2021-11-13T19:13:01-06:00 2020-12-31 861065772 DELOITTE TAX LLP 695 TOWN CENTER DRIVE SUITE 1000 COSTA MESA CA 92626 990 2020-01-01 264146730 GARY AND MARY WEST HEALTH INSTITUTE GARY 8585357000 10350 NORTH TORREY PINES ROAD LA JOLLA CA 92037 SHELLEY LYFORD PRESIDENT AND CEO 8585357000 2021-10-28 1 SHELLEY LYFORD 999009999 DIANA MCCUTCHEN P00545657 7144367100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SHELLEY LYFORD 10350 NORTH TORREY PINES ROAD LA JOLLA CA 92037 22500002 0 X WWW.WESTHEALTH.ORG X 2009 DE CONDUCTING MEDICAL RESEARCH WITH HOSPITALS TO REDUCE HEALTHCARE COSTS WITH A FOCUS ON SENIORS. 3 3 22 4 0 0 23000000 22500000 0 0 920 2 828 0 23001748 22500002 19280 51820 0 0 5578561 4690470 0 0 0 18533484 18720671 24131325 23462961 -1129577 -962959 9611066 9921581 4738567 6012041 4872499 3909540 X CONDUCTING APPLIED MEDICAL AND SCIENTIFIC RESEARCH INTO ACTIONS TO LOWER HEALTHCARE COSTS AND IMPROVE HEALTHCARE DELIVERY AND SUCCESSFUL AGING FOR SENIOR AMERICAN CITIZENS AND LEGAL RESIDENTS. FURTHERMORE, TO LOWER THE COST OF HEALTHCARE AND ENABLE SENIORS TO SUCCESSFULLY AGE, LIVING LIFE ON THEIR OWN TERMS WITH ACCESS TO HIGH-QUALITY HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE. 1 1 16705214 51820 IN 2020, THE GARY AND MARY WEST INSTITUTE (REFERRED TO BELOW VARIOUSLY AS WHI, WEST HEALTH INSTITUTE OR INSTITUTE) CONTINUED TO ACTIVELY CONDUCT APPLIED MEDICAL RESEARCH, IN CONJUNCTION WITH THE HOSPITALS LISTED ON SCHEDULE A, TO GENERATE THE EVIDENCE NEEDED FOR HEALTHCARE PROVIDERS, POLICYMAKERS AND COMMUNITIES TO ADOPT ADVANCING HEALTHCARE DELIVERY MODELS THAT IMPROVE CARE AND ACCESS, WHILE REDUCING COSTS, FOR THE NATION'S FAST-GROWING, DIVERSE POPULATION OF SENIORS. THESE MEDICAL RESEARCH EFFORTS DIRECTLY SUPPORTED WHI'S MISSION OF LOWERING THE COST OF HEALTHCARE AND ENABLING SENIORS TO SUCCESSFULLY AGE IN PLACE WITH ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE.OVER THE COURSE OF 2020, WHI PURSUED MEDICAL RESEARCH IN THE FOLLOWING KEY AREAS: 1. ADVANCING SENIOR-APPROPRIATE ACUTE CARE MODELS: THE INSTITUTE CONTINUES TO RESEARCH HOW PROVIDING SENIOR-FOCUSED CARE IN AN ACUTE SETTING, SUCH AS IN THE EMERGENCY DEPARTMENT, HOME AND COMMUNITY, CAN HELP SENIORS AGE SUCCESSFULLY AND AVOID THE FUNCTIONAL DECLINE THAT MAY OFTEN ACCOMPANY HOSPITALIZATION2. ADVANCING SENIOR-APPROPRIATE CHRONIC CARE MODELS: THE INSTITUTE CONTINUES TO RESEARCH HOW TO IMPROVE CARE FOR FRAIL, MEDICALLY COMPLEX SENIORS WHILE PRESERVING THEIR FUNCTION AND ALLOWING THEM TO REMAIN IN THEIR HOMES IN ACCORDANCE WITH THEIR WISHES. IN PARTICULAR, STUDYING THESE MODELS IN THE CONTEXT OF PACE (THE FEDERALLY-ESTABLISHED PROGRAM FOR ALL-INCLUSIVE CARE FOR THE ELDERLY) A WHOLE-PERSON, VALUE-BASED MODEL OF CARE, WAS AN AREA OF FOCUS.3. SENIOR-FRIENDLY TELEHEALTH MODELS: THE CORONAVIRUS PANDEMIC IN 2020 WAS A TIPPING POINT YEAR FOR TELEHEALTH, AND THE INSTITUTE CONDUCTED AND DEMONSTRATED SEVERAL RESEARCH EFFORTS TO DETERMINE HOW TELEHEALTH, DONE CORRECTLY, CAN ENABLE BETTER CARE EXPERIENCE AND OUTCOMES FOR SENIORS, BOTH DURING A PANDEMIC AND IN MORE NORMAL TIMES.4. ADDITIONAL AREAS: OTHER RESEARCH PROJECTS PURSUED WITH HOSPITAL AND HEALTHCARE COLLABORATORS FOCUSED ON ORAL HEALTH FOR SENIORS AND UNDERSTANDING THE IMPACT AND RISK FACTORS ASSOCIATED WITH COVID-19. THESE RESEARCH PROGRAMS ARE DESCRIBED IN FURTHER DETAIL BELOW.SENIOR-APPROPRIATE ACUTE CARE IN 2020, THE INSTITUTE CONTINUED AND EXPANDED ITS RESEARCH ACTIVITIES WITH HOSPITALS, HEALTHCARE SYSTEMS, AND OTHER KEY STAKEHOLDERS TO ADDRESS BETTER RESPONSES TO UNPLANNED ACUTE CARE OF SENIOR AMERICANS. UNPLANNED ACUTE CARE FUNDAMENTALLY DRIVES THE MAJORITY OF COST FOR VULNERABLE SENIORS AND RESULTS IN DEBILITATION AND FUNCTIONAL DECLINE AFTER INPATIENT HOSPITAL STAYS. TO ADDRESS THESE FACTORS, THE INSTITUTE CONDUCTED RESEARCH EFFORTS TO IDENTIFY MORE PROACTIVE AND OPPORTUNISTIC CARE THAT IS DELIVERED IN PLACE, WHENEVER POSSIBLE, AND TO ADVANCE HOME AND COMMUNITY-BASED ACUTE CARE ALTERNATIVES. THE RESEARCH OBJECTIVES WERE TO CONTINUE ADVANCING INNOVATIVE, PERSON-CENTERED, SCALABLE, AND SUSTAINABLE MODELS FOR ACUTE CARE OF SENIORS IN THE HOSPITAL EMERGENCY DEPARTMENT, HOME AND COMMUNITY.RESEARCH PROJECTS:GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC)THE INSTITUTE HAS FORMED, WITH MAJOR HEALTH SYSTEMS INCLUDING UNIVERSITY OF NORTH CAROLINA AND MOUNT SINAI IN NEW YORK, THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC), WHICH NOW INCLUDES EXPERT GERIATRIC EMERGENCY DEPARTMENT (GED) CLINICIANS FROM OVER 40 MEMBER EDS/HEALTH SYSTEMS TO PROVIDE RESEARCH, EDUCATION, AND TRAINING FOR OTHER HEALTHCARE PROVIDERS. GEDC MEMBERS' IMPLEMENTATION RESEARCH HAS ALSO PROVIDED EARLY EVIDENCE THAT GED GUIDELINE-BASED CARE IMPROVES PATIENT OUTCOMES AND IS COST EFFECTIVE, DEMONSTRATING THE VALUE OF GEDS TO PATIENTS, HOSPITALS, PAYORS, AND THE PUBLIC AT-LARGE.IN DIRECT RESPONSE TO THE GLOBAL PANDEMIC, THE GEDC ADAPTED THEIR EDUCATIONAL AND TRAINING OFFERINGS TO A WEB-BASED PLATFORM TO ACCOMMODATE VIRTUAL AUDIENCES; CONVENED SUBJECT MATTER EXPERTS FOR MONTHLY WEBINARS; PUBLISHED AND DISSEMINATED BEST PRACTICES; DEVELOPED A COVID-19 TOOLKIT; AND ESTABLISHED AN ONLINE RESOURCE LIBRARY WHICH FEATURES THREE TOOLKITS ON IMPLEMENTING DISTINCT GED-SPECIFIC QUALITY IMPROVEMENT INITIATIVES (DEMENTIA, DELIRIUM, AND FALLS/MOBILITY) THAT WERE CO-DEVELOPED BY GEDC AND WHI. DESPITE THE ONGOING PUBLIC HEALTH CRISIS, THE GEDC FACILITATED 17 EDUCATIONAL AND TRAINING EVENTS IN 2020, REACHING OVER 1,600 PARTICIPANTS (CLINICIANS AND HOSPITAL ADMINISTRATORS) FROM 15 COUNTRIES. GEDC ALSO CONTINUED OFFERING ITS SIGNATURE GED BOOTCAMPS IN DURHAM, NC WHICH INCLUDED TEAMS FROM TEN DIFFERENT VETERAN AFFAIRS (VA) HOSPITALS FROM AROUND THE UNITED STATES IN FEBRUARY 2020 AS WELL AS VIRTUAL BOOTCAMP SESSIONS FOR SAN DIEGO COUNTY'S 18 EDS. THE GEDC AND WHI ALSO JOINTLY LAUNCHED A HEALTHCARE SYSTEMS ROUNDTABLE TO LEVERAGE INSIGHTS FROM EIGHT ALREADY ACCREDITED HEALTH SYSTEMS (REPRESENTING 126 EDS) TO DEVELOP IMPLEMENTATION RESOURCES (E.G., GUIDE, TOOLKITS) FOR PROSPECTIVE HEALTH SYSTEMS WANTING TO BECOME ACCREDITED.ADDITIONALLY, GEDC RESEARCHERS DEMONSTRATED THAT A GED NURSE INTERVENTION WAS ASSOCIATED WITH REDUCED RISK OF HOSPITAL ADMISSION AT BOTH INITIAL ED VISIT AND 30 DAYS POST-ENCOUNTER AND THAT A GED PROGRAM INCLUDING SPECIALIZED NURSE OR SOCIAL WORKER CONSULTATION WAS ASSOCIATED WITH SIGNIFICANT REDUCTIONS IN READMISSIONS AND IN TOTAL MEDICARE EXPENDITURES AT 30- AND 60-DAYS POST-ED VISITS. S. THESE RESULTS WERE PRESENTED AT NATIONAL CONFERENCES AND PUBLISHED IN SCIENTIFIC JOURNALS.THE GEDC HAS EXTENDED THE PILOT PHASE OF THE NATIONAL RESEARCH DATA WAREHOUSE TO ENCOMPASS HOSPITAL AND PATIENT-LEVEL DATA FOR OVER 280,000 UNIQUE ED ENCOUNTERS ACROSS 12 EMERGENCY DEPARTMENTS, WITH DATA TRANSFER PENDING FROM TWO MORE SITES. WHI IS SEEKING DATA FROM