about Aging our Way.

Ellen

And Brendan, thank you for joining us also.

Brendan

Thank you for having me and glad to be here and looking forward to the conversation.

Ellen

Let's begin by learning more about your backgrounds. Could each of you share a little bit about what you do in your roles, how long you've been in the field of older adult services, and what brought you to this line of work? Secretary Kavulich, if I could start with you.

Jason

I've been in the human service field for about 25 years now. I started off very simply as a county caseworker in child welfare, worked my way all the way through the child welfare system into administration.

And was really asked by my local county administration to consider moving into older adult services, to aging. We had a vacancy in the aging director position for nearly three years. And when I moved into the space, it was—a light bulb came on. This was the work I was meant to do. I really fell in love with the work. I really fell in love with improving and making progress in the system that needed some love and care, and really transforming the lives of older Pennsylvanians has such a meaning for me right now that I don't know if I can ever really move out of aging services because I enjoy the work and what we get from the work so much.

Ellen

That's wonderful. Thank you. And Brendan, can you tell us a little bit more about your background?

Brendan

Sure. My background is in Human Services as well, a little bit of a different path from the secretary, but I spent 12 years at the Department of Human Services working on a variety of different areas. And towards the end, I got the privilege, as being the executive deputy secretary, to help and be part of the process that designed our MLTSS [Managed Long Term Services and Supports] program, Community HealthChoices, which, and then I left and then got to come on and see how it is on this side. And I think that's really one of the incredible things to work in human services and to work in state government, and to then see what happens and how the programs you designed come into play, is really incredible.

Community HealthChoices has been a passion of mine since we were designing it, but, you know, now that we've got it and I've been at UPMC for about seven years and have been working on Community HealthChoices for about five of those years. And, you know, we've really done some remarkable things in a short amount of time, and just really excited to talk about that and really how it complements a lot of it, because there is a lot of great things between the aging population that we see in Pennsylvania and being able to find creative and appropriate supports to keep them independent and safe.

Ellen

Great. Thank you. Secretary Kavulich, could you tell us about the Aging our Way, PA plan, what it entails, and how it was developed?

Jason

So, it's really, you know, it's a challenge to in a sound bite to really sum up Aging our Way, PA because it is a 10-year multi-sector plan for Pennsylvania, built by Pennsylvanians.

It's a call for all of us to focus in and look at the needs of older adults across the commonwealth and work together to provide a better life for them, a better way for them to stay in their communities, live longer, healthier lives, have the support services they need, to work across systems, to work across departments, to work across state agencies, to make sure that we're doing our due diligence to provide for them.

So it really is a series of tactics and a series of initiatives and goals that we will be working through over the next 10 years with all of our partners in government, all of our partners in communities and stakeholders all across the state, to make sure that we are being focused on older adults, we're listening to older adults, we’re being responsive to older adults, and building out an infrastructure and building up a support system that will help let them stay in their homes where they choose with the dignity and the grace that they deserve.

And it's really something that we as Pennsylvanians have not prepared for. We as a nation have not prepared for. But thanks to Governor Shapiro, thanks to the focus of the administration, we as the Department of Aging were asked to be conveners and bring all of us together across state government, across systems to build this plan. And we did that by listening to Pennsylvania. We did that by working together. And what you see before us, when you look on our website, when you look at the plan, is the culmination of all that work and the culmination of all of us pulling together to make a reality for older adults that they deserve.

And here we are, 372 days later, after the executive order signed by the governor producing a multi-sector plan that really is the envy of the nation right now. It was done right. And people really respect how it was done. Colleagues in other states come up to me who have multi-sector plans and say, we really wish our plan looked like yours, and that's a moment of pride. It's a moment of pride for my team. It's a moment of pride for Pennsylvania, because of how we did it. The level of engagement across the state, the level of engagement with 52 area agencies on aging, reaching out and having over 200 listening sessions, in 67 counties, 20,000 responses, listening to people, listening to their needs, listening to their caregivers, care recipients, providers, partners all throughout the aging services world really crafted this.

