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Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
Care Transitions Across the Continuum
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Care Transitions Across the Continuum

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Care Transitions Across the Continuum kickoff presentation as presented by Paul Diaz, CEO, Kindred Healthcare and Ben Breier, President and COO, Kindred Healthcare.

Care Transitions Across the Continuum kickoff presentation as presented by Paul Diaz, CEO, Kindred Healthcare and Ben Breier, President and COO, Kindred Healthcare.

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  • 1. PRESENTED BY:Paul J. Diaz, Chief Executive OfficerBenjamin A. Breier, President and Chief Operating Officer 1
  • 2. Our MissionKindred Healthcare’s mission is to promotehealing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employee and shareholder we serve. 2
  • 3. Leading Diversified Post-Acute ProviderWith a Focus on Developing Integrated Care Market Capabilities Transitional Care Hospitals (117) Inpatient Rehabilitation Hospitals (6) Hospital-Based Acute Rehab Units (104) Nursing and Rehabilitation Centers (224) RehabCare Total Sites of Service (2,104) Existing Integrated Care Market (12) Home Health, Hospice and Private Duty (102) Potential Integrated Care Market (9) Regional Support Centers As of September 30, 2012 3
  • 4. Kindred’s Value Proposition/Strategic Opportunityand our “CONTINUE THE CARE” Campaign• Be a leader in helping to coordinate and deliver high quality care at the lowest cost (particularly for those patients who are the highest users of healthcare services) – By providing superior clinical outcomes in the most appropriate setting, with an approach which is patient-centered, disciplined and transparent – By transitioning patients home at the highest possible level of function and wellness, therefore preventing avoidable rehospitalizations• Lower healthcare costs by reducing lengths-of-stay in acute care hospitals and throughout an episode of care• Participate in the development of new care delivery and payment models – To better coordinate care and manage patients with chronic conditions, including the dual-eligibles – To reduce avoidable rehospitalizations with our partners through our integrated care management teams and protocols 4 4
  • 5. Kindred HealthcareDelivering on Quality, Value and Innovation in Patient Care Delivery527,000 Patient  Outperforming patients and residents and Family  National Quality were cared for byKindred across the Satisfaction Benchmarks 92% of our patients, Kindred Transitional Care Hospitals,post-acute continuum residents and Nursing and Rehabilitation Centers– 2012 annualized. families indicate they and PeopleFirst Homecare and would recommend Hospice continued to improve key Kindred again. quality indicators and beat industry benchmarks through mid-2012.Sending More  … and More Quickly… … Reducing Patients Home… (Reducing Average Length‐of‐Stay) RehospitalizationFrom 2008 to mid-2012, From 2008 through mid-2012, Kindred Transitional CareKindred Nursing and we have reduced the total average Hospitals reducedRehabilitation Centers have length of stay in our Hospitals rehospitalization rates bydischarge 18% more by 8.5%, and in our Nursing and more than 16% from 2008 topatients home – with Rehabilitation Centers by 26%. mid-2012 (down to 11.2%) andnearly 53% of patients our Nursing and Rehabilitationdischarged home in 2012 Centers have reducedafter an average stay of 30 rehospitalizations by 10%days. over the same time period to 17.8%. 5
  • 6. Hospital Quality Data Kindred Exceeds National Benchmarks Patient/Family Satisfaction Scores on Many Key Quality Indicators (1 = Poor, 5 = Excellent) (Lower is better) 52.5 4.52 4.59 4.47 4.56 4.34 2.2 4.19 1.97 2 4 1.8 1.491.5 1.3 3 2006 1.1 0.99 2012 1 0.71 20.5 1 0 Ventilator-Associated Line-Related Blood Catheter Associated Pressure Wounds Pneumonia Stream Infection Urinary Tract Infection 0 National Benchmark Kindred 2012 Kindred 2006 Overall Care Pain Call Light Management Response As of September 30, 2012 6