AN ADDITIONAL 20 EDS IN 2021 AND WILL EXPAND UPON PRELIMINARY ANALYSES SUMMARIZING PATIENT DEMOGRAPHICS AND KEY ENCOUNTER AND DIAGNOSES INFORMATION. GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION (GEDA) PROGRAMIN 2018, THE INSTITUTE COMMENCED AN EFFORT WITH THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS TO ADVANCE THE GEDA PROGRAM, WHICH EXCEEDED ITS PRIMARY GOAL TO ACCREDIT AN ADDITIONAL 135 EDS IN 2020 DESPITE THE EFFECTS OF OF COVID-19. BY THE END OF 2020, OVER 200 EDS WERE FULLY ACCREDITED AND THERE ARE NOW GEDS IN OVER 170 CITIES AND TOWNS ACROSS 36 STATES. IN 2020, APPROXIMATELY 2.2 MILLION (OR APPROXIMATELY ONE IN TEN) OLDER ADULT ED VISITS IN THE US WERE MADE AT A HOSPITAL WITH AN ACCREDITED GED. DEMONSTRATING INTEREST FROM HEALTH SYSTEMS IN ACCREDITATION, 24 HEALTH SYSTEMS HAD MULTIPLE EDS APPLY FOR ACCREDITATION IN 2020, INCLUDING THE VETERANS HEALTH ADMINISTRATION (VHA) SYSTEM AND SHARP HEALTHCARE AND SCRIPPS HEALTH AS PART OF THE SAN DIEGO COUNTY SENIOR EMERGENCY CARE INITIATIVE. WHI, THE JOHN A. HARTFORD FOUNDATION AND THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS ARE SEEKING TO EXPAND THE GEDA PROGRAM THROUGH A HEALTH SYSTEMS APPROACH.SAN DIEGO COUNTY GERIATRIC EMERGENCY CARE INITIATIVETHE INSTITUTE, BASED IN SAN DIEGO COUNTY, CALIFORNIA, IS SEEKING TO HAVE 18 HOSPITALS IN SAN DIEGO COUNTY CERTIFIED AS GEDS THUS RENDERING THE COUNTY THE FIRST IN THE NATION TO HAVE ALL OF ITS EMERGENCY DEPARTMENTS ACCREDITED AS SENIOR-FRIENDLY. THE INSTITUTE, TOGETHER WITH THE GEDC AND UNIVERSITY OF CALIFORNIA SAN DIEGO, CONDUCTED A VIRTUAL TRAINING SESSION AND TWO QUALITY IMPROVEMENT IMPLEMENTATION WEBINARS FOR THE SAN DIEGO COUNTY EDS. SO FAR, TEN SITES HAVE BEEN ACCREDITED BY ACEP AND THE REMAINING EIGHT APPLICATIONS ARE UNDER REVIEW. WHI SEEKS TO TAKE THE LEARNING FROM THE SAN DIEGO COUNTY GED INITIATIVE TO COMMENCE SIMILAR EFFORTS THROUGHOUT CALIFORNIA.DARTMOUTH-HITCHCOCK EXPANSION OF GEDS TO RURAL AREAS (VIA TELEHEALTH)WHI PURSUED RESEARCH WITH THE DARTMOUTH-HITCHCOCK (D-H) HEALTH SYSTEM TO CREATE AND EVALUATE A NOVEL RURAL HUB-AND-SPOKE TELEHEALTH MODEL AND TRAINING SESSIONS. D-H HAS IMPLEMENTED NEW AND REVISED GERIATRIC ED WORKFLOWS AND PROTOCOLS, CONDUCTED THEIR FIRST GED PATIENT CONSULTATION, AND APPLIED FOR ED ACCREDITATION. VETERANS HEALTH ADMINISTRATION (VHA) GERIATRIC EMERGENCY DEPARTMENT SCALE AND SPREADTHE INSTITUTE WORKED TO IMPLEMENT AND SCALE GEDS THROUGHOUT HOSPITALS IN THE ENTIRE VHA SYSTEM. IN 2020, THE INSTITUTE SUPPORTED TRAINING, QUALITY IMPROVEMENT AND ACCREDITATION ACTIVITIES FOR 20 EDS (18% OF ALL VHA EDS). AS OF DECEMBER 2020, 17 EDS HAD APPLIED FOR ACCREDITATION AND THREE SITES ANTICIPATE APPLYING IN EARLY 2021. WHI SEEKS TO INCLUDE THE MAJORITY OF EDS IN THE VHA HEALTH SYSTEM IN ITS ACCREDITATION EFFORTS, WITH AN ULTIMATE GOAL OF ESTABLISHING A NATIONAL GED OFFICE WITHIN THE VHA. 311673 THE RISING COST OF HEALTHCARE IS A GROWING ECONOMIC AND PUBLIC HEALTH CRISIS THAT HURTS THE U.S. ECONOMY, THREATENS INDIVIDUAL FINANCIAL SECURITY, COMPROMISES CARE, AND REDUCES PATIENT ACCESS. THE COVID-19 PANDEMIC LAID BARE VULNERABILITIES IN OUR HEALTHCARE PAYMENT SYSTEM, SHINING LIGHT ON THE NEED TO LOWER COSTS AND IMPROVE ACCESS TO NEEDED CARE. IT IS ESSENTIAL TO NOTE THAT MANY ERRONEOUSLY ASSUME THAT DUE TO MEDICARE, OLDER ADULTS ARE INSULATED FROM THE TOXIC EFFECTS OF HIGH HEALTHCARE COSTS, BUT THE TRUTH IS THAT MANY SENIORS ARE HARD-HIT BY THE OUT-OF-POCKET BURDEN OF BOTH DRUG AND OTHER HEALTH COSTS. RAISE AWARENESS OF SPENDING CRISIS AND URGENCYTO FOCUS THE ATTENTION OF POLICYMAKERS, ADMINISTRATORS, THE BUSINESS COMMUNITY, AND THE GENERAL PUBLIC ON THE HEALTHCARE CRISIS, THE GARY AND MARY WEST HEALTH INSTITUTE (WHI OR WEST HEALTH INSTITUTE), IN CONJUNCTION WITH THE WEST HEALTH POLICY CENTER (WHPC), RELEASED SEVEN HIGHLY SUCCESSFUL NATIONAL POLLS IN PARTNERSHIP WITH GALLUP. THESE POLLS EXPOSED THE REALITY THAT AMERICANS' CONCERNS ABOUT THE COST OF CARE HAVE ONLY INCREASED AS A RESULT OF THE PANDEMIC. MOREOVER, NEARLY NINE IN TEN U.S. ADULTS ARE CONCERNED THAT THE PHARMACEUTICAL INDUSTRY WILL LEVERAGE THE COVID-19 PANDEMIC TO RAISE DRUG PRICES. ADDITIONAL PUBLIC AWARENESS ACTIVITIES IN 2020 INCLUDED A NATIONAL WEBINAR ON "WHY AMERICANS ARE SO WORRIED ABOUT RISING HEALTHCARE COSTS AND WHAT CAN BE DONE ABOUT IT" IN PARTNERSHIP WITH GALLUP, AS WELL AS A MEDIA FELLOWSHIP FOR JOURNALISTS COVERING THE HEALTH COST CRISIS. DEVELOP ACTIONABLE POLICIES TO LOWER DRUG COSTSSTRATEGIES TO REDUCE THE RISING COST OF PHARMACEUTICALS WERE A KEY COMPONENT OF WORK TO LOWER HEALTHCARE SPENDING. IN PARTICULAR, DEMONSTRATING PUBLIC SUPPORT FOR AND A POLICY STRATEGY TO EMPOWER CMS (THE SINGLE LARGEST PURCHASER OF HEALTHCARE IN THE US) TO NEGOTIATE DRUG PRICES FOR MEDICARE IS A KEY PRIORITY. THE AMERICAN BUSINESS COMMUNITY IS A KEY STAKEHOLDER THAT IS IMPORTANT IN ADDING MOMENTUM TO DRIVING LOWER DRUG PRICES. AS SUCH, WHI HAS CONTINUED WORK WITH BUSINESS GROUPS ON DRUG COST ISSUES, INCLUDING BUILDING A COALITION OF BOTH LARGE AND SMALL COMPANIES THAT ARE SHARING THE BURDEN PLACED ON BOTH EMPLOYERS AND EMPLOYEES BY HIGH HEALTH CARE AND DRUG COSTS. DEVELOP ACTIONABLE POLICIES TO REDUCE VOLUME INCENTIVES IN FEE-FOR-SERVICEVALUE-BASED CARE (VBC)WHICH INCORPORATES RISK FOR BOTH HEALTH AND SPENDING OUTCOMES INTO PAYMENT RATESHAS THE POTENTIAL TO REDUCE MANY OF THE VOLUME-BASED FINANCIAL INCENTIVES THAT ARE DRIVING UP PER-CAPITA HEALTHCARE COSTS. A PARTNERSHIP CONSISTING OF THE INSTITUTE, THE WEST HEALTH POLICY CENTER, AND THE DUKE-MARGOLIS CENTER FOR HEALTH POLICY HAS RELEASED NATIONAL AND STATE ROADMAPS IN 2020 WITH RECOMMENDATIONS FOR POLICYMAKERS ON WAYS TO ACCELERATE THE ADOPTION OF VBC PAYMENT MODELS. THIS WORK INFORMED THE DESIGN AND LAUNCH OF A THREE-YEAR COLLABORATION WITH THE DUKE-MARGOLIS TEAM TO TURN THESE POLICY RECOMMENDATIONS INTO ON-THE-GROUND ACTIONPRODUCING A HIGH-PROFILE WEBINAR IN 2020 TO EXAMINE THE ADVANTAGES THAT VBC OFFERS IN THE COVID-19 ENVIRONMENT, SPOTLIGHTING THE GARY AND MARY WEST PACE. COST OF CARE - PREPARING FOR OPPORTUNITIES TO EFFECT CHANGE:THE CONFLUENCE OF AN ELECTION YEAR COMING DURING A PERIOD WHEN HEALTH CARE HAS (RE)EMERGED AS ONE OF THE TOP ISSUES IN PUBLIC, SOCIAL, ECONOMIC, AND POLITICAL DISCOURSE HAS PRESENTED AN IMPORTANT OPPORTUNITY FOR WHI TO LEVERAGE ITS UNIQUE STRUCTURE OF HAVING BOTH MEDICAL RESEARCH AND POLICY EXPERTISE TO CATALYZE CHANGE FOR HEALTH COSTS AT A NATIONAL LEVEL AT WHAT IS POTENTIALLY A WATERSHED MOMENT FOR THE COST OF CARE. BEGINNING IN MID-2020, THE INSTITUTE, IN CLOSE COORDINATION WITH THE WEST HEALTH POLICY CENTER, ADVANCED A NUMBER OF COORDINATED WORKSTREAMS DESIGNED TO LEVERAGE WEST HEALTH INSTITUTE'S EXPERTISE AND RESOURCES TO PROVIDE POLICYMAKERS WITH THE TECHNICAL INFORMATION AND PUBLIC OPINION POLLING NECESSARY TO PRIORITIZE LOWERING THE COST OF