Understanding State-Level Variation in Medicaid Managed Care Maternity Kick Payments

Understanding State-Level Variation in Supplemental Maternity Kick Payments in Medicaid Managed Care

Introduction

Today, we’re exploring an intriguing study on the state-level variation in supplemental maternity kick payments in Medicaid managed care. This study, conducted by Samantha G. Auty, Jamie R. Daw, and Jacob Wallace, provides valuable insights into how these payments impact delivery costs and care quality.

Post Introduction

In this post, we’ll break down the key findings of the study, understand the implications of kick payments on Medicaid managed care, and discuss how these variations can affect maternal health outcomes across different states. Let’s get started by understanding the basics of Medicaid managed care and why kick payments are essential.

Detailed Story

What is Medicaid Managed Care?

Medicaid managed care (MMC) involves states contracting with private health insurers to provide Medicaid coverage. This model covers about 70% of pregnant Medicaid enrollees and finances approximately 41% of all births in the United States. Under MMC, insurers receive per-member-per-month capitated payments to cover a defined set of benefits. However, covering pregnant individuals poses a higher financial risk due to their increased healthcare needs, which often leads to states implementing one-time “kick payments” to MMC plans triggered by delivery events.

The Role and Variation of Kick Payments

Kick payments are designed to offset the higher costs associated with childbirth. The rates and use of these payments can significantly influence whether MMC plans are incentivized to attract or avoid pregnant enrollees. This study aimed to assess the prevalence and magnitude of these kick payments across different states and how they align with actual delivery costs.

Research Methodology

The researchers conducted a cross-sectional study, abstracting data from state documents and MMC contracts published between 2018 and 2020. They gathered information on whether states used kick payments, the services covered by these payments, and the specific rates.

Additionally, they compared these rates with average state Medicaid fee-for-service (FFS) payments for delivery hospitalizations in 2020 and the Medicaid-Medicare fee index.

Key Findings

The study revealed that out of the 38 states and the District of Columbia using comprehensive MMC, 33 states used maternity kick payments. These payments varied significantly, ranging from $2,838 in New Hampshire to $14,493 in Maryland. Interestingly, the variation in kick payment rates did not correlate with the Medicaid payments to physicians or the actual delivery costs, indicating that in some states, kick payments might exceed delivery costs, while in others, they fall short.

These payments varied significantly, ranging from $2,838 in New Hampshire to $14,493 in Maryland.
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Expert Insights

To further explore the implications of these findings, let’s delve into some expert insights.

Potential Implications of Low Kick Payment Rates

When kick payment rates are set too low, MMC plans might attempt to limit services for pregnant enrollees or restrict access to maternity care providers. This can lead to disparities in care quality and access, particularly affecting Black and Indigenous women, who are disproportionately enrolled in Medicaid and face higher risks of maternal mortality and morbidity.

The Need for Aligned Incentives

Aligning kick payment rates with actual delivery costs and care quality is crucial. States need to design Medicaid payment policies that support maternal health and promote health equity. This requires continuous research to understand the effects of these payments on care access, quality, and outcomes.

In-Depth Analysis

The Study’s Limitations

While the study provides valuable insights, it has some limitations. It could not directly associate kick payment rates with MMC plan behavior or maternal health outcomes. Additionally, the comparison was made with Medicaid FFS payments rather than the prices MMC plans paid for delivery services, which were unavailable.

The Path Forward

Further research is essential to evaluate the impact of kick payments on maternal care access and outcomes. Policymakers need comprehensive data to design effective Medicaid payment strategies that ensure equitable and high-quality maternal care.

Practical Tips

For state policymakers and healthcare administrators:

Regular Review of Kick Payment Rates: Ensure that kick payment rates are regularly reviewed and adjusted to reflect actual delivery costs and care quality needs.
Focus on Health Equity: Design payment policies that address disparities in maternal health outcomes, particularly for vulnerable populations.
Data-Driven Decision Making: Use comprehensive data to evaluate the impact of payment policies on maternal care access and outcomes.

FAQ Section

Q1: What are Medicaid managed care kick payments? A: Kick payments are one-time payments made to Medicaid managed care plans to offset the higher costs associated with childbirth.

