CDAO 2019 rich jolly Avamere presentation
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Avamere Health Services used advanced data analytics to optimize their bundled payments program under the BPCI initiative. They analyzed historical data to select bundles, monitored performance, and accessed readmission risk. Analytics helped manage the patient episode across settings like SNFs, hospitals, physicians, home health, and readmissions. This approach resulted in net financial gains each quarter, a meaningful impact on profits, and strong ROI. It also led to organizational learning, clinical improvements, and a constant improvement mindset across their core business.
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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