CARE. THESE WORKSTREAMS ARE FOCUSED NOT ONLY ON NEAR-TERM ACTIVITIES SURROUNDING THE 2020 ELECTIONS AND THE INITIAL WORK OF THE EXECUTIVE AND LEGISLATIVE BRANCHES BUT ALSO CONTEMPLATE MID-TERM (2022) ELECTIONS AND THE IMPORTANT WORK TO BE DONE OVER THE NEXT SEVERAL YEARS. DRIVE INSIGHTS THAT EMPOWER LIKE-MINDED STAKEHOLDERS GARY AND MARY WEST HEALTH INSTITUTE IS NOT ALONE IN ITS MISSION TO REDUCE THE COST OF HEALTH CARE AT BOTH AN INDIVIDUAL AND SOCIETAL LEVEL. IN ORDER TO BUILD MOMENTUM DURING THIS CRITICAL PERIOD, WHI HAS SUPPORTED SEVERAL INITIATIVES DESIGNED TO PROVIDE OTHER LIKE-MINDED CO-TRAVELERS INCLUDING CURRENT/FUTURE LEGISLATIVE AND ADMINISTRATIVE POLICYMAKERS AND REGULATORS WITH NEW INFORMATION AND INSIGHTS THAT CAN BE USED TO DETERMINE OPTIMAL PATHS FORWARD IN PRESSING FOR HEALTHCARE COST REFORM. TO THIS END WHI ENGAGED A SELECT GROUP OF INDIVIDUALS AND ORGANIZATIONS TO ASSIST WITH A NUMBER OF ACTIVITIES INCLUDING: *STATE-LEVEL SURVEYS FOR 2020 AND 2022 RACES ON HEALTHCARE PRIORITIES IN VOTING *OFFENSIVE AND DEFENSIVE MESSAGE TESTING ON PUBLIC OPTION AND BROADER HEALTH COVERAGE REFORMS *POLLING ON PUBLIC EXPERIENCE AND SENTIMENT (ALSO USED GALLUP INC. FOR THIS WORK)THE IMPORTANT INSIGHTS DISTILLED FROM THE ABOVE ACTIVITIES HAVE BEEN PACKAGED AND USED FOR TARGETED DISSEMINATION OF KEY MESSAGES TO POLICY INFLUENCERS AND AS WELL AS TECHNICAL ASSISTANCE INCLUDING INVITATION-ONLY BRIEFINGS TO KEY STAKEHOLDERS. PERFORM RESEARCH TO SUPPORT EVIDENCE-BASED POLICYBE IT MODELING THE EXPECTED FINANCIAL IMPACT CHANGES TO POLICY, DEFINING THE EXACT CONTOURS OF AN ISSUE FOR WHICH A POLICY FIX IS NEEDED, OR ASSESSING FEASIBILITY OF A SUITE OF VARYING POLICY SCENARIOS, RESEARCH IS A CORNERSTONE OF SOUND POLICYMAKING. TO INFORM AND EMPOWER CURRENT AND NEAR-TERM FUTURE POLICIES THAT ARE (OR WILL LIKELY BE) "ON THE TABLE AND THAT ARE WITH THE GRAIN OF HEALTHCARE COST REDUCTION, OVER THE SECOND HALF OF THE 2020 WHI (AND WHPC) LEVERAGED THE RESEARCH EXPERTISE OF SEVERAL EXTERNAL PARTIES. KEY ACTIVITIES IN THIS WORKSTREAM HAVE INCLUDED: *MODELING KEY COMPONENTS OF PUBLIC OPTION AND MEDICARE ADVANTAGE IMPROVEMENTS *DEVELOPING CBO-STYLE SCORES AND PROCEDURAL MEMOS TO INFORM POLICYMAKERS *ASSESSING CAPITALIZED DRUG MANUFACTURING COSTS (TO COUNTER REBUTTALS FROM PHARMA THAT PRICE REDUCTIONS EQUATE TO REDUCED INNOVATION)SIMILAR TO OPINION POLLING INSIGHTS, OUR RESEARCH HAS BEEN DISTRIBUTED TO A NETWORK OF STAKEHOLDERS FOR WHOM HEALTH COST CONTAINMENT IS A FOCUS (OR PARTIAL FOCUS- OFTEN COST CONTAINMENT TRAVELS ALONG WITH HEALTH ACCESS ISSUES). BY INTENTION, MANY OF THE EXPERTS WE HAVE ENGAGED TO DO THIS WORK ARE THEMSELVES IMPORTANT CONDUITS TO POLICYMAKERS IN A POSITION TO USE THIS RESEARCH. AMPLIFY THE NATIONAL CONVERSATION ABOUT THE NEED TO ACT NOWLIKE OUR WORK AROUND RAISING AWARENESS OF THE SPENDING CRISIS BUT WITH A MORE TIME-LIMITED FOCUS, OVER THE LATTER HALF OF THE YEAR WHI ENGAGED IN EFFORTS TO INFORM BOTH THE PUBLIC AS WELL AS DECISIONMAKERS ABOUT THE NEED TO SEIZE CURRENT OPPORTUNITIES TO TAKE ACTION. WHI ADVANCED A NUMBER OF CAMPAIGNS DESIGNED TO CATALYZE ACTION AT BOTH THE STATE AND NATIONAL LEVEL. SOME NOTABLE EXAMPLES INCLUDED: *A DIGITAL MEDIA CAMPAIGN IN KEY STATES INCLUDING ARIZONA, COLORADO, GEORGIA, IOWA, MAINE, MONTANA, AND NORTH CAROLINA USING BOTH TWITTER (2.8 MILLION IMPRESSIONS) AND FACEBOOK (1.9 MILLION IMPRESSIONS) TO SHARE MESSAGES AROUND THE ISSUE OF HEATH COSTS AND THE NEED FOR CHANGE AT STATE AND FEDERAL LEVELS *A TELE-TOWN HALL FEATURING MICHIGAN GOVERNOR GRETCHEN WHITMER ON WHAT CAN BE DONE ABOUT THE DEVASTING IMPACTS OF INACCESSIBLE/COSTLY CARE. THIS EVENT HAD OVER 19,000 ACTIVE PARTICIPANTS *EXPLAINER ANIMATIONS ON THE HIGH COST OF DRUGS AND HEALTHCARE CONSOLIDATION *TELE-TOWN HALLS FEATURING CONSUMERS WITH COMPELLING STORIES RELATED TO THE HIGH COST OF PRESCRIPTION DRUGS (REACHING OVER 20,000 TARGETS) 17016887 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 38 0 1 22 1 0 0 0 0 0 0 0 0 0 0 X 3 3 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 CA DE X SALLY HALLAK 8585357000 10350 N TORREY PINES ROAD LA JOLLA CA 92037 X CHARLES SEDERSTROM DIRECTOR 5.00 1.00 X 0 0 0 GARY L WEST DIRECTOR, CHAIRMAN 15.00 12.00 X 0 0 0 MARK MCCLELLAN DIRECTOR 10.00 5.00 X 0 0 0 NICHOLAS VALERIANI DIRECTOR 15.00 5.00 X 0 0 0 SALLY HALLAK VP OF F&C/SECRETARY AND TREASURER 40.00 15.00 X 0 247662 23606 SHELLEY M LYFORD PRESIDENT & CEO 30.00 35.00 X 720385 238338 31794 SIOBHAN GRAHAM VP, OPERATIONS & HR 50.00 X 0 237262 24207 TIMOTHY LASH EVP AND CHIEF STRATEGY OFFICER 30.00 35.00 X 622632 150542 48520 ZIA AGHA CHIEF MEDICAL OFFICER & EVP 40.00 8.00 X 672259 42708 52978 JONATHAN ZIFFERBLATT EVP, STRATEGY & SUCCESSFUL AG 50.00 X 0 378035 42393 ADRIAN KWONG PRINCIPAL DATA SECURITY ARCHIT 40.00 X 201098 0 20787 AMY STUCK SR. 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MANAGEMENT EVALUATED ITS TAX POSITIONS AND DETERMINED THAT IT HAS NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2020. THERE HAVE BEEN NO RELATED TAX PENALTIES OR INTEREST, WHICH WOULD BE CLASSIFIED AS TAX EXPENSE IN THE STATEMENT OF ACTIVITIES. 1 GARY AND MARY WEST SENIOR DENTAL CENTER INC 1525 FOURTH AVE SAN DIEGO CA 92101 473001738 501(C)(3) 5661 FMV OFFICE SPACE DONATION OF OFFICE SPACE FRONT PORCH COMMUNITIES AND SERVICES 800 N BRAND BLVD 19TH FLOOR GLENDALE CA 91203 954538269 501(C)(3) 14941 FMV DONATION OF SERVICES, SUPPLIES, AND EQUIPMENT DONATION OF SERVICES, SUPPLIES, AND EQUIPMENT SEACREAST VILLAGE RETIREMENT COMMUNITIES 211 SAXONY ROAD ENCINITAS CA 92024 951455284 501(C)(3) 13558 FMV DONATION OF SERVICES, SUPPLIES, AND EQUIPMENT DONATION OF SERVICES, SUPPLIES, AND EQUIPMENT SERVING SENIORS 1525 FOURTH AVE SAN DIEGO CA 92101 952850121 501(C)(3) 17660 FMV DONATION OF SERVICES, SUPPLIES, AND EQUIPMENT DONATION OF SERVICES, SUPPLIES, AND EQUIPMENT 4 0 PART I, LINE 2: GRANTS WILL ONLY BE MADE TO 501(C)(3) ORGANIZATIONS TO ENSURE THE NON-CASH ITEMS WILL BE USED PROPERLY. X 1 1 X X X X 1 1 0 0 0 0 0 1 0 SHELLEY M LYFORD PRESIDENT & CEO 505595 202421 194450 35917 20340 0 11140 6967 3855 9832 735380 255137 0 0 JOSEPH M SMITH FORMER CO-MANAGER/CMO THRU 3/31/16 0 231782 0 0 0 591438 0 10073 0 0 0 833293 0 0 TIMOTHY LASH EVP AND CHIEF STRATEGY OFFICER 469897 129654 132875 20888 19860 0 7448 10043 31029 0 661109 160585 0 0 ZIA AGHA CHIEF MEDICAL OFFICER & EVP 536025 42708 115906 0 20328 0 14250 0 38728 0 725237 42708 0 0 JONATHAN ZIFFERBLATT EVP, STRATEGY & SUCCESSFUL AG 0 296321 0 61000 0 20714 0 14250 0 28143 0 420428 0 0 JOSE UNPINGCO TECHNICAL DIRECTOR 228104 0 30506 0 505 0 13163 0 35089 0 307367 0 0 0 SALLY HALLAK VP OF F&C/SECRETARY AND TREASURER 0 196884 0 50600 0 178 0 12436 0 11170 0 271268 0 0 SIOBHAN GRAHAM VP, OPERATIONS & HR 0 198692 0 38300 0 270 0 11921 0 12286 0 261469 0 0 CHRISTOPHER CROWLEY PROGRAM MANAGER 206657 0 17324 0 1252 0 11261 0 