Plenary Session 1. Health Dimensions Group Health Dimensions Group

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1 Plenary Session 1 Kathleen M. Griffin, PhD Health Dimensions Group

2

3 March 31, 2011 Hospital, Post Acute and Long-Term Care Collaboration in Health Care Reform: Critical Success Factors National Summit: Transforming Hospital, Post Acute and Long-Term Care Delivery Systems for Health Care Reform Kathleen M. Griffin, Ph.D. 2

4 Post Acute Placement Varies by Acuity and by Market Patient Severity of Illness Levels in Acute Hospitals and in Post Acute Venues Note: SOI is measured by the 3M APR-DRC Grouper. Source: AHA, Analysis of the % Medicare Standard Analytical Files by The Moran Company 3

5 Hospitals and Post Acute Care: Fragmented Today Adapted from Kindred Healthcare 4

6 W h y P ost A cu te C a r e is E ssen tia l to Bending the Medicare Cost Curve PAC Setting 37.5% Medicare Fee-for-service Hospital Discharges Use Post Acute Care Percent Discharged from Hospital to PAC Setting Percent Rehospitalized After Using PAC Setting Percent Died in PAC Setting Percent Discharged to a Second PAC Setting Most Common Second PAC Setting Used SNF 17.3% 22.0% 5.4% 29.3% Home Health Home Health Hospice Inpatient Rehab Home Health Hospice Home health LTC Hospital SNF Inpatient Psych SNF TOTAL 40.0% 18.0% 6.2% 19.8% 5

7 Achieving Quality Outcomes for Seniors Requires a New Coordinated Care System EHR Care Transitions 6

8 Health Care Reform Drives Partnerships Between Hospitals & Post-Acute Providers for Coordinated Care System Hospital Readmission Penalties Accountable Care Organizations Bundled Payment 7

9 What Keeps Hospital CEOs Awake at Night? How do we reduce hospital readmissions to avoid penalties? Are we ready for accountable care? How do we drive down costs for reduced Medicare (and commercial) payments and bundling? 8

10 30-Day Rehospitalizations: Not So Good 19.6% of Medicare patients are readmitted within 30 days, and 28.2% within 60 days; only 10% of these readmissions are planned Jencks S et al. N Engl J Med 2009; 360:

11 30-Day Rehospitalizations for Medicare Fee-for-Service Patients 10

12 Health Care Reform and Penalties for Hospital Readmissions October 1, 2012 CMS will rank hospitals based on 30-day readmission rate for heart attack, heart failure, and pneumonia All readmissions with two exceptions Even if readmitted to another hospital In 2015, the program will expand to include COPD, cardiac bypass, stents, and other vascular conditions for total of seven conditions and more Worst quartile = up to 3% reduction of all Medicare payments by 2015 Does not apply to critical access hospitals 11

13 Health Care Reform and ACOs: Population- Based Health Care January 1, 2012 Integration and Accountability for a Defined Population Provider organization (physician or hospital led) Integrated (virtual or real): can provide or manage full continuum of care Sufficient i size (based on patients t of ACO s primary care physicians) i to support comprehensive performance measurement Core capacities: performance reporting, distributing savings Potential ACOs: integrated systems, hospitals with aligned practices, physician groups/networks; community health systems For whom is ACO accountable? Patients of its primary care MDs PCPs can only be in one ACO Patients are assigned to PCP they saw most frequently ACO then becomes accountable for quality and total per-patient costs, even if patient goes outside the system 12

14 ACO Statutory Requirements Legal structure t to receive, distribute savings Primary care professionals to serve minimum of 5,000 assigned Medicare FFS beneficiaries 3-year commitment to participate 13

15 New Payment Model from CMS: Shared Savings Current per-capita spending for assigned patients determined from claims for past three years Spending target t is negotiated t (private payers) or determined d (Medicare) If actual spending lower than target, savings are shared IF quality targets are also achieved ACO Launched Projected Target Actual Shared Savings Adapted from Brookings Institute 14 14

16 ACOs Drive Creation of an Effective Care Continuum Health Care Reform encourages multiple strategies to break down barriers between care settings 15

17 How Will Post Acute Providers Be Paid By ACOs? Shared savings? Unlikely very difficult to assess the contribution to savings by the Post Acute Provider Bundled B d payment? More likely predictable and can incentivize with ihbonuses Just SNF or all post-acute? Will vary by market One Midwest health system + PAC provider example $10, = 30 days 16

18 Health Care Reform and Bundled Episodic Payment January 1, 2013 Bundling = payment to a single provider entity of one amount for the full range of care during a hospitalization episode Episodic payment related to acute hospitalization: -3 through +30 days Hospitalization; re-hospitalization; post-acute care; outpatient hospital services including ED, physicians If spending reductions, expand at least by January 1, 2016 Initial focus on one or more of eight conditions Payment either single bundle or via bids 17

19 Health Care Reform: Hospital-Post Acute Partnership Takeaways Relationships will be data driven What are your patient outcomes? How many Medicare A go home from your LTACH, rehab hospital or unit, or skilled nursing facility? What is your 30-day readmission rate by condition, especially those for which hospitals soon will be penalized: AMI, CHF, and pneumonia? Post acute providers must be able to manage patients who typically would be 911 Increased ceasednursing us gskills sand RNs Physician/NP intensive management Coverage 24/7 Use of standard care pathways developed in concert with hospitals and physician groups 18

20 In Summary... Partnerships between hospitals/health systems, physicians and post acute providers are essential in the new world of health care delivery and payment Partnerships must be value-based: what do you bi bring? Hospital readmission reduction Cost management for patient episode of care Care transitions - coordination across the continuum Chronic care management to reduce ED visits and hospitalizations Electronic information exchange Ability to share payment risk based on outcomes 19

21 No Lone Rangers in Health Care Future: Your Risk is Mine; My Success is Yours 20

22 Kathleen M. Griffin, Ph.D. National Director, Post Acute and Senior Services Health Dimensions Group 4400 Baker Road, Suite 100 Minneapolis, MN fax:

23 22

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