The hospital super-user can eat up almost half of a provider’s resources. But a focus on this population’s overall health – increasing access to primary care, addressing the social determinants of health, for example – is making a big difference. At some institutions, patients who once were routinely admitted to the hospital are now getting care in ambulatory settings, embedded in comprehensive systems of services for primary care and community health. Learn how hospital and health system leaders around the country are managing such transitions, how patients are faring and the outlook for better care and lower costs.

1. The
complexity
and
size
of
Highmark
Health
can
drive
a
unique
approach
to
research
&
innova<on

2. 2
Higher
quality
outcomes
through
coordinated
care
transi<ons
throughout
the
post-­‐
acute
con<nuum
Be?er
pa<ent
experience
through
personal
rela<onships
with
our
Transi<onal
Care
Coordinators
Decreased
re-­‐admissions
by
puDng
pa<ents
in
the
right
seDng,
for
the
right
treatment,
at
the
right
<me
Healthcare@Home
Benefits

3. 3
…
provides
a
coordinated
model
for
accountable
post-­‐acute
care
Payer
Product
Integra;on

4. 4
Transi;onal
Care
Coordinators
&
Account
Execu;ves

5. 5
This
is
important
for
our
pa;ents,
and
for
us…
With
one
call,
healthcare
is
coming
home
1.800.381.8080
www.healthcareathome.com

6. C
O
N
F
I
D
E
N
T
I
A
L
Heart
Program
Overview
[date]

7. 7
Value
Healthcare@Home
Heart
Care
Program
7
2
Services Coverage Area Differentiators
3 4 5
Discharge Planning Southwest PA
Integration with
Healthcare@Home
Reduce Heart
Failure
Readmission
Reduced LOS
Overview
1 AHN Healthcare@Home provides the services and expertise to quickly
assess and direct patients to the right care setting or services before,
during and/or after they receive cardiac care
Improve
Patient
Satisfaction
Key
Optimize
quality of care
SNF/LTAC/Therapy Partner
AlignmentNorthwest PA
Central PA End-to-End Care Coordination
Care Coordination
Physician Rounding
At Home Cardiac Services Physician Driven

8. C
O
N
F
I
D
E
N
T
I
A
L
8
AHN
has
industry
physicians
and
ins;tu;ons
in
heart
&
breathing
care
Key
Data
Points
CHF
&
Surgery
Over
100
Cardiac
Physicians
• Physicians
=
58
• Partners
/
Aligned
=
50
Over
7,500
Cardiac
Pa;ents
Seen
Annually
• CHF
=
6,636
• Surgery
=
971
Over
13
Heart
Clinics
/
Rehab
Loca;ons
• See
next
slide
Na;onally
Recognized
Ins;tu;ons
• Joint
Commission
Advanced
Cer;fica;on
for
Heart
Failure
• Society
of
Thoracic
Surgeons
Highest
Three-­‐Star
Ra;ng
Sources:
AHN
2014
Census

9. C
O
N
F
I
D
E
N
T
I
A
L
9
AHN
Cardiac
&
Rehab
Loca;ons
–
CURRENT
STATE
ALLEGHENY GENERAL
• CHF Clinic
• Cardiac Rehab
WEST PENN
• Inpatient Rehab
FORBES
• Inpatient Rehab
• Cardiac Rehab
JEFFERSON
• Inpatient Rehab
• Cardiac Rehab
• CHF Clinic
SAINT VINCENT
• Inpatient Rehab
• Cardiac Rehab
ALLEGHENY VALLEY
• Inpatient Rehab
• Cardiac Rehab
CANONSBURG
• Inpatient Rehab

10. C
O
N
F
I
D
E
N
T
I
A
L
10
H@H
Heart
Care
Program
aligns
acute,
post-­‐acute,
payers
and
individual
prac;;oners
in
one
accountable
model