  • 7. Nursing and Rehabilitation Centers Survey Quality Outcome Ranking Report June 2012Selected Corporations Average Rank Rank Kindred ranked # 1 in Quality 6Kindred Healthcare 2.50 1 consecutive quartersGenesis Healthcare 3.13 2Golden Living 4.25 3 Ranking based on the following 8 standard survey measures:Good Samaritan Society 4.50 4Fundamental Clinical Consulting 5.13 5 1. Average # Deficiencies 2. Average # Deficiencies adjusted for stateHCR Manor Care 6.00 6 variationExtendicare 6.38 7 3. Percent facilities with “Serious” deficiencies 4. Percent facilities with “Serious” deficienciesSun Healthcare Group 6.75 8 adjusted for state variationLife Care Centers of America 8.13 9 5. Percent facilities with “substandard care”Sava Senior Care 9.88 10 6. Percent facilities with “substandard care” adjusted for state variationLavie 10.38 11 7. Percent “deficiency free” facilitiesSkilled Healthcare Group 11.00 12 8. Percent “deficiency free” facilities adjusted for state variation 7
  • 8. Kindred Nursing and Rehabilitation CentersOutperform National Benchmarks on Many Key Survey QualityOutcomes 30 27.22 25 19.55 20 Nation 15 Kindred 10.45 9.36 As of 10 September 30, 2012 6 5.89 5 3.09 1.36 0 Total Health Percent Severe Percent Substandard Percent Zero Deficiencies - Deficiencies (% ) Care Deficiencies (% ) Deficiencies (% ) Average (Lower is Better!) (Lower is Better!) (Higher is Better!) (Lower is Better!) 8
  • 9. Inpatient Rehabilitation Hospitals Exceeding National Benchmarks30 3 80 76.01 74.22 26.49 25.51 2.5725 2.5 2.3 6020 215 1.5 4010 1 205 0.50 0 0 FIM Gain FIM Efficiency Discharge to Community Kindred Inpatient Rehabilitation Hospitals National Average (Higher is better) As of September 30, 2012 9
  • 10. RehabCareIncrease (%) in Functional Outcomes From Admission toDischarge 70 65.2 60 56 52 51.6 50.6 51.5 50 46.8 40 30 20 10 0 Stroke Pulmonary Wound Brain Neurological Orthopedic Other Cardiac Dysfunction As of September 30, 2012 10
  • 11. PeopleFirst Homecare andHospice Exceeding National Benchmarks 98 98 98 98 99 98 100 93 89 80 65 63 60 PeopleFirst Homecare and Hospice National Benchmark 40 (Higher is better) 20 0 How Often How Often How Often How Often Wound How Often Checked for Pain Treated for Pain Breathing Im proved or Checked for Risk Im proved Healed Post-Op of Pressure Sores 98 96 99 100 93 93 95 91 91 80 60 40 25 26 20 0 How Often How Often Care How Often How often How Oftem Treated to Began in a Tim ely Patient/Fam ily Checked for Risk Patients Adm itted Prevent Pressure Manner Taught about of Falling to Hospital (low er Sores Medication is better) 11
  • 12. Vivi’s Story 12
  • 13. CONTINUE THE CAREAdvancing Our Integrated Care Strategy 13
  • 14. Why Post-Acute Care is an Important Part ofthe Evolving Healthcare Marketplace Demographics  Aging Demographics and Demand for  Post‐Acute Utilization is increasing Post‐Acute  Increasing Incidence of Chronic Disease Services are  Imperative to get Patients Home more quickly and to  Growing Coordinate Delivery of Care Through a Full Episode Post‐Acute Care  is a Critical Part  Patient Satisfaction of Quality  Quality and Clinical Outcomes Improvement  Care Coordination across Sites of Care and Patient‐ Centered Care Reduce Hospital Readmissions Post‐Acute Care  Can Help Reduce  Value‐Based Purchasing Costs in a  Readmission Penalties Rapidly Changing  Episodic / Bundled Payment Payment  Environment “Accountable Care” and Risk Payments 14 14
  • 15. Tremendous Opportunities Exist to BetterManage Patient Care for Patients DischargedFrom Acute Care Hospitals Currently there are 47.6 million Medicare beneficiaries with an estimated 9,100 individuals added to the program each day.(1) 35% of Medicare Beneficiaries are Discharged from Acute Hospitals to Post-Acute Care Medicare Patients’ Use of Post‐Acute Services Throughout an “Episode of Care” (2)Higher Intensity of Service Lower SHORT‐TERM  LONG‐TERM   INPATIENT  SKILLED  OUTPATIENT  HOME ACUTE CARE  ACUTE CARE  REHAB NURSING  HEALTH REHAB CARE HOSPITALS HOSPITALS FACILITIESPatients’ first site of discharge after acute  2% 10% 41% 9% 37% care hospital stay Patients’ use of site during a 90 day episode 2% 11% 52% 21% 61%(1) Source: U.S. Census Projections (2) Source: RTI, 2009: Examining Post Acute Care Relationships in an Integrated Hospital System 15 15
  • 16. Kindred Is Positioned to Help Determine the Most Appropriate Care Setting For Patients as they Continue Their Care Throughout a Post-Acute EpisodePatients Discharged From: Kindred Nursing and Kindred Transitional Care Hospitals Kindred Hospital‐Based IRFs Rehabilitation Centers 27%  6% 76%  53%  37% 14% Home Home Home Skilled  Inpatient  Skilled  Nursing  18% with  Rehab  35% with  Nursing  35% with  and  Home  Facility Home  and  Home  Rehab  Health Health Rehab  Health Centers Centers Source: Kindred Internal Data ‐ September, 2012 YTD 16 16
