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Success through partnerships_in_a_new_era_of_health_care_delivery_and_payment Presentation Transcript

  • 1.
  • 2. October 30, 2010Aging Services Providers: Success Through Partnerships in a New Era of Health Care Delivery and Payment
    House of DelegatesAAHSA - LeadingAge
  • 3. Drivers of Partnerships for Future Success of Aging Services Providers
    2
    • Accountable Care Organizations
    • 4. Bundled Payment
    • 5. Hospital Readmission Penalties
  • Accountable Care Organizations and Aging Services Providers
    3
    Physicians
    Outpatient
    Clinics/
    Centers
    Hospital
    ACO
    LTACH, Rehab,SNF, Home Health
    Behavioral Medicine
    Pharmacy
    • ACO responsible for Medicare Part A and Part B:
    • 6. Clinical care management (clinical integration)
    • 7. Capture data for continuum of care
    • 8. Measure, monitor costs and quality
  • How Will Post-Acute and Medicare Services in LTC Be Paid by ACOs?
    4
    • Medicare FFS + bonus: shared savings
    • 9. Bundled payment: Example
    $10,000 =30 days
    • Capitation PMPY: $ to manage post-acute and Medicare services in long-term care (home or NF) for ACO members based on actuarial analysis of member population
  • Why Post-Acute Is Key to Managing Health Care Costs
    5
  • 10. Three Strategic PartnershipImperatives for Aging Services Providers
    6
    Partner with hospitals and ACOs to address biggest concerns:
    • Length of stay (LOS)
    • 11. Pendingre-admission penalties
    Partner with other providers to enhance yourpost-acute andhome care continuum
    Partner with like providers to create one-stop chronic care management
    Strategy includes care transitions management and electronic health record
  • 12. Finding and Creating Our Partnerships
    7
    7
  • 13. Strategic Partnership Imperative 1
    8
    Partner with hospitals and ACOs to address biggest concerns:
    • Length of stay (LOS)
    • 14. Pendingre-admission penalties
  • What Do Hospitals (and Physician Group ACOs) Want from SNFs and HHAs?
    “Quality” Providers = (what this means to hospitals or physician group ACOs)
    Easy/quick transfers from hospital
    No/low 30-day readmissions to hospitals
    Low ED/admissions
    Proven capabilities to manage high acuity patients
    Good feedback from patients, families, and physicians
    Physician staff recognized by hospital or from physician group practice
    One-stop shopping for post-acute care and well-managed care transitions among venues
    In the future, EHR
    9
  • 15. SNF 30-Day Hospital Readmission Rates by State
    10
  • 16. Home Health 30-Day Hospital Readmissions by State
    11
  • 17. 12
    Data-Driven Hospital Relationships
    • Partner with hospitals to meet burning needs, especially concernsabout readmission penalties FY2012: pneumonia, AMI, CHF, and reduce excess LOS for all conditions discharged to SNFs
    • 18. Customize subacute programs to hospitals; and learn to use hospitalMedPar data
    12
  • 19. 13
    Data-Driven Hospital Relationships
    • Identify30-day readmission rates by condition: hospital versus nationally
    19.4%
    25.8%
    19.6%
    Heart Attack
    19.9%
    24.5%
    18.2%
    Heart Failure
    Pneumonia
    13
  • 20. 14
    Demonstrate Your 30-Day Readmission Rates
    • Demonstrate your30-day readmission rates by condition and your plans to continue to decrease
    12%
    19.4%
    25.8%
    19.6%
    Heart Attack
    15%
    Heart Failure
    11%
    Pneumonia
    14
    14
  • 21. 15
    Hospital and Physician Group ACO Partnership Takeaways
    • Relationships becoming data driven
    • 22. What are your patient outcomes? How many Medicare A go home?
    • 23. What is your 30-day readmission rate by condition, especially those for which hospitals soon will be penalized: AMI, CHF & pneumonia?
    • 24. Subacute units must be able to managepatients who typically would be “911”
    • 25. Increased nursing skills and RNs
    • 26. Physician/NP intensive managementof subacute patients
    • 27. Coverage 24/7
    • 28. Use of protocols, e.g., Interact, that help SNFsmanage higher-acuity patients
  • Strategic Partnership Imperative 2
    16
    Partner with other providers to enhance yourpost-acute andhome care continuum
  • 29. 17
    The New Reality for Aging Service Providers: Partnerships with Other Providers
    • Provide an array of aging services, not just skilled nursing and long-term care; be the navigator or partner for services or venues you do not offer = care management
    • 30. Become the preferred partner for integrated health systems or ACOs from whence Medicare dollars will flow
  • Strategic Partnership Imperative 3
    18
    Partner with like providers to create one-stop chronic care management
  • 31. Not-for-Profit Accountable Care Readiness Strategy: Aging Services Provider Partnerships
    19
    Create a not-for-profit consortium within a market that has more value than any organization individually
    Benefits:
    One-stop shopping for hospitals and ACOs
    Benchmarks for hospital readmissionsand ongoing comparison
    Post-acute provider partnerships in geographic areas creating care continuum with standardized protocols
    Care management projects
    Bundling experiments with Medicare Advantage Plans as we learn to take risks
    Apply for grants for demonstration projects
  • 32. Why Care Transitions Management: Because Current System Is Broken
    20
  • 33. Solution: Partner with Hospital, ACO, or Payer on Care Transitions
    Transitions coach
    Pre-discharge meeting/planning with patient and family
    Transition hospital to SNF-home or home (with or without home health)
    Home visit and telephonicfollow-up for 4-7 weeks
    21
  • 34. Care Transitions Programs
    22
    • Key tools and processes:
    • 35. Personal Health Record ( PHR)
    • 36. Medication reconciliation
    • 37. Identification of personal health goals
    • 38. Identification of “red flags” associatedwith chronic disease
    • 39. Plan for early response to changes in disease condition
    • 40. A partnership opportunity for post-acute providers with hospitals, ACOs and payers
  • “This time, like all times, is a very good one if you know what to do with it.” – Emerson
    23
    Kathleen M. Griffin, Ph.D. National Director, Post-Acute and Senior Services
    480-922-9366
    kathleeng@hdgi1.com
    Health Dimensions Group
    4400 Baker Road, Suite 100, Minneapolis, MN 55343
    763.537.5700 fax: 763.537.9200
    www.healthdimensionsgroup.com
    23