Integrating Post-Acute Providers with Health System Strategies

Transcription

1 Integrating Post-Acute Providers with Health System Strategies Bridging the Acute and Post-Acute Worlds The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

2 Linda Joel, FACHE President & CEO LindenGrove Inc. Margaret Lightner, FACHCA President & CEO Botsford Commons Senior Community Beaumont Health The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

3 Bridging Worlds Integrate and Co-Create Erase the Boundaries of Business Generate Data-Driven Insight

4 Learning Objectives Understand forces driving acute and post-acute provider collaboration Review postacute models of care Understand metrics for evaluating post-acute quality and value Review steps to create an integrated planning process

5 About LindenGrove Incorporated in 1986 Waukesha County WI Senior Health & Housing 4 Campuses 461 SNF Beds 72 CBRF Units Memory Care 117 RCAC Units Assisted Living 1,100 Employees Sponsor Health Systems Froedtert & The Medical College of Wisconsin ProHealth Care

6 LindenGrove Mission LindenGrove, a not-for-profit provider of health care and senior residential services in Southeastern Wisconsin, is committed to the continual enhancement of the quality of care and the quality of life of the persons it serves. LindenGrove is dedicated to developing and offering a range of high quality service in a professional, ethical, and financially responsible manner. LindenGrove strives to be the caregiver and employer of choice by creating a caring environment that is responsive and supportive for clients, their families, employees, and volunteers.

7 About Beaumont Health Incorporated in 2014 Health System 8 Hospitals 3,337 beds 7 Skilled Nursing 1272 beds Home Care 308,000 visits 2 Long-Term Acute Care Hospitals 90 beds Inpatient Rehab (multiple) System Net Revenue of $4.1 billion Nearly 5000 physicians 35,000 employees

8 About Beaumont Health Beaumont Health is a not-for-profit organization formed in September 2014 by Beaumont Health System, Botsford Health Care and Oakwood Healthcare to provide patients with the benefit of greater access to the highest quality, compassionate care, no matter where they live in southeast Michigan. Mission: Compassionate, extraordinary care every day Vision: To be the leading high-value health care network focused on education, innovation, compassion, and extraordinary outcomes 9/9/2015 8

9 Why an Integrated Planning Process? HHS January 26, 2015 News Release: Better, Smarter, Healthier: HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value.

10 The Future is Already Here Today: 20% Medicare FFS payments tied to alternative payment models 30% of Medicare FFS tied to alternative payment models 50% of Medicare FFS tied to alternative payment models ACOs, Bundled Payment, or other Health Care Payment Learning and Action Network Launched 85% of Medicare FFS tied to Quality or Value 90% of Medicare FFS tied to Quality or Value Hospital VBP or Readmission Reduction

11 Shared Challenges Acute and Post-Acute Providers Must Align Strategies. Both Impacted by Penalties and Incentives. Shift Care to Lower Cost Settings Improve Quality and Clinical Outcomes Improve Value and Reduce Spending Reduce Hospital Readmissions

12 Catalysts for Collaboration Proposed Bundled Payment: Total Joint FFS Beneficiaries Medicare Spend Per Beneficiary Began 2014, measures hospital costs including all Medicare A and B claims 3 days prior to admission through 30 days postdischarge. Site Neutral Payment Readmission Reduction Program: Hospital penalties started in 2013 and have increased annually through 2015 IRF and LTACH readmission measure coming in 2017 Skilled nursing facility 2% withhold and incentives - begins 2018 Home Health Care readmissions measures are in development

13 Medicare Spend Per Beneficiary Average Medicare Spending per Beneficiary for US and Highest- and Lowest- Cost PAC States Period Average (US) Highest (NJ) Lowest (OR) 1 3 Days Before Admission During Index Hospitalization 1 30 Days After Discharge Complete Episode $252 $239 $224 $10,122 $10,017 $10,945 $7,984 $9,508 $5,844 $18,358 $19,764 $17,013 Source: Medicare. Medicare hospital spending by claim web page.