  • 17. Positioned to Take Advantage of ChangingHealthcare LandscapeUniquely Positioned For Bundled Or Episodic Payment Environment “Continue The Care” Patient Service Intensity ACUTE CARE HOSPITALS TRANS LTACHs CARE ICU FREESTANDING/ HIH IN‐PATIENT  REHAB SAU SKILLED  TCC & OUTPATIENT  NURSING  TCU REHAB FACILITIES ASSISTED  HOME  LIVING HOSPICE HEALTH  CARE ADULT DAY  CARE HOME Patient Illness Severity 17 17
  • 18. Strategic Plan• Success in the Core – Take care of our teammates and promote performance improvement – Continue to improve quality and clinical outcomes – Promote our value proposition and grow admissions and rehab contracts – Execute on cost reduction initiatives and process transformation ‐ Project Apollo• Accelerate our Integrated Care Market (Cluster Development) Strategy – Develop service lines, clinical programs and integrated care management capabilities  across the care continuum ‐ Continue the Care – Expand and integrate health system, physician and managed care relationships – Continue to invest in IT (electronic health record) linkages• Aggressively expand Home Health and Hospice Services through acquisitions, JVs and  de novo development• Change business and asset mix and re‐deploy capital into faster growth, higher margin  businesses through portfolio realignment and continued development in our  Integrated Care Markets• Participate and Invest in New Integrated Care and Payment Models/Businesses,  including ACOs and Bundled Payment Demos with Government Sponsors (CMS), Health  Systems, Physician Groups and Managed Care Payors• Continue to explore avenues to create shareholder value and improve the  capital structure of the company 18 18
  • 19. Kindred’s Strategy is Designed to Preparefor Significant Policy and Market Trends Current Approximate Potential Future Payor Mix Payor Mix Managed Care Fee for Managed FFS service Care The Next 10 Years… (FFS) ACOs, bundle holders Hospitals Health systems Other PAC providers 19 19
  • 20. Different Payment Models to Define a Path toRisk-Based Contracting Across a Post-AcuteEpisode of Care Over Time Today Near‐Term Future High Shared Risk  Gain Share  for Post‐ with Partial  Acute  and/or Shared  Episode Kindred Risk Risk for Post‐ Acute Episode (e.g.,  (e.g., case rates  bundling or  Pay for  or bundled  case rates  Performance payment within  for full  sites of service  and/or across a  post‐acute  with Bonus  Medicare‐ post‐acute  episode) Payments and  Based Rates Penalties episode for  Level of Care  specific  PPD diagnoses) Low High Financial Alignment 20 20
  • 21. Kindred’s Integrated Care Strategy is designed to preparefor a Delivery System that is more Clinically Integrated withShared Financial Incentives Key Elements Steps to Advance Care and Payment Integration  Full Continuum CONTINUE THE CARE of Post‐Acute Care Services  1 • Expanding Home Health and Hospice capabilities in Local Integrated Care  • Enabling Physician coverage across sites of care Markets Patient‐Centered Care  MANAGING TRANSITIONS IN CARE Management Capabilities  • Developing tools to ensure appropriate patient placement  that Extend Across Post‐ and case management 2 Acute Sites of Care to  • Connecting sites of service through IT and clinical  Improve Quality and  program linkages Reduce Costs ADAPTING TO NEW PAYMENT SYSTEMS Aligned Payment  3 Today: Fee‐for‐Service  Incentives between  Providers of Healthcare  Near‐Term: Pay‐for‐Performance  Services and Payors Goal: Shared Incentives, Post‐Acute Bundle or  Episode of Care 21 21
  • 22. Accelerate Integrated Care Market and NetworkDevelopment Strategy Through Multiple Pilots andAdvancement of Key Enablers: 1 2 3 “Care Management” Managed Care Physician & Medical Staff  Develop and test capabilities  Development through demonstration  Advance volume and rates  projects and pilots, including  strategies and test different  Implement medical  patient assessment and case  payment models, including  leadership and physician  management tools and clinical  Bundled Payment Project  alignment across acute and  programs that are linked  with CMS post‐acute sites of care through an episode of care 4 5 Network Development I‐T Interoperability Implement strategies,  Advance Electronic Health  including Joint Ventures,  Record strategy (linking EMR  ACO participation with  between our sites of care and  Payors, Physicians and  physicians, payors and  Health Systems hospitals) 22
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