Q2: Why do kick payment rates vary between states? A: The variation can be due to different state policies, healthcare costs, and the structure of Medicaid managed care contracts.

Q3: How can low kick payment rates affect maternity care? A: Low rates can lead to MMC plans limiting services for pregnant enrollees or restricting access to maternity care providers, affecting care quality and access.

Q4: What can states do to improve kick payment policies? A: States should regularly review and adjust kick payment rates, focus on health equity, and use data-driven approaches to design effective payment policies.

Source

State-Level Variation in Supplemental Maternity Kick Payments in Medicaid Managed Care

Introducing the Care MAP Tool: A Comprehensive Guide

Introducing the Care MAP Tool, designed to support healthcare providers in managing complex care needs. This user-friendly, Excel-based tool offers a structured framework for effective care coordination, resource allocation, and patient management. With modules for an overview and practical scenarios, plus a comprehensive resource library and FAQ section, the Care MAP Tool enhances care strategies and improves patient outcomes. Download it today and elevate your care management practices.

Effective care management is crucial in today’s complex healthcare landscape. To support healthcare professionals and organizations, we are excited to introduce the Care MAP Tool, a valuable resource designed to aid in complex care management. This blog will provide an overview of the Care MAP Tool, walk you through an example scenario, and offer access to a resource library and frequently asked questions (FAQ) section.

Module 1: Care MAP Overview

The Care MAP (Management and Planning) Tool is designed to support healthcare providers in managing and planning care for patients with complex health needs. This tool provides a structured framework to help clinics navigate the intricacies of care coordination, resource allocation, and patient management. Here’s what you can expect from the Care MAP Tool:

Framework for Complex Care Management: The tool offers a comprehensive structure to address the multifaceted needs of patients requiring intensive care management.
User-Friendly Interface: The Excel-based tool is intuitive and easy to navigate, ensuring that healthcare providers can quickly integrate it into their workflows.
Scalable and Adaptable: Whether you’re a small clinic or a large healthcare organization, the Care MAP Tool can be scaled and adapted to fit your unique needs.

Module 2: Example Scenario

To illustrate the practical application of the Care MAP Tool, let’s walk through an example scenario:

Scenario: Managing a Patient with Multiple Chronic Conditions

Patient Overview:
- Name: Jane Doe
- Age: 65
- Conditions: Diabetes, Hypertension, Chronic Obstructive Pulmonary Disease (COPD)
Initial Assessment:
- Medical History Review: Gather comprehensive information about Jane’s medical history, including past treatments, hospitalizations, and medications.
- Social Determinants of Health: Assess factors such as living conditions, access to transportation, and social support.
Care Coordination:
- Interdisciplinary Team: Form a care team that includes primary care physicians, specialists, nurses, social workers, and community health workers.
- Care Plan Development: Create a personalized care plan that addresses Jane’s medical and social needs, with clear goals and timelines.
Monitoring and Evaluation:
- Regular Check-ins: Schedule regular appointments and follow-ups to monitor Jane’s progress.
- Adjustments: Modify the care plan as needed based on Jane’s response to treatment and changes in her condition.

Resource Library

The Resource Library is a curated collection of materials to further support your use of the Care MAP Tool. Here, you’ll find:

Guides and Manuals: Detailed instructions on how to use the Care MAP Tool effectively.
Case Studies: Real-world examples of the tool in action, showcasing its impact on patient outcomes.
Training Videos: Step-by-step video tutorials to help you and your team get up to speed quickly.

FAQ

To ensure you have all the information you need, we’ve compiled a list of frequently asked questions:

Q1: Who can use the Care MAP Tool?
A1: The tool is designed for healthcare providers, including clinicians, care coordinators, and administrative staff.

Q2: Is there a cost associated with the Care MAP Tool?
A2: No, the Care MAP Tool is available for free download.

Q3: How do I get support if I encounter issues with the tool?
A3: Support is available through our online helpdesk. You can also refer to the Resource Library for troubleshooting guides.

Care MAP Tool Download

By using the Care MAP Tool, you acknowledge that you have read and agree to the disclaimer below. If you share the tool, ensure that all individuals given access to it have reviewed and agreed to the disclaimer language before using it for any purpose.