And we did it in a very open process with a lot of public feedback. And what we got was a product that we all can be proud of, a product that we all can understand, and 10 years of planning that will evolve and will change, of course, because all of our needs will continue to change. But something that we all can get behind and support in any space that works or touches the lives of older adults.

Ellen

I think one of the great parts about the Aging Our Way plan is that it's not just about the Department of Aging going out and accomplishing all of this, but it's about all of the stakeholders, including other departments within the state, to come together to tackle these really tough issues that touch every single one of us. And so, can you talk about just a little bit more about some of the initiatives in there that you think are really the most important ones that we need to accomplish?

Jason

Well, I love that we touch on every department practically in state government, and I think that is something that we really should continuously uplift. And we talk about all the good things that are happening across the state that really impact older Pennsylvanians—our partners in DCNR [Department of Conservation and Natural Resources] and all the work they do in our state parks, making them more accessible for older Pennsylvanians every day. They don't realize they're accomplishing tactics in the plan.

Or when we're investing in local communities and we're redoing sidewalks or improving lighting, this is what older adults told us they need to happen. So, when DCED [Department of Community and Economic Development] is creating new space in a community or rebuilding a downtown, that is an investment that helps older Pennsylvanians. Just those quick examples, not to mention the countless examples that exist between our partners in the Department of Human Services, our Department of Health—these other departments that sometimes get overlooked as partners in aging really are doing things that shape the lives of older Pennsylvanians in a good way.

And highlighting their good work is one of the best wins that we have in the plan, pulling all of that together and showing all of Pennsylvania that we're pulling for you. If you're over the age of 60, we're doing things all along the way to change things for the better, to make sure that you can stay in your home, in your community, that you have the kind of community-based services that you need to transform your lives and support you as you grow older.

Ellen

That's wonderful. So, Brendan, UPMC Community HealthChoices is one of three managed care plans that offer Medicaid long-term services and supports in Pennsylvania. How are long term services and supports a part of the plan, and what can CHC MCOs [Community HealthChoices Managed Care Organizations] do to help in the implementation of the Aging Our Way, PA plan?

Brendan

Well, I think, you know, Jason, you hit on a lot of those pieces there.

I mean, I think at the end of the day, Community HealthChoices is really that infrastructure that's there. It's focused on the Medicaid population, folks that are dually eligible for Medicare and Medicaid. And we've built a lot of structure around all those different pieces. And we've built networks, and providers that really complement all the pieces that are in the plan. Chore services is a perfect example. When we talk about, you know, some of our home care services, you know, pest eradication, home modifications, things like that, where we've built an infrastructure that's able to truly keep seniors and people with disabilities independent and safe in communities and in their homes. And I think the plans really complement each other incredibly well. And when you have some of that infrastructure in place, you know, you can then look at how you can expand and build some of those partnerships.

Community HealthChoices is person centered. It's about meeting people where they are and understanding the needs that they have, to make sure that they have the supports to be able to remain in those communities and I think that's where a lot of the plan comes into place, too, because it is really getting that feedback. A lot of the process that you went through is incredible because it's helped inform us to start thinking a little bit differently about programs that we can do.

And we've been able to see a lot of significant changes with just a little bit of help. If we put a shower bar in someone's bathroom or a lift so that they can get up and down their stairs and do their laundry, it pays dividends because it means they're less likely to fall and hurt themselves, and then have to need higher levels of care. So, it not only frees up resources that can go to people that truly need that help, but it also really keeps people where they want to be. And that's safe and independent at home.

And that's really where I think a lot of the pieces really complement each other because, you know, being able to have accessible parks, being able to go to those parks and being able to have access to those points, that's where a lot of the MLTSS services provide that. And as a health plan, the MLTSS work and the services that we provided, it's funny because it's bled over into the physical health in the Medicare space where we're covering more things under Medicare that we had traditionally not covered to make sure that we can keep people safe and independent. So, it's actually having broader implications. And the federal government's actually taking note. And they want us doing more of these things.

The plan on aging is really just an incredible focal point, that it's forcing us in the ecosystem to really be better and to think differently about how we can approach the people that we serve, and really meet them where they are and make sure that we can put those pieces into place.

