National Health Policy Forum

Transcription

1 Natinal Health Plicy Frum December 2014

2 COURSE OUTLINE REMEDY PARTNERS OVERVIEW BPCI APPLICANT TYPES ELIGIBLE BPCI PARTNERS REMEDY CAPABILITIES 2 REMEDY'S ROLE: HOW WE FIT IN

3 WHO IS REMEDY PARTNERS? Remedy Partners is an Episde f Care cmpany serving as an Awardee Cnvener (general cntractr) fr CMS. We help hspitals, physician grups, skilled nursing facilities and hme health agencies develp and manage bundled payment prgrams fr CMS, cmmercial health insurers, emplyers and Accuntable Care Organizatins. We Cnvene multidisciplinary healthcare leaders that seek t add psitive value t the healthcare ecsystem. Leaders wh just as imprtantly have an enlightened view n the art f cllabratin Remedy Partners currently perates the largest and mst cmplete prgram within the BPCI demnstratin. Our prvider partners r prspective prvider partners are lcated in all 50 states.! 3 REMEDY'S ROLE: HOW WE FIT IN

4 HIGH LEVEL SCHEMATIC OF ROLES Awardee Cnveners participate in BPCI as a cnvening rganizatin that brings tgether multiple health care prviders, enter int agreements with CMS and bear financial risk fr the mdel, including all Episde Initiatrs that they cnvene.! Submissin Type Risk-Bearing Nn Risk-Bearing Single Awardee (Episde Initiatr) Awardee Cnvener (Remedy Partners) Facilitatr Cnvener Designated Awardee (Episde Initiatr) The entity takes risk under the facilitatr cnvener. Designated Awardee Cnvener The entity takes risk under the facilitatr cnvener. *BPCI Mdel 2 & Mdel 3 Only Surce: CMS. BPCI Backgrund n Mdel 2 & 3 fr Prspective Participants. February Episde Initiatr Episde Initiatr 4 REMEDY'S ROLE: HOW WE FIT IN

5 ELIGIBLE PARTNERS As an Awardee Cnvener, Remedy Partners wrks with partners t redesign care. Eligible partners fall int tw categries: Physicians / Practitiners, including thse wh may be separately paid by Medicare fr their prfessinal services (e.g. physicians, nurse practitiners, physician assistants, physical therapists). Participating Organizatins, including all ther prviders r suppliers with whm the applicant plans t partner (e.g. acute care hspitals, skilled nursing facilities, inpatient rehabilitatin facilities, hme health agencies). Episde-Initiating Bundled Payment Participating Organizatins are a subset f Bundled Payment participating rganizatins that initiate episdes. CMS, Distinguishing Between Applicant Rles in the Bundled Payments fr Care Imprvement Initiatives. Presented by the Prgram Team BPCI Patient Care Mdels Grup Innvatin Center CMS, March 8, REMEDY'S ROLE: HOW WE FIT IN

6 REMEDY CAPABILITIES Remedy s Data Analytics team helps Partners mnitr perfrmance and leverage pprtunities thrugh data review.! Data Management + Analytics CM / Care Crdinatin Center: Centralized Team f Nurses Care Management Sftware Slutins: Episde Cnnect Prgram Financing, Risk Pling + Reinsurance Cntracting 1. Managing Data Flws Mnthly Claim Files + Quarterly Recnciliatins 2. Benchmarking Versus peers + natinal leaders 3. Bundle + Risk Track Selectin 4. Risk Mdeling Dynamic view f risk 5. Perfrmance Reprting 6. Quarterly Recnciliatins 7. Advance Analytics Prgram Administratin 6 REMEDY'S ROLE: HOW WE FIT IN

7 REMEDY CAPABILITIES Remedy s Care Crdinatin Center wrks with patients and their care team members t implement a custm care plan.! Data Management + Analytics CM / Care Crdinatin Center: Centralized Team f Nurses Care Management Sftware Slutins: Episde Cnnect 1. Training Prgrams 2. Patient On-barding Assistance 3. Care Plan Review Implementatin + Crdinatin 4. Patient + Family Activatin Prgram Financing, Risk Pling + Reinsurance Cntracting Prgram Administratin 7 REMEDY'S ROLE: HOW WE FIT IN