Disclaimer: The Care MAP Tool is intended as a general framework to support considerations around complex care management in a clinic setting. It is not meant for final staffing, clinical, administrative, operational, and/or financial decision-making. Information obtained from this tool is not and should not be taken as legal or financial advice and is not a substitute for consulting a qualified professional. Community Initiatives does not accept responsibility for any loss that may arise from reliance on this tool.

Source Link:

Care MAP Tool

Download Materials:

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Feel free to reach out with any questions or feedback about the Care MAP Tool. Happy planning!

Decoding Healthcare Options: A Comparative Guide to ACOs, HMOs, and PPOs

This comprehensive guide offers an in-depth comparison of Accountable Care Organizations (ACOs), Health Maintenance Organizations (HMOs), and Preferred Provider Organizations (PPOs), three prominent healthcare models in the United States. It breaks down the fundamental differences and similarities across various dimensions, including network structure, patient choice and access to care, payment models, and their overall focus. Whether you’re a healthcare professional seeking clarity on these models or a patient navigating your healthcare options, this guide provides essential insights to understand how each model impacts care delivery, cost, and patient experience. By elucidating the complex landscape of healthcare options, this article empowers readers to make informed decisions about their healthcare needs, contributing to better health outcomes and satisfaction. Perfect for individuals looking to demystify healthcare terminologies and structures, our guide simplifies the decision-making process in choosing the right healthcare plan.

Given the popularity of this topic, we are publishing a table below presenting a comparison between ACOs, HMOs, and PPOs in a table format that can help readers quickly grasp the differences and similarities.

Navigating the landscape of healthcare options can be a daunting task for patients and providers alike. Among the plethora of models available, Accountable Care Organizations (ACOs), Health Maintenance Organizations (HMOs), and Preferred Provider Organizations (PPOs) stand out as prominent frameworks designed to streamline care delivery, manage costs, and improve patient outcomes. Each model boasts its unique structure and operational philosophy, catering to diverse healthcare needs and preferences. This blog post delves into the core characteristics of ACOs, HMOs, and PPOs, shedding light on their network structures, patient choice, access to care, and payment models.

At the heart of ACOs is a commitment to coordinated care, aiming to ensure that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. Unlike ACOs, HMOs emphasize preventive care within a closed network of providers, requiring patients to choose a primary care physician who oversees their health journey and referrals. On the other hand, PPOs offer a balance between flexibility and cost, providing patients the freedom to visit any healthcare provider, albeit at varying costs based on network status.

Understanding these differences is crucial for making informed healthcare decisions. Whether you’re a patient evaluating your healthcare plan options, a provider considering joining a healthcare network, or a policymaker analyzing healthcare system improvements, grasping the nuances of ACOs, HMOs, and PPOs can empower you to navigate the healthcare ecosystem more effectively. This comparison aims to illuminate the paths available for achieving high-quality, cost-effective care tailored to individual health needs.

Feature	ACO (Accountable Care Organization)	HMO (Health Maintenance Organization)	PPO (Preferred Provider Organization)
Network Structure	Self-defined network of clinicians.	Network defined by the health plan. Patients choose a primary care physician who acts as a gatekeeper.	Network defined by the health plan. More flexibility to see specialists without a referral.
Patient Choice and Access to Care	Patients cannot be limited to using only ACO clinicians. Freedom to see any clinician.	Requires seeing clinicians within the HMO network. Primary care physician referral needed for specialists.	Can use clinicians inside and outside the network. No referral needed for specialists, but higher cost for out-of-network services.
Payment Model	Fee-for-service payments, with potential for shared savings. No change to underlying fee-for-service structure for clinicians.	Capitation model where a clinician group receives a set amount per patient, incentivizing efficient care within the budget.	Fee-for-service basis within the network. Different rates for out-of-network services, without primarily using capitation.
Focus	Improving care coordination and quality while controlling costs.	Cost control, preventive care, and efficiency within a closed network.	Flexibility in provider choice with a broader network, offering a balance between cost and access to care.