Jason

And I really love how you highlight to the need for partners to do better and move forward together in a better way. And that's one thing that the plan does—[it] calls on us to put things aside that traditionally kept us from serving the consumers to the level that they needed to be served, and to find better ways to work together to make sure that individual can live the way they choose and with the services and supports that they need.

If it wasn't for my connectivity in the home modification space, our CHC provider would not have been able to make the inroads that they need to get their program off the ground. And that's back when I was an area agency on aging director. It's important for those partnerships to be fostered. It's important for us to work collaboratively together so that we're serving the person at the end of the day the way they need to be served. That is what our call to action is. And that's really what's most important. If we're not serving the older adult, then we're not doing our job.

Ellen

Brendan, can you talk a little bit about behavioral and physical health integration and how those things come together to provide better services for our members?

Brendan

To be honest with you, I mean, I think, I'm excited to talk about this because this is at the core of who we are at UPMC and really what we've built and the infrastructure that we've built. And a lot of UPMC Health Plan has been focused on, how do we serve these vulnerable populations. I mean, so much of the work that we do—yes, we have commercial insurance, Medicare—but, you know, a lot of it is really centered around what we do in the Medicaid population and for folks that are dually eligible.

One of the big things, and I think all these things that we've been working on, the social determinants of health and all the different efforts that we have, really complements a lot of what's in the plan and really starts to speak to some of the challenges that we see in the populations that we serve.

At the end of the day, the health and well-being of someone is more than just what you get in a doctor's office. You know, they always joke that 80 percent of health care is done outside of a doctor's office. So, you know, we're getting people into stable housing that in some cases they haven't had for a long time. And that really changes their life. They're not cycling in and out of an emergency room or an inpatient admission. Their quality of life is better. And with that stable housing, with some of the supports that we build around them in that person-centered way, they're able to live independent and fulfilled in life. They're able to get jobs, they're able to do many different things and have those supports in place.

One of the big things that we do when we look at the populations we serve is, we start to think about putting ourselves in their shoes and, how would they feel in what we're doing? What would that impact be if I was on their side? And we've done some interesting pilots.

So, we're the behavioral health managed care plan in Erie. We are a physical health managed care plan. We're a Medicare plan. We are the Community HealthChoices plan. And, you know, when you talk about some of the different government programs, people can get lost in between that and they can get lost in the shuffle. And it's really hard to navigate in many ways. So, we started a program in Erie, and it's been wildly successful in cutting out some of that bureaucratic red tape behind the scenes. So we're actually working together across all the different streams between Medicare, behavioral health, as well as CHC, to really work with an agency that acts on our behalf for that person and is really engaged fully with them and really building supports around them.

And some of the results that we've seen, if—we've made that invisible to that person, so they don't know all the things that are going behind the scenes, they don't know how our systems are working or who's paying what. But at the end of the day, what it's changing is their lives. Some of the individuals in the program, well they all have serious mental illness, and frequently the SMI population is cycling in and out of inpatient units, emergency rooms. They have altercations with law enforcement, all kinds of things like that.

When we've gotten folks enrolled in the program, it's incredible to see what's happened. We've changed their life. They have stable housing. They're at home. They're not cycling in and out of an ER. They're stable and they can actually hold down jobs. They can do all those things. And I think, you know, when we talk about the plan on aging, all the different things that go into it, it really shows what partnerships and what that engagement can really do.

You're talking about bridging those gaps, really kind of getting those conversations and those partnerships behind the scenes. And it's really just incredible to see how all that work comes into this plan. And we're excited for the next 10 years. We want to be your partner as we work through all those different elements and really best support the population in Pennsylvania.

Jason

And just a little more than a year and a half ago, I mean, I was in the trenches with people from your organization working through these challenges with individuals trying to make sure that the services were there. You know, things came out of discussions about bad situations because that's oftentimes how we in Human Services find solutions is through a bad situation.