8 REMEDY CAPABILITIES Remedy and ur partners can manage patients care using Episde Cnnect, a sftware that links care team members with real time data.! Data Management + Analytics CM / Care Crdinatin Center: Centralized Team f Nurses Care Management Sftware Slutins: Episde Cnnect Prgram Financing, Risk Pling + Reinsurance Cntracting 1. Real-Time Clinical Data Aggregatin 2. Patient On-barding + Assessment Eligibility + patient ID + tracking Day Care Templates 4. Site f Care Selectin Patient suitability fr hme r SNF care 5. PAP Assignment Designates a specific practitiner fr each stage f patient s episde 6. Secure Cmmunicatin HIPAA cmpliant messaging 7. Quality Data Cllectin and reprting 8. Prvider/Patient/Family Prtals + Apps 9. Wrkflw Tls fr Nurses + Call Center Prgram Administratin 8 REMEDY'S ROLE: HOW WE FIT IN

9 REMEDY CAPABILITIES Remedy ffers prgram financing and risk management slutins t manage the BPCI prgram.! Data Management + Analytics CM / Care Crdinatin Center: Centralized Team f Nurses Care Management Sftware Slutins: Episde Cnnect Prgram Financing, Risk Pling + Reinsurance 1. Risk Mitigatin 2. Accessing Scale Ecnmics 3. Financing fr Prgram Develpment 4. N Upfrnt Premiums r Cnsulting Fees 5. Sliding Scale f Risk / Reward Optins Prviders can dial-up r dial-dwn their level f risk / reward Cntracting Prgram Administratin 9 REMEDY'S ROLE: HOW WE FIT IN

10 REMEDY CAPABILITIES Remedy leverages data and expertise t create custm agreements between parties.! Data Management + Analytics CM / Care Crdinatin Center: Centralized Team f Nurses Care Management Sftware Slutins: Episde Cnnect 1. Analytics + Templates t Guide Cntract Negtiatins Library f cntracts Dedicated team f experts 2. Identifying key physicians, structuring and executing physician gainsharing arrangements Prgram Financing, Risk Pling + Reinsurance Cntracting Prgram Administratin 10 REMEDY'S ROLE: HOW WE FIT IN

11 REMEDY CAPABILITIES Remedy manages administrative tasks and CMS cmpliance s that Partners can fcus n driving care redesign.! Data Management + Analytics CM / Care Crdinatin Center: Centralized Team f Nurses Care Management Sftware Slutins: Episde Cnnect 1. Recruitment + Training 2. Call Center 3. CMS Cmpliance 4. Quarterly Recnciliatin + Cmpliance Prgram Financing, Risk Pling + Reinsurance Cntracting Prgram Administratin 11 REMEDY'S ROLE: HOW WE FIT IN

12 CARE MODEL COMPONENTS - DETAILED Remedy s Care Mdel is cmpsed f the fllwing cmpnents: Next Site f Care Optimizatin Assist prvider when deciding apprpriate next site f care, identify discharge needs and facilitate preferred prvider netwrk develpment. Interventins Patient Engagement and Educatin Cmmunicatin thrughut episde t patient and family members t check recvery prgress, prmte self-care, address issues and cncerns. Assessments Assessments t determine patient s current cnditin, needs and readmissin risk. Care Crdinatin Care Crdinatin Plans Diagnsis-specific care crdinatin plans, custmizable by patient s unique needs and cmrbid cnditins. Cntact Frequency Guidelines Dictates the minimum amunt f cntacts fr each patient by the care crdinatin team. 12

13 CARE MODEL COMPONENT TIMELINE Acute and Pst-Acute interventins frm prviders ptimize BPCI prgram perfrmance, patient utcmes and cst savings. Anchr ACH Pst-Acute Care Facility Hme w/ Hme Health Hme w/ Services INTERVENTIONS Next Site f Care Optimizatin Patient Engagement and Educatin Set by PAP Cmmences Cntinues Cntinues Cntinues Assessments Risk + Needs Needs Risk + Needs Risk + Needs CARE COORDINATION Care Crdinatin Plans Preliminary Updated Updated Updated Cntact Frequency Guidelines Based n latest Risk Prfile Based n latest Risk Prfile Based n latest Risk Prfile 13

14 NEXT SITE OF CARE TOOL A tl in Remedy s Pst-Acute Tlkit that uses evidence based guidelines t help hspital teams select the ptimal next care setting fr each patient. Prvides specific pst-acute needs and services t supprt ptimal prgress thrugh the episde. Captures all relevant dmains that impact safe and clinically apprpriate best next care setting. Maximizes the rle f the patient and their caregivers. Tracks all cntent regarding independence level, caregiver availability, prfessinal services and skilled needs frequency. Embedded int Episde Cnnect with full reprting functinality. Cmes with training manual fr case management departments and their supprt staff t ptimize tl use. 14