Financial Benefits of Doulas for Hospitals with Capitated Contracts

Doulas, with their specialized training in providing emotional, physical, and educational support during childbirth, are becoming increasingly integral in modern maternity care. For hospitals navigating the intricacies of capitated contracts—where fixed payments are made irrespective of services rendered—the role of a doula presents a compelling financial argument. Evidence suggests that doula-assisted births may lead to fewer medical interventions, shorter labor durations, and reduced postpartum complications. These reductions not only enhance the childbirth experience for mothers but also translate into tangible cost savings for hospitals. In an era where patient satisfaction is paramount and efficiency is sought, the integration of doulas in the childbirth process is both a qualitative and quantitative win for healthcare.

Reduced Interventions
Shorter Labor Duration
Improved Patient Satisfaction
Fewer NICU Admissions
Reduction in Postpartum Complications

The following is based on an article published in Becker’s Hospital Review: The Financial Benefits of Doulas for Hospitals with Capitated Contracts.

Doulas: Doulas are non-medical professionals trained to provide emotional, physical, and educational support to mothers before, during, and shortly after childbirth. They complement the medical care provided by doctors and nurses.

Capitated Contracts: In the healthcare setting, a capitated contract is a payment agreement where providers (like hospitals or doctors) receive a set amount (a “capitation”) for each enrolled person assigned to them, per period of time, whether or not that person seeks care. The amount is pre-determined and is meant to cover all the standard services the patient might need during that time frame.

Financial Benefits of Doulas for Hospitals with Capitated Contracts:

Reduced Interventions: Studies have shown that the presence of a doula during childbirth can reduce the need for certain medical interventions, such as cesarean sections, forceps, and vacuum deliveries. Since these procedures can be costly, a reduction in their frequency can lead to financial savings for hospitals.
Shorter Labor Duration: Some research indicates that doula-supported births might be associated with shorter labor durations. Shorter labors can reduce costs associated with prolonged hospital stays or additional medical care.
Improved Patient Satisfaction: Doulas can enhance the birthing experience for mothers, leading to higher patient satisfaction scores. Hospitals with higher patient satisfaction might attract more patients and potentially negotiate better rates with insurers.
Fewer NICU Admissions: There’s some evidence suggesting that doula support can reduce the likelihood of newborns being admitted to the Neonatal Intensive Care Unit (NICU). NICU care is expensive, so any reduction in admissions can translate to considerable cost savings.
Reduction in Postpartum Complications: Doulas can also support mothers postpartum, potentially reducing the risk of certain complications that would necessitate additional medical care or readmission to the hospital.

For hospitals under capitated contracts, the financial incentive is to provide care efficiently while maintaining quality. Since the payment is pre-determined and not based on the number or type of services rendered, reducing unnecessary interventions or complications can directly translate to cost savings.

It’s worth noting that while the financial benefits are a positive outcome, the primary goal of integrating doulas into maternity care is to enhance the childbirth experience and outcomes for mothers and babies. Improved patient well-being and satisfaction, combined with cost savings, make a compelling case for more widespread inclusion of doulas in maternity care settings.

Unleashing the Power of Healthcare Data: Exploring HRSA’s Data Portal

Discover the power of the HRSA Data Portal in revolutionizing healthcare research and planning. Developed by the Health Resources and Services Administration (HRSA), this web-based platform provides access to a vast array of comprehensive healthcare data. From primary care facilities to health workforce information, the HRSA Data Portal serves as a centralized repository for diverse datasets. Explore its key features, including interactive data visualization tools that enable users to gain insights and identify trends. Customizable reports and dashboards allow for tailored analysis, while the data download capability empowers researchers to perform in-depth analysis and integrate HRSA data into their own workflows. With its potential to inform evidence-based decision-making, the HRSA Data Portal can contribute to improved healthcare delivery, reduced disparities, and targeted interventions. Unlock the potential of data-driven solutions and work towards equitable access to healthcare resources with the HRSA Data Portal. Access it now to drive positive change.

Introduction:

In today’s data-driven world, information has become a valuable asset, particularly in the healthcare industry. Access to accurate and comprehensive healthcare data can drive research, inform policy decisions, and ultimately improve patient outcomes. Fortunately, the Health Resources and Services Administration (HRSA) understands the significance of data transparency and has developed a powerful tool: the HRSA Data Portal. In this blog post, we will delve into the depths of this invaluable resource and explore its potential to revolutionize healthcare research and planning.

What is the HRSA Data Portal?

