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11. joseph ebberwein ga partnership 03 2013


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11. joseph ebberwein ga partnership 03 2013

  3. 3. THA Group © 2013THE EVOLUTION OF THEIN-HOME HEALTH CARE INDUSTRYEvolution:“A gradual process in which something changes into adifferent and usually more complex or better form.” - TheAmerican Heritage DictionaryHome Care’s Creation1965 – In the Beginning…  Medicare creates benefits for non-profit home healthcare to substitute for last days of hospitalization
  4. 4. THA Group © 2013THE EVOLUTION OF THEIN-HOME HEALTH CARE INDUSTRY1980 - Congress saw that this was good…  Opened the benefit to full participation to proprietary home healthcare1988 - 1996  Home health beneficiaries increased 225%  Half of those patients received 200 or more annual visits (Hospitals Prospective Payment System precipitated need for Post Acute Service) …the pay-per visit world flourished
  5. 5. THA Group © 2013THE EVOLUTION OF THEIN-HOME HEALTH CARE INDUSTRY1997  Congress passes Balanced Budget Act of 1997  Medicare announces Interim Payment System (IPS) to curb growth.1998 - 1999  CMS’ costs saving effort resulted in 1/3 of Home Care Industry closing its doors. EVOLUTIONARY LESSON: Survival of the fittest and natural selection played out as over 1/3 of our industry became extinct.
  6. 6. THA Group © 2013THE EVOLUTION OF THEIN-HOME HEALTH CARE INDUSTRY2000 - Demand for home health care continued to grow…  Prospective Payment System (PPS) was created setting the stage for the evolutionary concepts of adaptation and improvisation to enhance chances of survival.
  7. 7. THA Group © 2013THE EVOLUTION OF TECHNOLOGY ININ-HOME HEALTH2001 - 2005 Advent of Telemonitoring Technology as a Tool  Remote Telemonitoring technology enabled knowing when the patient needed to be seen: Doing the Right Thing, At the Right Time, In the Right Place.  Telemonitoring took some of the “guesswork” out of home care EVOLUTIONARY LESSON: Those who improvised and adapted to technology early survived - some just barely.
  8. 8. THA Group © 2013THE EVOLUTION OF TECHNOLOGY ININ-HOME HEALTH CARE2001 - 2008 In-Home Technology Tools Telehealth  The total assimilation of the telemonitoring tool in the strategic direction of a home care organization Point of Care Information Systems  Electronic health records allowing flow of clinical information to be seamless, in real time, and available to all clinicians Telephony/Teletriage  Important methodology for data collection, care monitoring, and patient education EVOLUTIONARY LESSON: Selection and integration of multiple homecare technologies led to natural selection of the survivors.
  9. 9. THA Group © 2013“THE TIMES THEY ARE A-CHANGIN”… RELEVANCE TO IN-HOME HEALTH CARE 2009 - American Recovery and Reinvestment Act (ARRA) - Stimulus BillOpportunities  Hospital Penalties for Readmissions  4 out of 5 Diagnoses are Chronic Conditions 2010 - Patient Protection and Affordable Care Act (PPACA) - Health Care ReformOpportunities  Pay-for-Performance  Chronic Disease Management  Population Health Management  Employer Wellness  Independence at Home Model  State-Based Initiatives and  Hospital Re-Admission Reduction Advance Primary Care  Community-Based Care Transitions  Cost Effective Management  Meaningful Use and EHR Certification of the Medicaid/Dual Eligibles  Bundled Payments  Patient-Centered Medical Home
  10. 10. THA Group © 2013“THE TIMES THEY ARE A-CHANGIN”…VALUE-BASED PURCHASING (VBP)AKA ACCOUNTABILITY 2011 - Hospital VBP Plan ImplementationOpportunities  Care Transitions Program/Community-Based Organizations (CBOs) Program - 4/12/11  Data Collection for Hospitals Commences - 7/1/11 2012 - CMMI - Center for Medicare and Medicaid InnovationOpportunities  Pioneer Accountable Care Organizations (ACOs) Implemented - 1/1/12 CMS  Medicare Shared-Savings ACOs Awarded - 4/10/12 CMMI  Innovation Challenge Grants
  11. 11. THA Group © 2013“THE TIMES THEY ARE A-CHANGIN”…VALUE-BASED PURCHASING (VBP)AKA ACCOUNTABILITY2012 - CMS  Hospital VPB Penalties Commence for Readmission - 10/1/12Opportunities  Deduction of 1% of DRG per Discharge, Creating an Incentive Bonus Pool HHS  Deadline for Home Health VBP Plan (TBA)2013 & HHSBeyond -  Hospital VBP Penalties Deduction rises to 3% on 10/1/14Opportunities  Future VBP Plans for Physicians, Hospice, and SNF’s EVOLUTIONARY LESSON: Those who collaborate in alliances and work in teams increase chances of survival of the fittest.