14

15 Catalysts for Collaboration 3 Day Qualifying Stay SNF Understand this rule and the exceptions Waiver with Total Joint bundled payment Bundled Payment Models 2 and 3 ACO Growth in Participation in the Medicare Shared Savings Program Inpatient Rehabilitation Hospital changing presumptive eligibility rules Patient Experience Scores Quality Measures Across the Continuum of Care IMPACT Act

16 Strategic Partners in the New World All provider types must increase their ability to manage the episode of care together Physicians 404 ACOs in the MSSP as of April ,600 Acute Care Hospitals Hospitals Health Plans Post- Acute Providers 15,000 SNFs 12,000 HHAs 1100 IRFs 400 LTACHs

17 All ACOS by State January 2015 Includes MSSP, Commercial and Medicaid ACOs Source: Leavitt Partners Center for Accountable Care Intelligence

18 Overcoming the Language Barrier RUGs CMG DRG MDS IRF-PAI CMI SNF IRF LTACH HHA HHRGS 60% Rule IMPACT 25% Rule ADLs

19 HHA ADLs IMPACT IRF LTACH RUGs SNF VBP MDS IRF-PAI LTC CMI The Language of Post-Acute Transformation Acronym List Home Health Agency Activities of Daily Living Improving Medicare Post-Acute Care Transformation Inpatient Rehab Facility Long-Term Acute Care Hospital Resource Utilization Groups Skilled Nursing Facility Value Based Purchasing Minimum Data Set Inpatient Rehabilitation Facility Patient Assessment Instrument Long Term Care Case Mix Index

20 PAC Providers Differ Markedly Setting Dominant Payer Ave Length of Stay Inpatient Rehab Facility Long Term Acute Care Medicare + Commercial Top Diagnoses 13 days Brain Injury, stroke, spinal cord injury, fractures, debility Medicare >25 days Vent dependent, hemodialysis, critical care cases Home Health Care Medicare 60 Day Episode of Intermittent Care SNF: Subacute Care SNF: Long Term Care Post-surgical and/or multiple chronic conditions Medicare days Joints, fractures, stroke, other neuro, heart failure Medicaid Ave. 2 years Multiple chronic conditions

21 Understand PAC Quality Metrics These are examples of just some of the quality measures for post-acute care PAC Provider Type Rating System Criteria Inpatient Rehab Facility CMS Quality Reporting Program LTACH CMS Quality Reporting Program Skilled Nursing Facility CMS 5 Star Rating Short stay measures Long stay measures Home Health Agency CMS QRP: Health improvement measures Health care utilization measures HHCAHPS Pressure Ulcers CAUTI 30 day readmissions CAUTI CLABSI Influenza vaccine 30 day readmissions Staffing Health Inspections Quality Measures from the Minimum Data Set 30 day readmissions Patient experience Function or wellness How much other healthcare the patient uses 30 day readmissions

22 Top 5 DRGs Using PAC Services Includes 30% of Medicare FFS claims in 2008

23 5 Common Pathways for SNF Patient Transitions 60 day Pathway % of Episodes Ave Cost per Episode A-S 17.10% $25,568 A-S-H-C 16.40% $25,547 A-S-C 15.00% $20,417 A-S-A-S 3.30% $41,552 A-S-E 2.30% $28,035 Subtotal 54.10% $25,223 Other 45.90% $33,928 Total 100% $29,219 Prevent Study A= Acute Hospital S = SNF H = Home Care C = Community Physician E = Emergency Room Dobson A, DaVanzo J, Heath S, Shimer M, Berger G, Pick A, Reuter K, El-Gamil A, Manolov N. (2012) claims data.

24 Key Elements of the Integrated Plan Data Management - Interoperability Challenge: Varied EMRs, Analytics and Metrics Challenge: Quality and Capacity Narrow Post-Acute Network Care Transition Management Challenge: Many Coordinators, but Fragmented Communication 24

25 Evaluate Your PAC Partner Options Leadership Clinical Innovation Post Acute Partner Criteria Quality Metrics How Many Partners Are Necessary to Meet Demand and Ensure Access? EMR Capability Service Capacity and Access Medical Staff Support

26 Evaluate your PAC Partner Options Narrow Post-Acute Network Challenge: Quality and Capacity 1. Geographic coverage 2. Adequate capacity 3. Focus on high quality, high performing partners 4. Collaboration to improve outcomes for patient 26

27 Connect the Data Data Management - Interoperability Challenge: Varied EMRs, Analytics and Metrics 1. Health Record Exchanges link medical record data from acute to post-acute; and to primary care physician 2. PAC Common assessment form, common quality metrics and clinical standards; single payment structure 27