The HRSA Data Portal is a web-based platform that provides access to a wealth of healthcare data collected by the Health Resources and Services Administration. HRSA is an agency of the U.S. Department of Health and Human Services, tasked with improving access to healthcare services for underserved populations. The Data Portal serves as a centralized repository for various datasets, enabling users to analyze, visualize, and download information relevant to health resources, health workforce, and other critical healthcare domains.

Exploring the Key Features:

Comprehensive Data Collection: The HRSA Data Portal offers an extensive collection of datasets covering diverse aspects of healthcare, including but not limited to primary care facilities, healthcare workforce, medically underserved areas, and health disparities. This wide-ranging data facilitates a holistic understanding of the healthcare landscape and enables researchers, policymakers, and healthcare professionals to identify gaps and target interventions more effectively.
Interactive Data Visualization: The Data Portal incorporates interactive data visualization tools that empower users to explore healthcare data visually. From dynamic charts and graphs to geospatial mapping, these visualization features provide a user-friendly interface for gaining insights and identifying trends, patterns, and disparities across different regions and demographics. This functionality enhances data comprehension and assists in evidence-based decision-making.
Customizable Reports and Dashboards: Users can create custom reports and dashboards using the available datasets within the HRSA Data Portal. This flexibility allows individuals to tailor their analysis and focus on specific areas of interest. Whether one is conducting research on healthcare access in rural communities or examining workforce distribution in underserved regions, the ability to customize reports streamlines the data exploration process and promotes targeted investigations.
Data Download Capability: The Data Portal provides direct access to downloadable datasets in various formats, allowing researchers and analysts to integrate the HRSA data into their own analytical tools and workflows. This feature empowers users to perform in-depth analysis, conduct advanced statistical modeling, or combine HRSA data with other sources to gain a comprehensive understanding of healthcare dynamics.

The Potential Impact:

The HRSA Data Portal has the potential to revolutionize healthcare research, planning, and policy development. By fostering transparency and access to valuable information, the platform can facilitate evidence-based decision-making, leading to more effective resource allocation, improved healthcare delivery, and reduced health disparities. Researchers can leverage the data to identify gaps in healthcare access, evaluate the impact of interventions, and propose targeted solutions. Policymakers can utilize the insights gained from the data to shape healthcare policies that address the needs of underserved populations, ultimately enhancing the overall health of communities.

Conclusion:

The HRSA Data Portal stands as a testament to the power of data in transforming the healthcare landscape. Its robust collection of datasets, interactive visualization capabilities, customizable reports, and data download functionality provide a comprehensive toolkit for healthcare researchers, policymakers, and professionals. By leveraging this platform, stakeholders can gain valuable insights, make informed decisions, and work towards a future where healthcare resources are equitably distributed and accessible to all. The HRSA Data Portal serves as a beacon of hope, empowering us to unlock the potential of data-driven solutions in improving healthcare outcomes for communities across the nation.

Area Health Resources Files

BHW Clinician Dashboards

BHW Program Applicant and Award Data

Grants

Health Center Service Delivery and Look–Alike Sites

Health Professions Training Programs

Maternal and Child Health Bureau

National Health Service Corps (NHSC), Nurse Corps, and Substance Use Disorder Treatment and Recovery (STAR) and other Programs

National Practitioner Data Bank

Nursing Workforce Survey Data

Organ Donation and Transplantation

Ryan White HIV/AIDS Program

Shortage Areas

Uniform Data System

Workforce Projections

HRSA Data Portal Access

Eligibility: Contract Language (Payer v Provider) and Sample to Use

Eligibility: Contract Language (Payer v Provider) and Sample to Use.

Payer contracting negotiations are a critical aspect of managing healthcare costs and ensuring access to care for patients. During contract negotiations, payers and providers work to establish agreements on reimbursement rates, covered services, and other important details. These negotiations can be complex and time-consuming, requiring careful attention to legal and financial considerations. Ultimately, successful negotiations can help to ensure that patients receive high-quality care at a reasonable cost, while providers are fairly compensated for their services.

What language to negotiate from a provider v a payer’s perspective:

Favorable to physician:

Payor shall be responsible for identifying and verifying eligibility of Members. Payor shall provide each Member with an identification card. It is the Payor’s responsibility to update and maintain eligibility files and systems to ensure that eligibility verification is timely and accurate. Physician may rely on eligibility verifications obtained from a Payor or its designee and Payor shall reimburse Physician in accordance with this Agreement even if a Member is later determined to be ineligible on the date of service.