15 POST ACUTE TOOLKIT A cmmunicative and cllabrative pst-acute infrastructure fcused n mitigating risk, imprving utcmes, and lwering cst. COMPONENT SAFE TRANSITIONS DESCRIPTION Early invlvement f Hme Health Agencies in discharge planning EPISODE CONNECT List f active patients fr SNF peratrs and Hme Health prviders SNF users enter transitins and clinical LOS updates CAPABILITIES SURVEY Business intelligence questinnaire t learn abut and assess SNF capabilities LENGTH OF STAY GUIDELINES Evidence-based prtcls fr determining medically apprpriate LOS READMISSION REVIEW Rt cause analysis t identify trends r gaps in SNF and Hme Health Services prcesses 15

16 POST ACUTE TOOLKIT IMPACT Deplyment f the tlkit s cmpnents leads t meaningful imprvement acrss key success drivers. Length f Stay Management Preferred SNF s use prven benchmarks fr guidance n length f stay and crdinatin f efficient transfer t the next site f care. Efficient Transitins Remedy BPCI patients receive earlier hme health evaluatins which allw fr mre efficient transitins back hme. Streamlined Care Crdinatin Regular cmmunicatin and a standard update prcess with Care Crdinatin Team keeps patient s prgress n track with gals stated in patient s care crdinatin plan. Re-admissin Analysis Cncise tl used t investigate and trend the rt cause fr readmissins. 16

17 PREFERRED PROVIDER NETWORK DEVELOPMENT Remedy wrks with Episde Initiatrs t develp a netwrk f physicians and pst-acute prviders t enhance and crdinate care. Gainsharing: Create financial alignment with prviders wh invest time, effrt and resurces twards Care Redesign The gal is t develp an engaged ecsystem in which current gaps in care are filled Quality Measures Preferred Prvider Netwrk: Leverage histrical perfrmance analytics t assess prvider perfrmance and narrw the netwrk Remedy s Cntracting Team ffers a cmprehensive slutin that supprts lcal pay-frperfrmance agreement negtiatins and executin effrts Benefits f narrw netwrk: Aligned prviders wrking clsely t seamlessly transitin patients between sites f care, imprved data sharing t enable rt-cause analysis and engaged stakehlders acrss cntinuum Enhanced cmmunicatin with patients abut their care crdinatin plan, medical cnditin, gals and site f care chices 17

18 ELEMENTS OF CARE COORDINATION Standard care crdinatin plans and patient specific data gathered at the pint f care are integrated t create custmized care crdinatin plans that are updated n a regular basis. *90-day Mdel 2 Episde Care Crdinatin Plan Fr bundle diagnsis Care Crdinatin Plan Fr c-mrbid cnditins Clinical Risk Assessment Cmpleted at pint f care Patient Specific Custmized Care Crdinatin Plan Needs Assessment First call template Cntact Frequency Guidelines Clinical Risk Assessment Cmpleted day 40-50* by phne Cntinually Updated Care Crdinatin Plan Needs Assessment Subsequent call template 18

19 CARE COORDINATION PLANS FOR BUNDLE DIAGNOSIS The Care Crdinatin Plans are diagnsis-specific care guidelines. Educatinal plans are custmizable by patient s unique needs; by prviding reminders and self management techniques, they help the patient t recgnize symptms early and prevent readmissins. The Care Crdinatin Plans cnsist f: 48 bundle specific interventins fr the Care Crdinatin Team t emply Patient educatin n managing cnditins, self-management techniques, preventing cmplicatins, and recgnizing and reprting symptms early Care Crdinatin Plans are activated: 1. After a patient s discharge frm an Episde Initiatr s facility 2. Upn first cntact with patient r pst-acute facility / service 19

20 ASSESSMENTS Remedy utilizes several assessments deplyed thrughut the episde t gauge the patient s cnditin and needs. ASSESSMENT TYPE Clinical Risk Assessment DESCRIPTION Cmpleted while patient in hspital r sub-acute facility Stratifies patients by risk level (Lw r High) fr readmissin and determines the fllw-up frequency Re-administered at any time, but mandatry apprximately half-way thrugh episde Needs Assessment Cmpleted with each patient and/r family cntact Reviews patient s needs and all attempts made t meet them Cmplements readmissin rt cause analysis Questins: general wellness, medicatins, fllw-up appintments, ADL s, pain, necessary services, gals, emergency plan 20