  12. 12. THA Group © 2013A “SEISMIC HABITAT SHIFT”…
  13. 13. THA Group © 2013“THE CHANGE…A “SEISMIC HABITAT SHIFT” A Shift from: Volume-Based Reimbursement Value-Based Reimbursement Short-Term Acute Long Term Chronic Care (all stages of life) Institution-Based Community-Based Care Provider Dictated Provider Counseled for Patient Ownership of Self-Management Single Provider Responsibility Physician Directed “Practice Teams” for Care A Shift to:  Patient by Patient Individual Focus Population Focus Quality ACCOUNTABILITY for: Efficiency “Slow-Spending” BOTTOM LINE: Survival Requires A Redesigned Healthcare Practice Model
  14. 14. THA Group © 2013A MAJOR FORCE OF NATURE…THE VALUE TSUNAMI Creating a Culture that Embraces Change… Relentless Pursuit Quality of Value* = Cost Quality = Clinical Outcomes X (Patient Satisfaction + Brand Image) Cost = Clinical Efficiency X Accuracy X Capacity *As Perceived by the Customer
  15. 15. THA Group © 2013A CULTURE THAT EMBRACESEVOLUTION NATURALLY EVOLVESRELENTLESS PURSUIT OF VALUE Past Current/FutureLeadership Hierarchical Servant LeadershipContinuum of Care Provider-Centered: Patients Patient-Centered: Service Arranged Around Service Lines Lines Arranged Around PatientsClinical Practice Philosophy Independent Practice Silos Team PracticePatient Care Philosophy Nurturing Caregivers in Patient-Centered Care that Patient-Dependent Role Empowers Patient for Self -ManagementPatient Care Delivery Face-to-Face In-Home Visits Remote Technology-Targeted (Many Unnecessary Visits) Face-to-Face Visits (Only Necessary Visits)Compensation Volume Incented Outcomes Incented
  16. 16. THA Group © 2013A CULTURE THAT EMBRACESTECHNOLOGY NATURALLYSPURS INNOVATION Riding the Evolutionary Tsunami Wave of Innovation  Overcoming Fear of Technology - “It Will Replace Me”  Embracing Technology As a Tool - “It Makes Me Look Good”  Increased Efficiency  Enhanced Quality  Sophisticated Image
  17. 17. THA Group © 2013ONCE YOUR CULTURE “ADAPTS” TOTECHNOLOGY - YOU’RE READYTO RIDE THE WAVE…Providers Technologies ModelsHospital Systems Electronic Health Records Care TransitionsPhysician Groups Consumer Health Records Medical HomesPost Acute Care Remote Personal TelemonitorsProviders ACOs• Home Health Medication Adherence Devices• Hospice Disease Management• SNF Medication Reconciliation Programs• Rehab Centers Devices Medicaid Health Homes Assistance Monitors Bind Providers Together Value Based Purchasing Models Develop Shared Savings Collaborate on Joint Incentives EVOLUTIONARY LESSON: Commonality of Key Technologies Integrated Across Care Settings is Necessary to Produce Value and Avoid Extinction
  18. 18. THA Group © 2013THA GROUP’S EVOLUTION
  19. 19. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONDAY BEFORE YESTERDAY Remote Telemonitoring Ushered in the Age of Telehealth  “Telehealth” - The total assimilation of the Telemonitoring Tool into the strategic direction of home care organization: it’s clinical model and it’s business model  Practice of Telehealth requires: - Integration of Point-of-Care Technology & Remote Telemonitoring System - Virtual / “Telephonic” Visits and seamless flow of real time data result in enhanced clinical plans of care and protocols
  20. 20. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONDAY BEFORE YESTERDAY Practice of Telehealth Produces Value: High Quality Clinical Outcomes
  21. 21. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONDAY BEFORE YESTERDAY Practice of Telehealth Produces Value: Clinical Efficiencies Total Visits Skilled Nurse Visits
