CDAO 2019 rich jolly Avamere presentation
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Presentation for CDAO (Chief Data and Analytics Officer) event in 2019
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CDAO 2019 rich jolly Avamere presentation
- 1. Using Advanced Data Analytics to Optimize Bundled Payments Rich Jolly Executive VP Technology & Strategy Avamere Health Services/Avamere Family of Companies CHIEF DATA & ANALYTICS OFFICER EXCHANGE – Healthcare NOVEMBER 17-19, 2019 | DALLAS, TX
- 2. • S – Situation • About AFC & the opportunity • T – Task • Background on BPCI • A – Approach • Analytics & its use • R – Result • Financial and organizational benefits Agenda
- 3. Avamere Family of Companies Home Health & Hospice Agencies Skilled Nursing Facilities Community Based Care (Long term, memory care, etc.) Therapy Services Source: 2019 Avamere Quality Report
- 4. The Value-Based Care Spectrum Amount of financial Accountability for providers: Key characteristics: Degree of risk between providers and health systems: • Pay for volume • Performance -based contracts for doctors and hospitals • Primary Care Incentives • Episode- based payments for specific diagnoses • Accountable Care Orgs • Shared savings/ risk • Capitation Fee for Service Performance- Based Bundle Payments Population Health (e.g. ACO) RISK RISK RISK RISK
- 5. The Key Role of Post-Acute Care Source: Medicare Learning Network, IMPACT Presentation 2/4/2016 $500 Billion Medicare Spending $74 Billion Total Medicare PAC spending (14.8%) 6.4 Million Medicare Beneficiaries 2026 Year Medicare runs out of funds Skilled Nursing Homes 46% Home Health Agencies 38% Hospice 11% Inpatient Rehab 4% LTACHs 1% 15,000 post-acute providers operate in the United States. Above represents % Breakdown by Type of Post Acute Facility
- 6. • S – Situation • About AFC & our opportunity • T – Task • Background on BPCI • A – Approach • The beef – analytics & its use • R – Result • Financial and organizational benefits Agenda
- 7. BPCI BPCI-Advanced Entities that can initiate/ ‘own’ bundles Acute Care Hospitals, Physician Groups, Skilled Nursing Facilities, Long Term Care Hospitals, Inpatient Rehab Facilities, Home Health Agencies Acute Care Hospitals or Physician Groups Dates Effective 4/20/15 to 9/30/18 10/1/18 to 12/31/23 Bundle Period 30, 60 or 90 day 90 day only Episodes (DRGs) 48 29 inpatient, 3 outpatient BPCI evolves to BPCI-Advanced
- 8. BPCI: managing 90 day Medicare cost J. Smith Day 1 Day 90 SNF Stay (22 days at $550/day) HHA Episode (34 days at $3400) MD Visits (~$2100 in charges) ED or Readmit SNF Stay #2 (3 days at $550/day) Out-Patient Medicare A or B Charges i. MD Visits ii. Labs iii.Out-patient procedures iv.DME Medicare A or B Charges i. MD Visits ii. Infusions iii.Labs iv.Out-patient procedures v. DME Medicare A or B Charges i. Labs ii. Out-patient procedures iii.DME Other charges billed Medicare A or B What’s excluded? ▪ Readmission due to unrelated DRG ▪ Hospice services SNF Home Health What’s included? ▪ Board and lodging billed under Medicaid ▪ Medicare Part D Meds
- 9. • S – Situation • About AFC & the opportunity • T – Task • Background on BPCI • A – Approach • Analytics & its use • R – Result • Financial and organizational benefits Agenda
- 10. • Calculate historical bundle performance and add confidence limits based on distributions • Determine: • Amount of episode management you are prepared to do • Assess the efficacy of management • Assess your risk level Selecting Bundles
- 13. Managing the Episode Skilled Nursing Facility (SNF) Acute Care Facility Physicians Post-Acute Care Home Health Care Readmit Patient Flow - Best practices per DRG - Optimize physician cases - Patient episode management - SNF network optimization - Best practice SNF to HH handoff - HH network management
- 14. • S – Situation • About AFC & the opportunity • T – Task • Background on BPCI • A – Approach • Analytics & its use • R – Result • Financial and organizational benefits Agenda
- 15. • Net Gain in each quarter • Meaningful impact on business bottom line • Strong, positive ROI • Costs: Analytics, Episode Management and extra resources at facilities • Organizational learning & growth • Clinical & Process improvements impact core business (e.g. reduction in readmission rates makes SNF more attractive to referrers) • Create a constant improvement (Lean) mindset Strong Direct Benefits
- 16. Build a virtuous cycle Successful Analytics Projects More Organizational Confidence More Resources