28 Develop Care Partners & Care Planning Care Transition Management Challenge: Many Coordinators, but Fragmented Communication 1. Choosing the right PAC setting 2. Care Planning Episode of Care 3. Care Re-design CMS Standardized Assessments 4. Care Navigation Sustained engagement w/patient across the continuum 28

29 Care Transition Management Care Transition Management is a process that should be a strategic initiative and shared by acute and post-acute providers. Insurance Case Manager Hospital Care Manager Community Physician a 360 loop, engaging all providers involved in the episode of care over at least 60 days postdischarge. Transition Management SNF Clinical Team Patient & Care-Giver Home Care Case Manager

30 What About Patient Choice? May 17, 2013: Revision to State Operations Manual (SOM), Hospital Appendix A Interpretive Guidelines for 42 CFR , Discharge Planning Although not required under the regulations, hospitals would be well advised to develop collaborative partnerships with post-hospital care providers to improve transitions of care that might support better patient outcomes. This includes not only skilled nursing facilities, but also providers of community-based services.

31 Let s Be Clear (c)(6) The hospital must include in the discharge plan a list of HHAs or SNFs that are available to the patient, that are participating in the Medicare program, and that serve the geographic area (as defined by the HHA) in which the patient resides, or in the case of a SNF, in the geographic area requested by the patient. HHAs must request to be listed by the hospital as available. If the patient is enrolled in a managed care insurance program that utilizes a network of exclusive or preferred providers, the hospital must make reasonable attempts, based on information from the insurer, to limit the list to HHAs and SNFs that participate in the insurer s network of providers.

32 Key Stakeholders Patients Physician Partners Post-Acute Care Providers Care Transition Providers POPULATION HEALTH STRATEGY 32

33 Steps Toward an Integrated Plan Clarify Hospital Service Line Short and Long Range Forecasted Growth System Population Health Strategies Hospital VBP Performance and Risks Research PAC Provider Quality Metrics 30 Day Readmission Rates by PAC Provider and DRG PAC Provider Clinical Capabilities for High Acuity Patients Align Narrow the Network of PAC Providers with Clinical and Quality Capabilities Convene Selected PAC Providers Set Common Goals and Expectations; Prioritize Clinical Integration Tactics Measure Agree on Data Sources and Reporting Mechanisms Establish a Shared Dashboard Develop an Accountability Process

34 Branding Your Strategy POPULATION HEALTH STRATEGY 34

35 Branding Your Strategy Vision/ Mission Clinical Innovation Key Stakeholders Strategy Patient Touchpoints Affiliation Agreements L:inkage of Partners 35

36 Dashboard Example #1 Sample Dashboard Medicare FFS patients Hospital X and Post-Acute Partners Criteria SNF Target SNF 1 SNF 2 HHA Target HHA 1 HHA 2 LTACH Target LTACH 1 IRF Target IRF 1 # of Patients Placed from Hospital X % 30 Day Hospital Readmissions % Patients with ED visit PAC Average Length of Stay Overall PAC Average Length of Stay for Hospital X pts by Discharge DRG: AMI CHF COPD Hip/Knee Replacement Pneumonia Patient Satisfaction 36

37 Dashboard Example #2 Quality Improvement Organization Collaborative Dashboard QIO Collaborative Dashboard Hospital X and Post-Acute Partners Acuity Measures Physician Services Quality Metrics Criteria SNF Target SNF 1 SNF 2 Census Length of Stay Evaluations Completed within 24 hours of admission PCP Appointment within 7 days of discharge Discharge summary provided to PCP UTI Nosocomial Pneumonia Falls with Major Injury Pressure Ulcers New or Worsened Influenza Vaccine All-Cause Readmission Rate Residents that went to ED and returned within 24 hours 37

38 Optimize Current Innovation If bundled payment is something your hospital is focused on, align with PAC providers that are eager to participate and are clinically capable. Create integrated clinical programs to maximize volume and expertise within a small number of select PAC providers. Address quality issues through collaborative learning and improvement initiatives.

39 Focus On Learning Generally speaking, hospital-centric organizations have a steep learning curve when it comes to the post-acute continuum. Likewise, post-acute providers see through their own lens and have to learn the language and priorities of the hospital organization.

40 Questions? Thank you The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development