But just the changes that you're talking about, the work that we're doing to make a blended care plans with individuals, working to add these enhanced services, responding to what older adults told us to, and that is better behavioral health services for them, in our responses from Aging our Way, PA is transformative to this system. You know, they seem to the general person on the street small changes or common-sense changes. But in government, in big structures like ours, these changes make a difference for the people in the field that are out there every day in the trenches, trying to keep people in their homes, in their communities, and stabilizing them. And this is the work that is doing that.

And it's actually, you know, we in Harrisburg, we here in Pittsburgh, cost unfortunately drives a lot of decisions. But doing better services, we have come to realize, doing better for the people we serve is what keeps costs down and keeps people stable, happy, living the lives that they should be living. So, I think we've turned a corner because of our plans in realizing that, and now we're putting it into action.

Ellen

Great. So, plans can be really great, but implementation can be challenging. And the challenges that you face as you go through implementation can be pretty significant. What are some of the biggest challenges that you think you’re going to face in implementing this 10-year plan?

Jason

I think there's always and forever going to be challenges with funding in my space—in any space in human services, to be honest with you. There's always need, and we can't always fill that need right away. So, I think we'll always see challenges in trying to draw down resources.

And that's where partnerships are important. Finding good partners, not just in government, but partners in communities to help blend resources. That's a big part of Aging our Way, PA, the blending of resources to looking for resources that are not traditional government resources or using government resources to leverage additional resources from other sources. That's something we talk about. That's something that's part of our plan moving forward.

So, resources will always be a challenge. Keeping partners engaged, keeping partners at the table is important too. Sometimes we see the energy behind plans goes away because partners don't stay engaged. And I think that's why we very strategically started in the very beginning with the steering committee being the long-term care council. There's something that's embedded in statute. There's a structure that will continue to keep the plan honest, that will keep the plan alive. And as long as those individuals remain engaged with the Department of Aging and all our sister agencies that have a place on the council, you'll see that the plan stays at the forefront of what we're doing to convene service providers, to convene community partners, and to make sure that the plan keeps moving over the next 10 years.

And we’re accomplishing tactic after tactic, you know, starting off this year with our focus on the caregiver toolkit, you know, and growing next year to see what our next priority is going to be. But letting the long-term care council and the partners that are involved there help steer that, help guide us, and really make it a more open process with the right kind of feedback so that we know what we're doing is really having the impact we intend.

Ellen

Secretary Kavulich, what are you most hopeful about when it comes to the health, well-being, and quality of life for older Pennsylvanians?

Jason

I'm hopeful that older adults get to make their choice, and that the systems are there to support them in that choice; that it's really about them. It's about serving them the way they have asked us to serve them, and that what they need is at their fingertips, that they can easily access it, that they don't have to jump through hoops [so] that the supports are available and easily implemented so they can live the way they want to.

I really think older adults have, up until now, had to make some hard choices, you know. Housing is a struggle. Services is a struggle. Transportation is a struggle. Nutrition is a struggle. Older adults have done so much for every single one of us, and they've built the communities we live in. They are our volunteers.

Just in the Department of Aging alone we have over 11,000 volunteers. The vast majority of them are older adults. They keep our PA medical system going that helps individuals choose Medicare Part B. They volunteer at your schools. They volunteer at your little leagues. They do all the things that keep our towns, our communities, our society moving forward. And at the end of the day, there's always a struggle in their lives, whether it be to get to where they need to, whether it be to find the right kind of resources so that they can get their property tax and rent rebate done, whether it be to access just the chore services that they need to get the laundry done because they can't do the cellar steps anymore.

But I have hope that now with plans like this coming to fruition, with all of us pulling in the same direction and focusing in on a person-centered approach to service, I see hope that in the next 10 years, we're going to change the entire infrastructure of services for older adults, that our state is going to be a leader and a model for how this work should be done, and that we're going to do exactly what we set out to do and improve their lives and give them the dignity of choice they deserve.

Ellen

That’s wonderful. Brendan, same question for you.

Brendan

You know, there's a lot of optimism, and one of the big things that I would just add on to what you said is there's more innovation, I think. The state plan has actually given us more of a focal point on this, and it's forcing us to start to think a little bit differently and get a little more creative. We know that there aren't enough in the younger generations, to care for all the seniors that we have. So, we have to find some better ways to do it. And what are those other solutions?