Favorable to payor:

Physician will verify a Member’s eligibility before providing a Covered Service unless the situation involves the provision of an Emergency Service in which case Physician will confirm eligibility in a manner that is consistent with Law on redeterminations of eligibility. Physician will not be reimbursed for any services furnished to a patient who was not an eligible Member on the date of service

Alzheimer Care Coordination Payments

Alzheimer’s care coordination payments are financial incentives or compensation provided to healthcare providers or organizations to coordinate the care and support for individuals with Alzheimer’s disease or related dementias. The aim is to improve the quality of care, reduce medical costs and improve patient outcomes by having providers work together and share information. These payments may come from government programs, private insurance, or other funding sources.

The amount of care coordination payments can vary widely, depending on several factors such as the individual’s specific needs, the resources available, and the funding source. Some common funding sources for care coordination payments include Medicare, Medicaid, and private insurance, and the amount of compensation may differ based on these sources. For example, Medicare may provide a set payment for certain services related to care coordination, while Medicaid may have different payment rates based on the state and the individual’s specific needs. Additionally, private insurance plans may have different coverage and payment amounts for care coordination services. As such, it’s difficult to provide a specific dollar amount for care coordination payments, but they can range from a few hundred dollars to several thousand dollars per year.

Environmental Scan on Care Coordination in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)

This environmental scan was prepared at the request of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) as background information to assist the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in preparing for a theme-based discussion on the role care coordination can play in optimizing health care delivery and value-based transformation. The discussion will consider care coordination in the context of Alternative Payment Models (APMs) and physician-focused payment models (PFPMs).ⁱ The environmental scan is based on information that was publicly available relating to this topic in the literature and from discussions with previous PTAC proposal submitters and subject matter experts, current as of the time that the analysis was completed.

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Toolkit Managed Care Resource

The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior authorization, credentialing, network adequacy, out-of-network payment, and contract termination. The Database also contains relevant AMA policy, issue briefs, advocacy resources, model legislation, and a State Laws Map.

2023 Managed Care Resource Kit

Payment Issues

Network Issues

Contract Changes / Disputes

Coverage / Utilization Review

Claims Processing

Changing Demographics & Value Based Care

The United States is going through a fundamental shift in its demographics. By 2035, there will be more seniors than children under the age of 18.

The United States is going through a fundamental shift in its demographics. By 2035, there will be more seniors than children under the age of 18. This comes as the number of clinicians and caregivers for those seniors is decreasing rapidly, putting pressure on healthcare and social service systems to improve the efficiency of how they care for our nation’s seniors.
Telehealth and connected care have the potential to increase the reach of the healthcare system where seniors want to receive care. Regardless of reimbursement and incentives, connected care and telehealth are essential for any healthcare system to adapt to our nation’s changing demographics and provide care that helps seniors age-in-place.

The U.S. is stuck in a system of volume-based (fee-for-service) care that continues to drive up costs without providing better outcomes for patients.

The U.S. is stuck in a system of volume-based (fee-for-service) care that continues to drive up costs without providing better outcomes for patients. At a time when so many Americans and employers are looking for new solutions to high prices and poor health outcomes, value-based care can slow the trajectory of costs. Instead of clinicians charging patients and insurers for every appointment, test, or service, value-based payment approaches provide clinicians with more flexibility and accountability to focus on meaningful, cost-effective services to improve their patients’ overall health. Opportunities for success include fewer visits to the doctors’ office, fewer trips to the emergency room, and ultimately the elimination of avoidable hospitalizations.

The United States is going through a fundamental shift in its demographics. By 2035, there will be more seniors than children under the age of 18.

This comes as the number of clinicians and caregivers for those seniors is decreasing rapidly, putting pressure on healthcare and social service systems to improve the efficiency of how they care for our nation’s seniors.

Telehealth and connected care have the potential to increase the reach of the healthcare system where seniors want to receive care.

Regardless of reimbursement and incentives, connected care and telehealth are essential for any healthcare system to adapt to our nation’s changing demographics and provide care that helps seniors age-in-place.