18052 0 254546 0 0 0 AMY STUCK SR. DIR., VALUE-BASED ACUTE CARE 156061 0 26019 0 610 0 9270 0 40728 0 232688 0 0 0 LIANE WARDLOW DIRECTOR, CLINICAL RESEARCH 166702 0 22275 0 218 0 9653 0 30843 0 229691 0 0 0 ADRIAN KWONG PRINCIPAL DATA SECURITY ARCHIT 184551 0 16301 0 246 0 9332 0 11455 0 221885 0 0 0 PART I, LINE 1A THE USE OF BUSINESS CLASS MAY BE AUTHORIZED UNDER THE CIRCUMSTANCES LISTED BELOW: (1) INTERNATIONAL TRAVEL; (2) BUSINESS OR FIRST CLASS IS THE ONLY SERVICE OFFERED BETWEEN TWO POINTS; (3) COACH CLASS WOULD BE MORE EXPENSIVE OR TIME CONSUMING, E.G., WHEN, BECAUSE OF SCHEDULING DIFFICULTIES, TRAVELING BY COACH WOULD REQUIRE AN UNNECESSARY HOTEL EXPENSE, CIRCUITOUS ROUTING (2 OR MORE LAYOVERS), OR AN UNDULY LONG LAYOVER WHEN MAKING CONNECTIONS; (4) AN ITINERARY INVOLVES OVERNIGHT TRAVEL WITHOUT THE OPPORTUNITY FOR NORMAL REST BEFORE THE COMMENCEMENT OF WORKING HOURS; OR (5) THE USE OF BUSINESS CLASS IS NECESSARY TO REASONABLY ACCOMMODATE A DISABILITY OR MEDICAL NEED OF A TRAVELER. PART I, LINE 3 COMPENSATION FOR THE CEO WAS ESTABLISHED BY THE BOARD OF DIRECTORS OF THE GARY AND MARY WEST HEALTH INSTITUTE AND PAID BY THE INSTITUTE. THE FOLLOWING WAS USED TO ESTABLISH THE COMPENSATION: 1)COMPENSATION COMMITTEE; 2)FORM 990 OF OTHER ORGANIZATIONS; 3)COMPENSATION SURVEY OR STUDY; 4)APPROVAL BY THE BOARD OF DIRECTORS. PART I, LINES 4A-B JOSEPH SMITH IS AN OFFICER WITH REFLEXION HEALTH, INC., A RELATED ORGANIZATION WITH WHI. HE RECEIVED A SEVERANCE PAYMENT OF $591,012 UPON TERMINATION IN 2020. EACH OF THE FOLLOWING INDIVIDUALS TIM LASH, ZIA AGHA AND SHELLEY M. LYFORD (LISTED ON SCHEDULE J) PARTICIPATED IN THE 457(B) NONQUALIFIED DEFINED CONTRIBUTION PLAN OFFERED BY THE WEST HEALTH INSTITUTE. THE GARY AND MARY WEST HEALTH INSTITUTE MAKES AN ANNUAL CASH CONTRIBUTION FOR EACH EMPLOYEE IN AN AMOUNT EQUAL TO THE APPLICABLE DOLLAR AMOUNT IN EFFECT FOR THAT YEAR. FOR 2020 THIS AMOUNT WAS $19,500. CONTRIBUTIONS WERE MADE FOR TIM LASH, ZIA AGHA AND SHELLEY LYFORD. JONATHAN ZIFFERBLATT ALSO LISTED ON SCHEDULE J PARTICIPATED IN THE 409A NONQUALIFIED DEFINED CONTRIBUTION PLAN OFFERED BY THE GARY AND MARY WEST MANAGEMENT COMPANY, INC., A RELATED ORGANIZATION. FOR 2020 THIS AMOUNT WAS $19,500. CONTRIBUTIONS WAS MADE FOR JONATHAN ZIFFERBLATT. PART I, LINE 7 EACH OF THE MANAGERS IS ELIGIBLE FOR AN ANNUAL DISCRETIONARY BONUS, SUBJECT TO BOARD APPROVAL, WHICH IS BASED ON INDIVIDUAL PERFORMANCE AND LIMITED TO A MAXIMUM PERCENTAGE OF BASE COMPENSATION. SEE PART V DISCLOSURE 0 PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS GARY WEST, CHAIRMAN OF THE WEST HEALTH INSTITUTE, IS A MEMBER OF 99 TEN BUSINESS SOLUTIONS, LLC. GARY WEST IS TREATED AS AN INTERESTED PERSON FOR PURPOSES OF SCHEDULE L, PART IV. ADDRESSING BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS. THERE WERE BUSINESS TRANSACTIONS BETWEEN THE INSTITUTE AND 99 TEN BUSINESS SOLUTIONS, LLC DURING 2020. TOTAL TRANSACTION AMOUNT IS $355,585 FOR IT CONSULTING SERVICES PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS WEST HEALTH INSTITUTE ("WHI") SHARE A COMMON OFFICERS. TIMOTHY LASH, ZIA AGHA AND JONATHAN ZIFFERBLATT. IN 2020, GARY AND MARY WEST SENIOR SERVICES AND WHI ENTERED INTO A JOINT RESEARCH COLLABORATION AGREEMENT VALUED AT $2,045,000. FORM 990, PART III, LINE 2 FORM 990, PART III, LINE 1 CONTAINS A REVISED MISSION STATEMENT FOR THE ORGANIZATION, AND LINES 2 AND 3 ARE ANSWERED "YES" FOR THE PURPOSES OF UPDATING THE STATEMENT OF THE ORGANIZATION'S PROGRAM SERVICES SINCE THE DESCRIPTIONS INCLUDED IN THE ORGANIZATION'S FORM 1023 APPLICATION FOR RECOGNITION OF EXEMPTION HAVE EVOLVED. MOST, IF NOT ALL, OF THESE CHANGES HAVE BEEN REPORTED IN PREVIOUSLY FILED FORMS 990, BUT THE ORGANIZATION WISHES TO SET FORTH A CLEAR STATEMENT OF ITS CURRENT MISSION AND PROGRAM ACTIVITIES. WHEN THE ORGANIZATION WAS CONCEIVED AND ESTABLISHED IN 2009, IT HAD A BROAD MISSION OF IMPROVING HEALTHCARE AND LOWERING ITS COST THROUGH MEDICAL RESEARCH IN CONJUNCTION WITH ONE OR MORE HOSPITALS, BUT IT HAD A NARROW METHODOLOGY IN MIND AT THE TIME USING WIRELESS COMMUNICATIONS TECHNOLOGIES. IN THE INTERVENING YEARS, THE ORGANIZATION HAS NARROWED ITS MISSION BUT BROADENED ITS METHODOLOGY. THE ORGANIZATION IS STILL A MEDICAL RESEARCH ORGANIZATION ENGAGED IN MEDICAL RESEARCH IN CONJUNCTION WITH MULTIPLE HOSPITALS, BUT IT HAS NARROWED ITS MISSION TO FOCUS ON IMPROVING HEALTHCARE FOR SENIOR AMERICAN CITIZENS AND LEGAL RESIDENTS, BASICALLY MEANING THOSE ELIGIBLE FOR PARTICIPATION IN THE FEDERAL MEDICARE PROGRAM. AFFORDABLE COST FOR HEALTHCARE IS STILL AN IMPORTANT OBJECTIVE, BUT IMPROVEMENTS IN THE QUALITY OF HEALTHCARE AND SUPPORTIVE SERVICES FOR SENIOR AMERICANS, SUCH AS ADEQUATE NUTRITION, ARE ALSO CRITICAL CONSIDERATIONS. THE FOCUS ON WIRELESS COMMUNICATIONS TECHNOLOGIES HAS BEEN REDIRECTED TO THE IDENTIFICATION OF POLICIES, HOSPITAL PROTOCOLS, STANDARDS OF CARE, INTEGRATION AND COORDINATION OF CARE FOR BOTH INPATIENTS AND OUTPATIENTS, AND SIMILAR IMPROVEMENTS IN MEDICAL, DENTAL, PREVENTATIVE AND RESTORATIVE CARE FOR SENIOR AMERICANS. CURRENTLY, THE ORGANIZATION CONDUCTS ITS MEDICAL RESEARCH IN CONJUNCTION WITH HOSPITALS IN THE HEALTHCARE SYSTEMS OPERATED BY THE UNIVERSITY OF CALIFORNIA, SAN DIEGO HEALTH SYSTEM IN LA JOLLA, CA, DARTMOUTH-HITCHCOCK CLINIC IN LEBANON, N.H., MOUNT SINAI HEATH SYSTEM IN NEW YORK, N.Y., JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE IN BALTIMORE, MD., THE UNIVERSITY OF NORTH CAROLINA HEALTH SYSTEM IN CHAPEL HILL, N.C., THE FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH IN MANHASSET, NY., AND MANY OTHERS. THE ORGANIZATION USES THE RESULTS OF ITS MEDICAL RESEARCH TO INFORM POLICY ANALYSES AND PROPOSALS FOR PRESENTATION TO FEDERAL AND STATE HEALTHCARE AGENCIES AND LEGISLATIVE BODIES IN WASHINGTON, D.C. AND SACRAMENTO, CA, CAREFULLY LIMITING THOSE ACTIVITIES TO REMAIN WITHIN THE REALM OF POLICY ADVOCACY PERMITTED BY FEDERAL AND STATE TAX LAW. EXAMPLES OF CURRENT RESEARCH PROJECTS INCLUDE A MEDICAL ANALYSIS OF THE OUTCOMES OF THE USE OF TELEMEDICINE IN CONJUNCTION WITH GERIATRIC EMERGENCY ROOM CARE AND PATIENT-INITIATED TECHNOLOGICAL INPUTS, THE DEGREE OF SUCCESS IN USING TECHNOLOGY TO SCREEN HOSPITAL PATIENTS AND THE MEDICAL OUTCOMES POSSIBLE THROUGH EXPANDING ACCESS TO PHARMACEUTICALS BY LOWERING PRODUCTION AND DISTRIBUTION COSTS FOR HOSPITALS. FORM 990, PART III, LINE 3 SEE NARRATIVE TO FORM 990, PART III, LINE 2, NEW PROGRAM SERVICES, WHICH INCLUDEDS A DESCRIPTION OF CHANGES TO PROGRAM SERVICES. FORM 990, PART III, LINE 4A, (CONTINUATION): DELIRIUM RESOURCES FOR THE EMERGENCY DEPARTMENT IN 2020, WHI ENGAGED EDS AT ST. MARY MERCY (LIVONIA, MICHIGAN), MAINE MEDICAL CENTER AND UNIVERSITY OF NORTH CAROLINA HILLSBOROUGH (COMMUNITY HOSPITAL UNDER THE UNC HEALTH CARE SYSTEM) TO TEST UPDATED DELIRIUM PROTOCOLS. DATA AND RESPONSES WILL BE INCORPORATED INTO FINAL PROTOCOLS