  22. 22. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONDAY BEFORE YESTERDAY Practice of Telehealth Produces Value: • Enhanced Capacity And Productivity • Grew Volume 50% Without Added CCM’s
  23. 23. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Adaptation & Emerging Business Models: 78M Baby Boomers Coming will demand further adaptation 75¢ - 85¢ of every Health $ Spent on Chronic Disease = Unsustainable system
  24. 24. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Adaptation & Emerging Business Models: Clinical Provider Partnerships across settings is critical to the sustainability of future health care models - Care Transitions & Care Management Empowered patients/families with “tools” for self management –AKA: Adaption to Inevitable Chronic Disease EVOLUTIONARY HYPOTHESIS: Collaboration should result in Reprogramming of DNA… Old Practices and Habits
  25. 25. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Mutation: Integrated Disease Management Pilot Project (2007-2008)  Demonstrate that chronic illness can be managed successfully by combining: - Partnered Physicians - Empowered Patients / Families - Homecare Provider Practicing Telehealth
  26. 26. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Mutation: Two phases: Intervention and Follow-Up  Patients agreed to: - Monitor / transmit vital signs daily - Call the homecare provider before visiting Emergency Department (ED), except in true emergencies  Physicians agreed to: - Not direct patients to EDs for non-life threatening exacerbations  Telehealth Provider agreed to: - Educate, monitor, coach, call daily, and respond within 15 mins with care coordination
  27. 27. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Mutation:Results:Intervention Phase: 6 monthsRe-hospitalization Rates:7% - PilotCompared to34% - Medicare Claims Data (90 days)
  28. 28. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Mutation:Results:Follow-up Phase: 6 monthsRe-hospitalization Rates:23% - PilotCompared to50% - Medicare Claims Data
  29. 29. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONYESTERDAY Mutation: EVOLUTIONARY LESSON: Highest probability of sustainability must be founded on 3 pillars of rock solid support via collaboration between: - Empowered Patients / Families - Technology Driven In-Home Care Providers - Physician Integration
  30. 30. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONTODAYNatural Selection:  Results from regional hospital partnership  Hospital awarded American Heart Association award for reductions  30 Day Rehospitalization Rate (27 months) = 8.4% Evolutionary Lesson: Care Transitions is Critical
  31. 31. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONTODAY  Able to directly correlate utilization to interventions  $104,000 (32%) decrease in hospital charges  Need for on-going monitoring is indicated EVOLUTIONARY LESSON: Need to stratify patients with a formal system tool
  32. 32. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONTODAY  “Worst Offenders”  Self-funded  Multiple Chronic Conditions  Major Psychosocial Challenges  Significantly reduced hospital charges by 85% EVOLUTIONARY LESSON: 3 months is not adequate to activate for self-management
  33. 33. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONTODAY Natural Selection: EVOLUTIONARY LESSON: Collaborative/Integrated Health Care occurs when Technology Enabled In-Home Health Care Models evolve into Care Management Models to improve the Transitions of Care across settings
  34. 34. THA Group © 2013DAWNING OF A NEW AGE…