21 CONTACT FREQUENCY GUIDELINES* Cntact frequency guidelines shwn belw indicate hw ften the care crdinatin team cntacts facilities, hme health services, and patients based n the Risk Assessment. Between weeks 6 and 7 the Care Crdinatin Team re-administers a risk assessment t re-evaluate apprpriate level f cntact. SITE OF CARE Hme Withut Services Hme With Services HIGH RISK LOW RISK Weeks 1-6 Weeks 7-13 Weeks 1-6 Weeks *90-day episde Skilled Nursing Facility

22 INPATIENT CARE REDESIGN TASKS Remedy supprts Care Redesign acrss five inpatient cmpnents. 1. FIND identify eligible BPCI patients by Wrking DRG r primary diagnsis. Episde Cnnect assists in patient identificatin. 2. ON BOARD first face-t-face patient interactin that educates patients n BPCI. Remedy prvides a script and cllateral t educate the patient 3. FLAG ntify internal and dwnstream prviders they are caring fr a BPCI patient. Remedy prcess re-engineering, tls and Episde Cnnect help prviders cmmunicate acrss the cntinuum. 4. INTERVENTION address gaps in care, imprve care quality and facilitate crsscntinuum netwrk develpment 5. DISCHARGE suggest ptimal next site f care; educate patients and dwnstream prviders n the care plan. Remedy s Next Site f Care Tl helps determine mst apprpriate site f care. 22

23 REMEDY MODEL 2 INTERVENTION TIMELINE (90 DAY)* Acute and Pst-Acute interventins frm prviders ptimize BPCI prgram perfrmance, patient utcmes, and cst savings. 1.Flag BPCI patient sn after inpatient admissin 3.Perfrm first risk assessment survey n patient 5.Discuss PAC plan and gals with patient + caregiver 7.Cmplete patient discharge summary and med rec 9. Fllw-up with SNF abut patient s care plan, LOS, + prgress 10.Educate Patient n next site f PAC 12.Perfrm secnd patient risk assessment (Day 40-50) 14.Apprvea ny changes t care plan 16.Cntact patient based n risk level Anchr MS- DRG - ACH Pst- Acute Care - Facility Hme w/ Hme Health Hme w/ Services 2.Onbard the patient: educate abut BPCI 4.Use decisin guideline t determine PAC Site f Care (SOC) 6.Cmmunicate with next PAC SOC facility abut care transitin 8.Flag patient as BPCI at PAC SOC * TIMELINE NOT TO SCALE, NOR AN EXHAUSTIVE LIST OF ALL INTERVENTIONS 15.Cnnect 11.Cmplete patients t patient cmmunity discharge resurces summary 13.Fllwup with patient n their health and care plan adherence 23

24 REMEDY TOOL CHEST Remedy prvides a prtfli f prprietary technlgy and tls t supprt ur partners success in the BPCI prgram. Clinical Risk Assessment Tl: patient questinnaire that determines fllw-up call frequency by stratifying patients int high r lw risk levels based n clinical and scial factrs; administered at the beginning and half way pints f the episde. Needs Assessment Tl: patient r caregiver phne interview administered by care crdinatrs t identify fllw-up needs, appintment bking, scial supprt systems, emergency plans, and patient symptm recgnitin; review ther unmet needs that may lead t pr health utcmes and readmissins. Next Site f Care Tl: a case management decisin tree that assists acute care partners in determining the ptimal next site f care fr patients. Pst-Acute Tlkit: a cmmunicative and cllabrative pst-acute infrastructure fcused n mitigating risk, imprving utcmes, and lwering cst. Episde Cnnect: BPCI care management platfrm that allws prviders t access the episde s data feed, manage care crdinatin plans, track patients and send HIPAA secure messages t care teams. Patient Prtal: web service platfrm that prvides patients access t their EHR, track their care crdinatin plan, engage in care crdinatin, and cmmunicate with prviders. PAP Prtal: web service platfrm that prvides real-time patient data t physicians, prvides episde ntificatins, place t cmplete Cperatin Survey, and mbile enabled. 24

25 A payment system built arund episdes f care is the beginning f a real effrt t cnsider ur pdns. It is an explradn, nt an explanadn. Nt a blueprint, an exacdng map, r a definidve guide. It is the first step in a lnger jurney t answer the fundamental quesdn plaguing s many wh face ur healthcare industry with hnesty: What d we d? Histry tells us that all great shins have small beginnings. Realigning ur healthcare system wn t cme in a single dramadc leap. It will be the accumuladn f millins f steps, day aner day, away frm ppressin and tward liberty. 25 PRESENTATION 123