IN 2021. HOME-BASED ACUTE CARE LEARNING AND ACTION NETWORK (HOMELAN) IN 2020, THE INSTITUTE COMPLETED A RESEARCH EFFORT CALLED THE HOME-BASED ACUTE CARE LEARNING AND ACTION NETWORK (HOMELAN), DESIGNED TO PROMOTE HOME AND COMMUNITY-BASED ACUTE CARE ALTERNATIVES TO HOSPITALIZATIONS. THIS WORK WAS DONE WITH 11 HOSPITALS AND HEALTHCARE PROVIDERS ACROSS THE US, INCLUDING: MOUNT SINAI, INTEGRA, GEISINGER, TRINITY HEALTH, UC SAN DIEGO, UNITYPOINT, VNA HEALTH GROUP OF NEW JERSEY, MONTEFIORE-WHITE PLAINS HOSPITAL, BELLIN HEALTH, HEALTH PARTNERS, AND THE INTEGRATED HEALTH CARE ALLIANCE. THE INVESTIGATED ALTERNATIVES FOCUSED ON SERVICES THAT WERE BOTH LOWER IN COST AND ALSO PROVIDED CARE BETTER MATCHED TO THE NEEDS OF COMPLEX, FRAIL OLDER ADULTS AND SHOULD LEAD TO NATIONAL EFFORTS TO CONVINCE PROVIDERS TO ASSUME FINANCIAL RISK AND DIMINISH VOLUME-BASED FINANCIAL INCENTIVES SUCH AS THOSE IN TRADITIONAL FEE-FOR-SERVICE MEDICARE. DESPITE THE DISRUPTIONS CAUSED BY THE COVID-19 PANDEMIC, THE 2020 HOMELAN RESULTS INCLUDED AVOIDANCE OF OVER 1,280 EMERGENCY ROOM VISITS AND MORE THAN 625 INPATIENT HOSPITAL ADMISSIONS, SAVING MEDICARE A GROSS AMOUNT OF NEARLY $8M. THIS RESEARCH WILL CONTINUE IN 2021, WITH A FOCUS ON TRACKING AND OPTIMIZING THE BOTTOM-LINE (NET) FINANCIAL RESULTS, BOTH TO MEDICARE AND TO THE PROVIDERS THEMSELVES. INSTITUTE FOR ACCOUNTABLE CARE (IAC) IN 2020, THE INSTITUTE UNDERTOOK TO PROVIDE A NATIONAL PERSPECTIVE ON ITS DATA-DRIVEN EFFORTS TO PROMOTE VALUE-BASED MEDICAL CARE. THIS WORK WAS DONE WITH THE INSTITUTE FOR ACCOUNTABLE CARE (IAC), THE RESEARCH ARM OF THE NATIONAL ASSOCIATION OF ACCOUNTABLE CARE ORGANIZATIONS (NAACOS). IN 2020, THE INSTITUTE AND THE IAC CONDUCTED AND COMPLETED A NATIONWIDE INVENTORY OF HOME-BASED CARE SERVICES ADOPTED BY ACCOUNTABLE CARE ORGANIZATIONS AND RELATED RISK-BEARING ORGANIZATIONS. THE FINDINGS WERE THAT SOME ORGANIZATIONS ACCELERATED THEIR HOME-BASED CARE SERVICES IN THE FACE OF THE COVID PANDEMIC, IN PART DUE TO THE AVAILABILITY OF INFRASTRUCTURE ORIGINALLY CONTEMPLATED FOR THEIR VALUE-BASED CARE INITIATIVES AND THAT MANY ORGANIZATIONS CITED DIFFICULTIES IN MAINTAINING AN OPERATIONAL RETURN ON INVESTMENT (ROI) AS A MAJOR CHALLENGE TO EXPANDING THEIR HOME-BASED RESOURCES. IN THE LAST QUARTER OF 2020, THE INSTITUTE COMPLETED ADDITIONAL RESEARCH WITH THE IAC LOOKING SPECIFICALLY AT THE UTILIZATION OF TELEMEDICINE AND OTHER FEDERAL EMERGENCY WAIVERS. THESE RESULTS ARE CURRENTLY IN THE ANALYSIS PHASE WITH RESULTS AVAILABLE IN EARLY 2021. WHI'S RESEARCH EFFORTS WITH THE IAC IN 2021 WILL CONTINUE WORK TO CORROBORATE AND EXPAND WHI'S DATA-DRIVEN AND VIRTUAL APPROACHES TO VALUE-BASED CARE DESIGN, AS WELL AS CONTINUING TO AFFORD WHI MORE DIRECT INSIGHT INTO THE EVOLVING PAYMENT AND POLICY LANDSCAPE. SENIOR-APPROPRIATE CHRONIC CARE WHILE ALL SENIORS (AND INDEED ALL HUMANS) SEEK TO HAVE A HIGH QUALITY OF LIFE, THIS MAY TAKE DIFFERENT FORMS AND EXPRESSIONS DEPENDING ON THE INDIVIDUAL. SYSTEMATICALLY ADDRESSING THE ONGOING COMPLEX MEDICAL, BEHAVIORAL, AND SOCIAL NEEDS OF OLDER ADULTS IN A COST-EFFECTIVE MANNER WHILE ENSURING THAT WHAT MATTERS MOST TO THEM IS TAKEN INTO ACCOUNT IS AN IMPORTANT PART OF THE INSTITUTE'S RESEARCH. THESE ACTIVITIES COVER A VARIETY OF AREAS. HOME-BASED PRIMARY CARE RESEARCH PROJECTS: HOME-BASED PRIMARY CARE (HBPC) IS A MULTIDISCIPLINARY ONGOING CARE STRATEGY FOR PROVIDING IN-HOME TREATMENT PRIMARILY TO ADDRESS MEDICALLY COMPLEX HOMEBOUND SENIORS' NEEDS. RECENT STUDIES HAVE DEMONSTRATED THAT HBPC CAN BE A COST-EFFECTIVE STRATEGY FOR DELIVERING CARE TO FRAIL PATIENTS WHILE MAINTAINING OR IMPROVING QUALITY OF CARE AND PATIENT SATISFACTION. SUSTAINABILITY FOR A QUALIFIED CLINICAL DATA REGISTRY (QCDR) FOR HBPC PRACTICES IN 2016, THE INSTITUTE BEGAN A COLLABORATION WITH THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, JOHNS HOPKINS UNIVERSITY, AND THE JOHN A. HARTFORD FOUNDATION TO ESTABLISH THE NATIONAL HOME-BASED PRIMARY CARE & PALLIATIVE CARE REGISTRY, WHICH CONTINUED INTO 2020. THE REGISTRY AND ITS CUSTOM MEASURES FOR HOME-BASED CARE OF MEDICALLY COMPLEX FRAIL SENIORS HAS BEEN SUCCESSFULLY APPROVED EACH YEAR BY THE CENTERS FOR MEDICARE AND MEDICAID AS A QUALIFIED REGISTRY, WHICH ALLOWS PRACTITIONERS OF HOME-CARE MEDICINE TO PARTICIPATE IN VALUE-BASED PAYMENTS AND QUALITY IMPROVEMENT ACTIVITIES. THE REGISTRY, WHICH CONTAINS DATA FROM OVER 400 PROVIDERS CARING FOR OVER 50,000 PATIENTS, WAS SUCCESSFULLY REAPPROVED AS A QUALIFIED REGISTRY BY CMS FOR 2020. THE INSTITUTE CONTINUED TO PARTICIPATE IN THE SECOND ITERATION OF THE NATIONAL HOME-BASED PRIMARY & PALLIATIVE CARE LEARNING COLLABORATIVE. DUE TO CHANGES IN REGULATIONS AT THE CMS LEVEL, THE VENDOR HOSTING THE REGISTRY PROGRAM MADE THE DECISION NOT TO CONTINUE TO SUPPORT SUCH REGISTRIES. NEVERTHELESS, THE INSTITUTE SUCCESSFULLY COMPLETED ITS GOAL OF CONTRIBUTING TO THE FIELD OF HOME-BASED PRIMARY CARE BY DEVELOPING MEASURES THAT WILL IMPROVE QUALITY OF CARE FOR MILLIONS OF SENIORS AND SERIOUSLY ILL POPULATIONS ACROSS THE COUNTRY. NORTHWELL HOME-BASED MONITORING WHI IN 2020 CONTINUED ITS RESEARCH PROJECT WITH NORTHWELL HEALTH IN A HOME-BASED MONITORING PROGRAM, AIMING TO EXPAND THE PATIENT CENSUS IN THIS PRACTICE THROUGH REDESIGN OF THE SCHEDULED IN-HOME VISITS USING DIFFERENT CARE TEAM COMPOSITION AND TELEHEALTH TECHNOLOGY. THIS NEW TELEHEALTH MODEL, FIRST IMPLEMENTED IN 2019, EXTENDED THE REACH OF THE PRIMARY CARE PROVIDER TO ADDRESS ACUTE CHANGE IN CONDITIONS IN THEIR PATIENTS BY USING TELEHEALTH WITH EMERGENCY MEDICAL TECHNICIANS (EMTS) AS A "FACILITATED TELEHEALTH MODEL." THE MODEL ALLOWED FOR PROVIDERS TO EXPAND THEIR REACH AND CONDUCT TEN VISITS IN A DAY VERSUS FIVE VISITS A DAY WITHOUT TELEHEALTH. SURVEY RESULTS FROM THE INITIAL EFFORTS DEMONSTRATED THAT 97% OF PATIENTS OR CAREGIVERS WERE SATISFIED WITH MANAGEMENT OF THEIR MEDICAL ISSUE WITH THIS FACILITATED TELEHEALTH MODEL. WHI AND, NORTHWELL HEALTH WILL CONTINUE TO EVALUATE THIS CARE MODEL. PALLIATIVE CARE RESEARCH PROJECTS: PALLIATIVE CARE PROVIDES AN EXTRA LAYER OF SUPPORT FOR THE SERIOUSLY ILL, GIVING THEM RELIEF FROM SYMPTOMS AND THE STRESS OF DISEASE BURDEN, ULTIMATELY IMPROVING THE PATIENT'S AND FAMILY'S QUALITY OF LIFE. THE INSTITUTE'S GOAL IS TO SPUR ADOPTION OF HOME AND COMMUNITY-BASED PALLIATIVE CARE PROGRAMS FOR SENIORS WITH SERIOUS ILLNESS AND IS CONDUCTING TWO MAJOR RESEARCH PROJECTS THAT AIM TO ADDRESS THIS GOAL. PROJECT HOPE HOME-BASED PALLIATIVE CARE THE INSTITUTE CONTINUES TO COLLABORATE WITH THE ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI TO CREATE, DELIVER, AND EVALUATE A CLINICAL MODEL WHICH PROVIDES PALLIATIVE CARE TO PATIENTS IN THEIR HOME. A KEY OBJECTIVE OF THIS WORK IS DISSEMINATION OF THE COMMUNITY-BASED PALLIATIVE CARE MODEL; TO THIS END, THE RESEARCH TEAM HAS COMPLETED DEVELOPMENT OF A PLAYBOOK AND IMPLEMENTATION TOOLKIT THAT OUTLINE