And I think I'm hopeful that between the plan, all the things that are coming around, what's going on in CHC, we're able to address some of the disparities that are at the core of what we're seeing. But then also, how can we be smarter about it, and really keep people as independent as they can and all the things that we all share those goals of? But let's get creative. Let's find some innovative ways to go about and do that. And I think everything you've done with the plan is exactly the right way. It's partnerships. It's trying to understand and have the dialogue and conversation. Because many of the things that we all struggle with and a lot of seniors struggle with, it's—they're not unique. It may seem unique at the time, but we have to have the conversation and get the right people to the table to really start to move the needle, because there's a lot of great programs across the nation, across the world, that we could do some different things here to better serve the population and really find those creative, innovative approaches and kind of cutting through some of the problems and the challenges.

Some of those challenges aren't going to go away. But if we all come together, we can really start to find effective solutions to be able to better support everybody and keep them safe and independent.

Jason

And that's a call to action. Remove the red tape, make sure that the services are accessible, make sure that we're communicating and working together, and make sure we keep working, we keep sitting at the table with each other and talking through the challenges and looking for a better way.

Technology is a solution that really is underutilized in this space. And with the university structure that we have in Pennsylvania, with all the good work that's done in Pennsylvania, we can really change the world in a short period of time, as long as we're focused.

The attitude is that there's no one department, there's no one agency, there's no one provider is key here because it's all of us. If we're going to move through this time when we'll see the largest explosion in the older adult population in our history, we all have to be committed to doing this the right way.

Ellen

I want to thank you both today for taking time to talk with us on “Good Health, Better World.” This was a wonderful conversation about a plan that we really look forward to seeing in action, and to being a partner together in implementing the plan. And just really, again, want to say thank you for joining us today on the podcast, it’s really been wonderful.

Jason

Thank you for having me. Thank you for uplifting the work of the Department of Aging, all our partners, and really helping us come together and highlight all the good work that we're going to do for the next 10 years as partners.

Brendan

And thank you for being here, Jason, and for your partnership with us. We're incredibly supportive of all the work that you want to do and glad to be one of those stakeholders and those partners to really help make it happen and a reality. So thank you.

Ellen

We hope you enjoyed this episode of “Good Health, Better World.” Be sure to tune in next time and visit upmchealthplan.com/goodhealth for resources and show notes.

This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their care provider. Views and opinions expressed by the host and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.

Guest speakers:

Jason Kavulich

Secretary of Aging, Pennsylvania Department of Aging

Secretary Jason Kavulich brings 24 years of experience in the human services field to the mission of serving and advocating for Pennsylvania’s 3.4 million older adults age 60 and over. Progressing from a county caseworker through supervisor and administrator positions within the Lackawanna County Office of Youth and Family Services, he was appointed Director of the Lackawanna County Area Agency on Aging in 2016. In 2021, his efforts to assist older adults during the COVID-19 pandemic were honored by the County Commissioners Association of Pennsylvania and the Pennsylvania House of Representatives. Later in 2021, he spearheaded a coalition of non-profit, business, and education leaders to bring the new federal Elderly Cottage Housing Opportunity (ECHO) program to Lackawanna County—the first northeastern Pennsylvania county to do so. In 2022, under Jason’s leadership, Lackawanna County became an early adopter of the Department of Aging’s Shared Housing and Resource Exchange (SHARE) program.

 

Brendan Harris

President, UPMC for You and State Programs

Brendan Harris’ lifelong interest in politics and public policy has led to a wide range of experience in health care, administrative policymaking, and oversight. Prior to joining UPMC, Harris served as part of the Department of Human Services (DHS) executive team for over a decade—a department that serves more than 3 million Pennsylvanians, operates with a $39 billion budget, and has over 16,000 employees. As the Vice President for UPMC Community HealthChoices, Brendan led UPMC’s efforts to provide long-term services and supports for older Pennsylvanians and individuals with physical disabilities. He currently serves as President of UPMC for You and State Programs.