  35. 35. THA Group © 2013BACK TO THA’s DNAThe Value Equation: Quality CostMaximize value by doing:The RIGHT Thing Patient-Centered Chronic Care Management Physician-led, integrated Care TeamThe RIGHT Way empowered by health information technologyThe RIGHT Place AT HOMEThe RIGHT Partners Patient / Family, Patients MD, & Care TeamThe RIGHT Team RN Patient Advocate, Health Coach, Care Delivery TeamThe RIGHT Practices Evidence-based best practices coupled with activation for self-managementThe RIGHT Processes Patient Stratification Tool, Care Transitions
  36. 36. THA Group © 2013IN-HOME HEALTH CARE’S EVOLUTIONTOMORROW - DAWNING OF A NEW AGE The Reinvention of In-Home Healthcare Tomorrow …The RIGHT Model Innovation in Management of High Cost, At Risk Patients Leading to: • Lower Overall Cost of Care • Improved Clinical Outcomes • Enhanced Quality of Life for Patients and Families Aligning Interests of: • The Patient • The Care Providers • The Payors
  37. 37. THA Group © 2013
  38. 38. THA Group © 2013“REVELATIONS”…TOMORROW - DAWNING OF A NEW AGETHE RIGHT MODEL -  Nurse PractitionersNew Patient-Centered  RN Patient AdvocatesCare Team  Behavioral Specialists  Health Coaches  Clinical Specialists:  Palliative Care  WOCN  Respiratory  Rehabilitation  Nutritionist/Dietician  Medical Social Worker  Pharmacists
  39. 39. THA Group © 2013“REVELATIONS”…TOMORROW - DAWNING OF A NEW AGE The RIGHT TechnologyRemote Telemonitoring Video “Virtual Visits”  Algorithmic Software  Allows for “Virtual Visits” For: - Specific for Chronic Disease Management  Nurse Practitioner Consults With Physicians  Software Delivers Chronic - “Virtual ED” Visits -To Prevent Disease Patient Education Rehospitalization & Reinforcement (videos)  Pharmacy “Virtual” Consults  Behavioral Specialists “Interventions”  Data Analytics by Specific Chronic Disease
  40. 40. THA Group © 2013“REVELATIONS”…TOMORROW - DAWNING OF A NEW AGE The RIGHT Technology Remote Medication Remote PERS (Personal Adherence Emergency Response System)  Programmable device to  Software that discerns deliver medicine at body position and alerts/ specific dosage and time summons help  Tracks and alerts “missed”  Panic button with audio medications  Increases independence  Increases independence
  41. 41. THA Group © 2013“REVELATIONS”…TOMORROW - DAWNING OF A NEW AGE The RIGHT Technology Integrated EHR Systems Personal Health Record Across Providers  HIEs  Single source for patient’s  Dashboard for real time salient health information decision support information  Housed on secure site  Provides a “bridge” to physicians and other providers
  42. 42. THA Group © 2013“REVELATIONS”…TOMORROW - DAWNING OF A NEW AGE The RIGHT Technology Customizable Point of Care Customer Portals EHR/ Clinical Intelligence  Embedded evidenced-based  Provides MDs, patients / best practices families, & payors real time “Makes it nearly access to data impossible not to do the  Enhances communication RIGHT THING” tailored to customer preferences  Transforms in-home (email, text, etc.) healthcare delivery model
  43. 43. THA Group © 2013RESEQUENCING OUR DNA The RIGHT Partners IDENTIFY THE RIGHT PARTNERS  Hospitals (Rehospitalizations)  Physician Groups (Medical Home)  Payors PAYORS  Medicare Advantage Plans  State Medicaid Plans  Medical Care Management Organizations (CMOs)  Commercial Insurers  Self-Insured Employee Groups  Third Party Payors
  44. 44. THA Group © 2013THE RIGHT TIME…Environmental Changes Legislation  ACA - Supreme Court Decision CMS Senior Leadership  Demonstration Projects  New Care Delivery Models Sequestration  Continued reduction in payments to providers EVOLUTIONARY LESSON: If a species is unable to adapt to environmental changes, it becomes extinct.
  45. 45. THA Group © 2013The RIGHT Time Is…NOW!