HOW HEALTH SYSTEMS CAN ADOPT THIS MODEL WITHIN THEIR SYSTEM. THE PLAYBOOK AND TOOLKIT WILL BE ACTIVELY DISSEMINATED IN 2021. BLUE SHIELD HOME-BASED PALLIATIVE CARE EVALUATION AND DISSEMINATION STUDY BLUE SHIELD OF CALIFORNIA ("BLUE SHIELD") IS CURRENTLY CONTRACTING WITH ITS PROVIDERS ACROSS CALIFORNIA TO DELIVER HOME-BASED PALLIATIVE CARE TO SERIOUSLY ILL INDIVIDUALS AS A PLAN BENEFIT. AS PART OF A RESEARCH STUDY, THE INSTITUTE HAS SERVED AS AN INDEPENDENT EVALUATOR OF THE PALLIATIVE CARE PROGRAM AND IS INVESTIGATING THE 49,000 LIVES COVERED BY BLUE SHIELD OF CALIFORNIA CURRENTLY ELIGIBLE FOR HOME-BASED PALLIATIVE CARE, AND WHAT FACTORS INFLUENCE ENROLLMENT INTO THE PROGRAM. TO DRIVE THE DISSEMINATION OF THIS PROGRAM TO OTHER HEALTHCARE PAYERS, THE INSTITUTE ALSO EVALUATED THE COST-SAVINGS OF THE PROGRAM RELATIVE TO THE COST OF DELIVERING THE PROGRAM. IN 2020, THE INSTITUTE COMPLETED ANALYSIS OF HEALTH CARE UTILIZATION OF BLUE SHIELD MEMBERS WHO RECEIVED THE HOME-BASED PALLIATIVE PROGRAM. RESULTS OF THE STUDY SHOWED THAT BLUE SHIELD MEMBERS WHO RECEIVED HOME-BASED PALLIATIVE CARE USED HEALTH CARE SERVICES MORE THAN MEMBERS WHO DID NOT RECEIVE SERVICES. HOWEVER, THE MEMBERS WHO RECEIVED HOME-BASED PALLIATIVE CARE SERVICES WERE HIGHLY VARIABLE WITH SOME MEMBERS DECREASING UTILIZATION AND OTHER MEMBERS INCREASING OR NOT CHANGING UTILIZATION. IN 2021, THE INSTITUTE WILL EVALUATE THESE DIFFERENCES IN AN EFFORT TO IDENTIFY THE CHARACTERISTICS OF MEMBERS WHO BENEFIT THE MOST FROM HOME-BASED PALLIATIVE CARE. FORM 990, PART III, LINE 4A, (CONTINUATION): CENTER TO ADVANCE PALLIATIVE CARE (CAPC) MEDICARE ADVANTAGE AND ACCOUNTABLE CARE ORGANIZATION LEARNING COMMUNITY PROJECT IN MAY 2019, THE INSTITUTE PARTNERED WITH CAPC TO BEGIN A THREE-YEAR LEARNING COMMUNITY PROJECT AIMED AT EXPANDING PALLIATIVE CARE SERVICES WITHIN HEALTH INSURANCE PLANS AND ACOS. ACTIVITIES OF THE LEARNING COMMUNITY INCLUDE CONVENING MEDICARE ADVANTAGE (MA) PLANS AND HEALTH PROVIDERS PARTICIPATING IN ACO MODELS AND PROVIDING ACCESS TO EXPERTS AND TECHNICAL ASSISTANCE TO EXPEDITE THE DISSEMINATION OF PALLIATIVE CARE STRATEGIES. THE OUTCOME IS TO HAVE PARTICIPATING HEALTH PLANS AND ACOS IMPLEMENT AT LEAST ONE OF FOUR STRATEGIES, RELATING TO CASE MANAGER SKILL BUILDING, PROACTIVE BENEFICIARY IDENTIFICATION, DEVELOPMENT OF HOME-BASED PALLIATIVE CARE SERVICES, OR CREATION OF NETWORK STANDARDS AND INCENTIVES. IN 2020, THE INSTITUTE WORKED WITH CAPC AS AN ACTIVE PARTICIPANT IN COACHING CALLS WITH THE 40+ ACOS AND MA PLANS. THE TEAM ATTENDED VIRTUAL CONVENINGS AND VIRTUAL OFFICE HOURS FOR THE LEARNING COMMUNITY THROUGHOUT THE YEAR. THE INSTITUTE PARTICIPATED IN THE DEVELOPMENT OF TOOLKITS SUMMARIZING LEARNINGS FROM THE VIRTUAL EVENTS. PACE-RELATED RESEARCH PROJECTS: THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROVIDES WRAP-AROUND MEDICAL AND SOCIAL SERVICES FOR SENIORS WHO WOULD OTHERWISE NEED NURSING HOME LEVEL CARE. MANAGING THE CHRONIC CONDITIONS AND NEEDS OF THIS HIGH-COST, HIGH-NEED POPULATION SEGMENT REQUIRES COORDINATED CARE TO ENABLE AGING-IN-PLACE AT HOME. THE INSTITUTE IS WORKING CLOSELY WITH THE GARY AND MARY WEST PACE CENTER TO DEVELOP AND EXECUTE ON AN INNOVATIVE PROGRAM OF APPLIED MEDICAL RESEARCH STUDIES TO ENHANCE AND EXPAND THE SERVICE DELIVERY OF PACE PROGRAMS AT A NATIONAL SCALE. IDENTIFYING AND ADDRESSING CAREGIVERS' NEEDS APPROXIMATELY 17.7 MILLION PEOPLE IN THE UNITED STATES ARE SERVING AS CAREGIVERS FOR A SENIOR WITH THE MAJORITY PROVIDING CARE TO AN OLDER ADULT WITH SIGNIFICANT HEALTH AND/OR FUNCTIONING NEEDS. CAREGIVERS ARE OFTEN SUPPORTING AND ATTENDING TO THE HEALTH CARE NEEDS OF THE CARE RECIPIENT WHILE ALSO NEEDING TO SUPPORT THEMSELVES AND SOMETIMES OTHERS. CAREGIVERS ARE MORE LIKELY TO EXPERIENCE PHYSICAL, EMOTIONAL, AND ECONOMIC HARM DUE TO THE TOLL OF EXTENSIVE CAREGIVING THAN NON-CAREGIVERS. THESE NEGATIVE EFFECTS OF CAREGIVING CAN BE EXACERBATED BY POOR HEALTH IN THE CAREGIVER, WORK IN LOW-WAGE JOBS WITH LIMITED FLEXIBILITY AND/OR THE LACK OF CHOICE ABOUT ASSUMING THE CAREGIVING ROLE DUE TO FINANCIAL CONSTRAINTS. IN 2020, THE INSTITUTE HAD PLANNED TO ASSESS THE LEVEL OF BURDEN OF CAREGIVERS USING THE ZARIT BURDEN SCALE TO IDENTIFY UNMET NEEDS AND DETERMINE THE TYPES OF SERVICES THAT CAN BE DEPLOYED TO ADDRESS THOSE NEEDS. HOWEVER, DUE TO THE COVID-19 PANDEMIC, WHI WAS UNABLE TO HAVE A STAFF MEMBER MAKE HOME VISITS ON A REGULAR BASIS, POTENTIALLY SPREADING COVID-19 AND/OR EXPOSING PARTICIPANTS AND THEIR CAREGIVERS UNNECESSARILY. CONSEQUENTLY, WHI SHIFTED TO EFFORTS TO 1) SUPPORT THE IMPLEMENTATION OF TELEHEALTH, 2) WRITE AND DISSEMINATE (THROUGH WEBINARS AND PRESENTATIONS) IMPLEMENTATION RESOURCES RELATED TO PROVIDING SAFE, VIRTUAL CARE FOR PACE PARTICIPANTS, AND 3) REDESIGN THE CAREGIVER PROGRAM SO THAT IT COULD BE RUN SAFELY AND EFFICIENTLY DURING AND POST-PANDEMIC. WHI HAS NOW REDESIGNED THE CAREGIVER PROGRAM AND IS ACTIVELY WORKING TOWARDS IMPLEMENTATION IN Q1 2021. IMPROVING PALLIATIVE AND END-OF-LIFE CARE IN PACE PACE PROGRAMS PROVIDE MEDICAL CARE AND NON-MEDICAL SERVICES TO SERIOUSLY ILL PATIENTS AND THEIR CAREGIVERS USING AN INTERDISCIPLINARY TEAM (IDT) APPROACH THAT ENABLES THE PATIENT TO REMAIN IN THEIR HOME AND COMMUNITY AND PROVIDES THE CAREGIVER WITH MUCH NEEDED SUPPORT. PALLIATIVE CARE IS AN ESSENTIAL COMPONENT TO THE CARE DELIVERY IN THE PACE MODEL. HOWEVER, LITTLE IS KNOWN ABOUT THE BEST PRACTICES, PROCESSES, AND GAPS IN PROVIDING THIS CARE IN THE PACE ORGANIZATION. WEST HEALTH INSTITUTE AND THE CENTER TO ADVANCE PALLIATIVE CARE HAVE CONVENED A LEARNING COMMUNITY TO INCREASE QUALITY OF PALLIATIVE CARE IN PACE. THE PACE PALLIATIVE CARE LEARNING COMMUNITY WILL FOCUS ON (1) INCREASING TRAINING FOR PACE STAFF, (2) IDENTIFYING PALLIATIVE CARE QUALITY METRICS FOR PACE, AND (3) DEVELOPING CARE PROCESSES FOR END-OF-LIFE CARE FOR PACE PARTICIPANTS. IN 2020, THE INSTITUTE WORKED WITH GMW PACE TO: * FORM A PALLIATIVE CARE WORKGROUP THAT PARTICIPATED IN THE CAPC LEARNING COMMUNITY AND DEVELOPED A PLAN TO IDENTIFY WORKFLOWS THAT SUPPORT GOALS OF CARE DISCUSSIONS WITH PACE PARTICIPANTS AS WELL AS DATA COLLECTION OF POLST (PHYSICIANS ORDERS FOR LIFE-SUSTAINING TREATMENT) AND GOALS OF CARE CONVERSATION METRICS * HAVE STAFF COMPLETE PALLIATIVE CARE TRAINING MODULES AND TRACK PROGRESS * IMPLEMENT WORKFLOWS AND DEFINE MEASURES TO TRACK PROCESS (CONTINUE TRACKING NUMBER OF POLST COMPLETIONS, DOCUMENTATION OF MEDICAL DECISION MAKERS AND GOALS OF CARE CONVERSATIONS AND FACILITATE THE STAFF TO ATTEND THE MEETING OF PACE LEARNING COMMUNITY CONVENING * ITERATE ON PALLIATIVE CARE WORKFLOWS THROUGH A PLAN-DO-STUDY-ACT (PDSA) CYCLE (AS NEEDED) * EVALUATE THE IMPACT OF THIS WORK AND DISSEMINATE AS APPROPRIATE. CLINICAL-DECISION SUPPORT DASHBOARD BUILDING ON WEST HEALTH INSTITUTE'S EXISTING WORK TO ADVANCE THE USE OF DATA AND DATA ANALYTICAL TOOLS SUCH AS DECISION-SUPPORTING DASHBOARDS, THE INSTITUTE WILL ESTABLISH A CLINICAL DECISION SUPPORT DASHBOARD FOR USE IN PACE ORGANIZATIONS ACROSS THE US. THE HYPOTHESIS ASSUMES THAT DELIVERING TIMELY METRICS IN AN EASY-TO-CONSUME MANNER WILL HELP PACE CLINICAL STAFF DELIVER TARGETED SERVICES MORE EFFICIENTLY AND EFFECTIVELY TO THE MOST AT-RISK PACE PARTICIPANTS. IN 2020, THE RESEARCH PROJECT SOUGHT TO 1) IDENTIFY THE MOST CLINICALLY RELEVANT MEASURES TO AID CLINICAL DECISION SUPPORT FOR THE PACE CARE TEAM, 2) DOCUMENT THE FEATURES AND DATA ARCHITECTURE REQUIRED FOR THE DASHBOARD, 3) EXECUTE A CONTRACT WITH A VENDOR WHO CAN PROVIDE AN APPLICATION THAT FITS WHI'S SPECIFICATIONS, AND 4) BEGIN IMPLEMENTATION AND DASHBOARD DEVELOPMENT. CENTER TO ADVANCE PALLIATIVE CARE (CAPC) PACE LEARNING COMMUNITY PROJECT AS MENTIONED ABOVE IN THE PALLIATIVE CARE RESEARCH SECTION, WHI PARTNERED WITH CAPC TO BEGIN A THREE-YEAR LEARNING COMMUNITY PROJECT AIMED AT ENHANCING PALLIATIVE CARE TRAINING AND PROGRAMS WITHIN PACE PROGRAMS ACROSS THE COUNTRY. NINE PACE PROGRAMS WERE SELECTED, REPRESENTING SEVEN STATES AND OVER 8,000 PACE PARTICIPANTS. TWO OF THE NATION'S LARGEST PACE PROGRAMS ARE AMONG THE PARTICIPANTS. IN 2020, THE INSTITUTE PARTNERED WITH CAPC AND NATIONAL PACE ASSOCIATION TO LEAD THREE VIRTUAL CONVENINGS ON VARIOUS TOPICS, THREE VIRTUAL OFFICE HOURS, AND COACHING CALLS WITH EACH OF THE NINE LEARNING COMMUNITY PARTICIPANTS. THE TEAMS STAYED APPRISED OF PARTICIPATING PACE PROGRAMS' UTILIZATION OF THE CAPC MEMBERSHIP AND PROVIDED RESOURCES THROUGHOUT THE YEAR AS NEEDED. ALTHOUGH THE COVID-19 PANDEMIC AFFECTED ALL THE PARTICIPATING PROGRAMS, THE PACE PROGRAMS WERE HIGHLY ENGAGED GIVEN THE IMPORTANCE OF PALLIATIVE CARE DURING THIS TIME. REDUCING POTENTIALLY AVOIDABLE HOSPITAL AND ED ADMISSIONS PACE PARTICIPANTS PRESENT WITH A HIGHER PREVALENCE OF CHRONIC DISEASE, DISABILITY, AND SOCIAL COMPLEXITY, ALL OF WHICH INCREASE THE LIKELIHOOD OF COSTLY UNPLANNED ACUTE EPISODES, LEADING TO EMERGENCY DEPARTMENT (ED) VISITS AND HOSPITAL ADMISSIONS. IN 2020, TO RESEARCH THE UNDERPINNINGS OF A MORE EFFECTIVE EARLY WARNING SYSTEM, A "CALL PACE FIRST" INITIATIVE WAS IMPLEMENTED. PARTICIPANTS, DURING THEIR ON-BOARDING PROCESS AND ORIENTATION TO THE PACE PROGRAM, ARE GIVEN VERBAL AND WRITTEN INSTRUCTIONS TO CALL THE PACE CLINIC IF THEY ARE EXPERIENCING NON-LIFE-THREATENING HEALTH ISSUES. THEY ARE PROVIDED A 24/7 PHONE NUMBER TO CALL AND A REFRIGERATOR MAGNET FOR EASY ACCESS. WHI ALSO BEGAN PRELIMINARY INVESTIGATIONS INTO ASYNCHRONOUS TECHNOLOGIES THAT DO NOT REQUIRE AN ACTUAL PHONE CALL. GIVEN AN ADEQUATE EARLY WARNING, THE PACE CLINIC IS ALREADY EQUIPPED WITH SOME AGILE RESPONSE INFRASTRUCTURE, INCLUDING SAME-DAY APPOINTMENTS AND TRANSPORTATION TO AND FROM THE CLINIC. BECAUSE SOME PACE PARTICIPANTS REMAIN CONDITIONED TO CALL 911 IN AN EMERGENCY, THE INSTITUTE ALSO LOOKED FOR OPPORTUNITIES TO INTERCEPT PARTICIPANTS NON-LIFE-THREATENING MEDICAL CONCERNS DURING A 911 ACTIVATION. MIDWAY THROUGH 2020, THE INSTITUTE ENGAGED IN A PARTNERSHIP WITH THE CALIFORNIA PARAMEDIC FOUNDATION TO DEVELOP A "TREAT AND REFER" PILOT PROJECT IN COLLABORATION WITH THE NORTH COUNTY JOINT POWERS AUTHORITY, UC SAN DIEGO BASE-HOSPITAL ED PHYSICIANS AND OCEANSIDE FIRE. WHI AND THESE PARTNERS DEVELOPED WORKFLOWS AND CONDUCTED LIVE "TABLE-TOP" SIMULATIONS IN AN ENTIRELY VIRTUAL SETTING. FORM 990, PART III, LINE 4A, (CONTINUATION): TELEHEALTH AT THE ONSET OF THE 2019-2020 PANDEMIC, LOCAL AND NATIONAL HEALTH SYSTEMS AND OTHER HEALTHCARE PROVIDERS SOUGHT GUIDANCE FROM WEST HEALTH INSTITUTE IN RAPIDLY IMPLEMENTING AN EFFECTIVE TELEHEALTH PROGRAM. WHI WORKED WITH LOCAL POST-ACUTE/LONG-TERM CARE FACILITIES (PALTCS) AND HOSPITAL EMERGENCY DEPARTMENTS TO DEVELOP ELECTRONIC MEANS TO FACILITATE COVID-19 TESTING AND TELEHEALTH VISITS. WHI WAS ALSO ABLE TO SHARE KNOWLEDGE AND BEST PRACTICES IN TELEHEALTH DURING THIS CRITICAL TIME, INCLUDING VIRTUAL PRESENTATIONS/WORKSHOPS AND PUBLICATIONS. RESEARCH PROJECTS: EMERGENCY DEPARTMENT TO PALTC ACTIVITIES TO AID THE RESPONSE TO COVID-19, THE TELEHEALTH TEAM CREATED LOCAL ED TO PALTC TELEHEALTH TOOLKITS, INCLUDING DOCUMENTATION ON HOW TO ENGAGE WITH LOCAL PROVIDERS FOR TELEHEALTH ENABLED APPOINTMENTS. MOREOVER, PATHWAYS TO CONTINUE THIS ACTIVITY POST-COVID-19 WERE LAID OUT TO ENABLE A MORE ROBUST SYSTEM GOING FORWARD. TELEHEALTH IMPLEMENTATION AND "HOW-TO" GUIDE FOR LOCAL CLINICS THE TEAM FACILITATED DEVELOPMENT OF TELEHEALTH PROCESSES FOR SENIORS AT THE GARY AND MARY WEST SENIOR WELLNESS CENTER AND RELATED SITES, INCLUDING PROVISION OF EQUIPMENT, CONSULTATION, AND WORKFLOWS. AS PART OF THIS, A "HOW-TO" DOCUMENT WAS CREATED FOR LOCAL CLINICS AND CONGREGATE HOUSING FOR HOW TO ENGAGE WITH LOCAL PROVIDERS FOR TELEHEALTH ENABLED APPOINTMENTS. SPECIFIC TO COVID-19, THE TEAM PROVIDED CONSULTATIVE SUPPORT FOR PROCESSES AND COMMUNICATION FOR VIRAL TESTING AT SENIOR HOUSING SITES IN SAN DIEGO (RUN BY LOCAL ORGANIZATION SERVING SENIORS) AND HELPED ESTABLISH WORKFLOWS AND LOGISTICS FOR TESTING AND TELEHEALTH. DISSEMINATION AND KNOWLEDGE SHARING IN ADDITION TO PARTICIPATING/MODERATING OVER A DOZEN PANELS AT A VARIETY OF CONFERENCES, THE TEAM'S DISSEMINATION EFFORTS INCLUDED LEADING VIRTUAL WORKSHOPS AT THE AMERICAN TELEMEDICINE ASSOCIATION (ATA) ANNUAL CONFERENCE AND THE AMERICAN ACADEMY OF AMBULATORY CARE NURSING (AAACN) ANNUAL CONFERENCE. ADDITIONALLY, A SUITE OF DOWNLOADABLE RESOURCES FOR TELEHEALTH WAS CREATED ACROSS THE FOLLOWING TOPICS: * PALTC PROGRAM LAUNCH CHECKLIST * PROVIDER PROGRAM LAUNCH CHECKLIST * TELEHEALTH VISIT WORKFLOW FOR POST-ACUTE AND LONG-TERM CARE FACILITIES * HOW TO PROVIDE TELEHEALTH TO PACE PARTICIPANTS IN THEIR HOMES * TELEHEALTH WORKFLOW (DIRECT-TO-PATIENT) * HOW TO PROVIDE HOME-BASED PRIMARY CARE USING TELEHEALTH: DIRECT-TO-PATIENT MODEL ADDITIONAL COLLABORATIONS COVID-19 RISK FACTORS RESEARCH: IN 2020, WHI ENGAGED IN RESEARCH WITH JOHNS HOPKINS UNIVERSITY AND FAIR HEALTH TO UTILIZE MEDICARE AND PRIVATE INSURANCE CLAIMS DATA TO DETERMINE THE MOST COMMON UNDERLYING COMORBIDITIES AND RISK FACTORS ASSOCIATED WITH MORTALITY FROM COVID-19. THESE ANALYSES ALSO INVESTIGATED THE ROLE OF MEDICATIONS IN THE COURSE OF COVID-19 INFECTION, ELUCIDATING THE FACTORS ASSOCIATED WITH A SHORTER COVID-19 HOSPITALIZATION AND A FULL COVID-19 RECOVERY. THE RESULTS OF THESE ANALYSES WERE DISSEMINATED WIDELY AND GUIDED VACCINE ALLOCATION PLANNING AND THE IMPROVEMENT OF FUTURE RESPONSES TO COVID-19. THIS RESEARCH ACTIVITY WILL CONTINUE IN 2021. ORAL HEALTHCARE RESEARCH: ACROSS THE NATION, MANY SENIORS CANNOT AFFORD DENTAL CARE. MEDICARE, THE PRIMARY HEALTH INSURER FOR SENIORS, DOES NOT COVER ROUTINE DENTAL CARE. THE INSTITUTE'S APPLIED RESEARCH WITH COLLABORATORS HAS BEEN ADDRESSING THE CRITICAL NEED FOR IMPROVED ORAL HEALTHCARE FOR VULNERABLE SENIORS AND HAS PRODUCED RESULTS THAT WERE PREPARED FOR PUBLICATION IN 2020. FORM 990, PART VI, SECTION A, LINE 2 THE MAJORITY OF THE CURRENT DIRECTORS AND OFFICERS HAVE A "BUSINESS RELATIONSHIP" AS DEFINED IN THE FORM 990 INSTRUCTIONS, WITH EACH OF THE OTHER CURRENT OFFICERS AND DIRECTORS BECAUSE OF POSITIONS THEY HOLD WITH AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 3 GARY AND MARY WEST MANAGEMENT COMPANY, INC., ("WMC") IS A NON-PROFIT, TAXABLE ENTITY THAT PROVIDES SERVICES TO AFFILIATED ORGANIZATIONS. CERTAIN SUPERVISORY, FINANCIAL AND OTHER ADMINISTRATIVE FUNCTIONS ARE PERFORMED BY EMPLOYEES OF GARY AND MARY WEST MANAGEMENT COMPANY, INC. SALLY HALLAK, SIOBHAN GRAHAM, AND JONATHAN ZIFFERBLATT ARE OFFICERS OF WHI AND RELATED ORGANIZATIONS BUT ARE DIRECT EMPLOYEES OF WMC. (REFER TO SCHEDULE J). TOTAL OFFICER COMPENSATION PAID TO THESE OFFICERS IS $953,165. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NON-PROFIT, NON-STOCK CORPORATION WITH THREE MEMBERS DURING 2020. ONE INCORPORATED MEMBER DESIGNATED AS A PERMANENT MEMBER, THE GARY AND MARY WEST FOUNDATION, AND TWO NON-INCORPORATED MEMBERS WHICH ARE ELECTED AND TERM-BASED MEMBERS, JAMES K HASSON AND THOMAS CULHANE. ADDITIONALLY, MEMBERS APPOINT AND CAN REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE AUTHORITY TO ELECT AND REMOVE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS REQUIRE MEMBER APPROVAL: 1. THE DISSOLUTION, LIQUIDATION, MERGER, CONSOLIDATION, RECAPITALIZATION OR OTHER REORGANIZATION OF THE CORPORATION; 2. THE SALE, LEASE OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE CORPORATION; AND 3. ANY CHANGES PROPOSED TO BE MADE BY THE CORPORATION'S BOARD OF DIRECTORS TO THE CORPORATION'S CERTIFICATE OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 INFORMATION WAS COMPILED FROM THE ORGANIZATION'S CORPORATE AND ACCOUNTING RECORDS AND PROVIDED TO THE ORGANIZATION'S OUTSIDE TAX PREPARER. THE COMPLETED FORM 990 WAS REVIEWED BY THE ORGANIZATION'S CFO, OUTSIDE LEGAL COUNSEL AND CEO. UPON SATISFACTORY COMPLETION OF THE INTERNAL REVIEW PROCESS, A DRAFT OF THE FORM 990 WAS CIRCULATED TO THE ORGANIZATION'S AUDIT COMMITTEE AND BOARD OF DIRECTORS FOR REVIEW. THE FORM 990 WAS THEN FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE DIRECTORS AND OFFICERS OF THE INSTITUTE MET REGULARLY THROUGHOUT 2020 AND DISCUSSED ALL ACTUAL AND POTENTIAL CONFLICTS OF INTEREST THAT EXISTED WITH RESPECT TO OTHER NON-PROFIT AND BUSINESS ORGANIZATIONS. THE DIRECTORS AND OFFICERS ALSO COLLECTED ANNUAL WRITTEN CONFLICT OF INTEREST STATEMENTS FROM ALL DIRECTORS AND OFFICERS. NO FAILURES OF COMPLIANCE WITH THE POLICY WERE FOUND. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS A COMPENSATION APPROVAL PROCESS FOR ITS EMPLOYEES. FOR THOSE PAID IN EXCESS OF $100,000, A BASIC COMPENSATION STUDY IS PERFORMED AND COMPENSATION RANGES ARE REQUIRED TO BE APPROVED BY THE BOARD OF DIRECTORS. FOR THOSE PAID IN EXCESS OF $250,000, SUCH AS THE CEO, AN ENHANCED STUDY OF COMPARABLE COMPENSATION IS PERFORMED AND THE BOARD OF DIRECTORS REVIEWS AND APPROVES COMPENSATION LEVELS. THE ORGANIZATION HAS ALSO RETAINED THE SERVICES OF AN OUTSIDE COMPENSATION CONSULTANT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS CERTIFICATE OF INCORPORATION AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON THE REQUEST FOR SUCH DOCUMENTS. FORM 990, PART VII: THE ORGANIZATION HAS A MANAGEMENT SERVICES AGREEMENT WITH THE GARY AND MARY WEST MANAGEMENT COMPANY, INC., A RELATED NON-PROFIT CORPORATION, WHEREBY THE GARY AND MARY WEST MANAGEMENT COMPANY, INC. PROVIDES CERTAIN ADMINISTRATIVE SUPPORT SERVICES TO THE ORGANIZATION. SUCH SERVICES INCLUDE THAT OF VARIOUS SENIOR MANAGEMENT ROLES. THE BELOW OFFICER'S COMPENSATION FROM GARY AND MARY WEST FOUNDATION WERE PRORATED AND REPORTED ON PART VII: SHELLEY LYFORD, TIMOTHY LASH AND ZIA AGHA. THE PERIOD THAT GARY AND MARY WEST FOUNDATION WAS CONSIDERED A RELATED PARTY IS 3/1/2020 - 12/31/2020. FORM 990, PART IX, LINE 11G CONSULTANTS: PROGRAM SERVICE EXPENSES 539,461. MANAGEMENT AND GENERAL EXPENSES 2,370,914. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,910,375. STUDIES/WHITEPAPERS/RESEARCH: PROGRAM SERVICE EXPENSES 9,893,314. MANAGEMENT AND GENERAL EXPENSES 1,750. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,895,064. STAKEHOLDER COMMUNICATIONS: PROGRAM SERVICE EXPENSES 6,625. MANAGEMENT AND GENERAL EXPENSES 3,426. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,051. OTHER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 987. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 987. GARY AND MARY WEST HEALTH POLICY CENTER 1909 K STREET NW SUITE 730 WASHINGTON DC 20006 275388874 SEE SCH R, PART VII DE 501(C)(3) PF N/A 0 GARY AND MARY WEST HEALTH ENDOWMENT INC 1313 N MARKET ST SUITE 5300 WILMINGTON DE 19801 272953865 FINANCIAL SUPPORT DE 501(C)(3) 11 N/A 0 GARY AND MARY WEST FOUNDATION 10350 N TORREY PINES RD LA JOLLA CA 92037 470793015 SEE SCH R, PART VII DE 501(C)(3) PF N/A 0 GARY AND MARY WEST MANAGEMENT COMPANY INC 5800 ARMADA DRIVE SUITE 100 CARLSBAD CA 92008 454040871 SEE SCH R, PART VII DE N/A C 0 REFLEXION HEALTH INC 225 BROADWAY SUITE 650 SAN DIEGO CA 92101 455417842 SEE SCH R, PART VII DE DIGITAL HEALTH CORP C 0 DIGITAL HEALTH CORP 225 BROADWAY SUITE 650 SAN DIEGO CA 92101 820903337 SEE SCH R, PART VII DE GARY AND MARY WEST HEALTH ENDOWMENT INC C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 PART II: IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: GARY AND MARY WEST HEALTH POLICY CENTER, INC. PRIMARY ACTIVITY: POLICY RESEARCH TO DEVELOP MORE AFFORDABLE HEALTHCARE MODELS ENABLING SENIORS TO SUCCESSFULLY AGE. PART II: IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: GARY AND MARY WEST WEST FOUNDATION PRIMARY ACTIVITY: PROVIDES OUTCOMES-BASED FUNDING TO SUPPORT INITIATIVES THAT LOWER THE COST OF HEALTHCARE TO ENABLE SENIORS TO SUCCESSFULLY AGE. PERIOD THAT GARY AND MARY WEST FOUNDATION WAS CONSIDERED A RELATED PARTY IS 3/1/2020 - 12/31/2020. PART IV: IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION: NAME OF RELATED ORGANIZATION: GARY AND MARY WEST MANAGEMENT COMPANY, INC. TYPE OF ENTITY: GARY AND MARY WEST MANAGEMENT COMPANY, INC. IS A NON-STOCK, NON-PROFIT CORPORATION TAXED AS A C-CORPORATION THAT PROVIDES CERTAIN ADMINISTRATIVE SUPPORT SERVICES. PRIMARY ACTIVITY: PROVIDING MANAGEMENT AND ADMINISTRATIVE SUPPORT SERVICES. PART IV: IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION: NAME OF RELATED ORGANIZATION: REFLEXION HEALTH INC. PRIMARY ACTIVITY: DEVELOPING SOFTWARE TO BE USED BY PHYSICAL THERAPISTS AND PATIENTS IN PHYSICAL REHABILITATION TO LOWER THE COST OF HEALTH CARE. PART IV: IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION: NAME OF RELATED ORGANIZATION: DIGITAL HEALTH CORP. PRIMARY ACTIVITY: HEALTHCARE COMPANY THAT HARNESSES THE POWER OF THE LATEST TECHNOLOGY TO ACCELERATE AND IMPROVE PATIENT RECOVERY AT HOME.