EvergreenHealth is the largest single location home health provider in the Pacific Northwest, serving over 129,000 visits in 2015. They have adopted a horizontal leadership model with 5 managers overseeing 50+ clinicians each. This empowers clinicians to identify issues and lead innovation projects to solve problems. EvergreenHealth aims to become a high acuity home health provider by developing programs like same day joint replacement and partnerships with skilled nursing facilities and telehealth. Their approach is to be open and responsive to physician needs, form clinician task forces to address challenges, and invest in clinician education to drive lasting cultural changes that position them as a top provider.

1. EvergreenHealth’s journey to become a high acuity HH provider
Brent Korte, Director of Home Health
EvergreenHealth
Kirkland, WA

2. Largest single location HH provider in the Pacific Northwest
265 Clinicians
129,000 visits in 2015
Hospital based in Kirkland, WA
Horizontal leadership structure
 5 Managers each overseeing 50+ employees
 Model that mandates clinician inclusion and referent leadership

3. Identify opportunity/issue
 All ideas are considered from all staff
Clinicians and support staff solve the problem
 Present problem=>Interest gauged=>SIG forms=>Innovation project begins
Why give it to the clinicians to solve?
 Utility: They will be doing the work
 Expertise: If we hire the right people, our clinicians are a pool of experts
 Engagement: The more they are able to lead, the higher engagement
 Think tank: 265 minds are better than 1

4.  Innovation: Tech vs. Healthcare
 Technology innovates to:
• Change the world, to disrupt, to make $$$
 Healthcare innovates to survive because..
• we were told to…in 20,202 pages/11.5M words through the
regulations of the ACA
 Tech hears: “Do the unthinkable, break the mold and change the
world”
 Healthcare hears: “Do better, less $$, more ”, “oh and partner with
everyone”, and by the way “you need to compete with your new
partners”.
 Tech: Change is literally in the air…..Good food and flying packages
 Healthcare: EvergreenHealth’s plans

5. Psychiatric Nursing/Occupational therapy program
 Trying to get ahead of behavioral/mental health issues
COPD and CHF pathways involving telehealth and community
partnerships
Value Based Purchasing Model
 Restructured all processes to achieve success with outcomes
HH for Same Day Joint Replacement….

6. Outpatient TKA happening for years..but at very low rates.
 As of March 2014, only 1.6% of all TKA surgeries**
 Few non-HMO Home Health providers have programs
Why did we decide to pursue this program?
 To innovate is to compete:
• Top Surgeons in Seattle metro area are performing outpatient TKA more often
• Top Surgeons in Seattle metro area refer to EH…for now

7. Answer: The need identified us.
Surgeon #1-Top ortho MD in US, but “what is bundling?”
Visit to local 90 bed SNF, same question.
And then. Call on drive back from Surgeon #2-Help me design our
OTJR Program
 Quotes

8. Expectations:
Prehab visit
PT waiting at patient’s home
daily or BID visits for next three days
Reality:
Prehab visit
PT waiting at patient’s home
Daily or BID visits for next three days

9. How we reacted to these asks:
 “We’ll figure it out”
 Orthopedic Special Interest Group engaged the next day
• Study best practices
• Audits of Total Joints over past year
• Deep dive into quality metrics affecting surgeons
 Ortho “Strike Team” formed
 Ongoing planning with go live set for October for TKR, August for
partials and anterior hips
Cultural shift to: The answer is yes, what’s the question?

10. Skilled Nursing Facilities
How can HH compete with Skilled Nursing?
 MDs care about LOS, pain/swelling/infection control, HCAHPS,
readmissions
 We think we can get most patients to 110-120 knee flexion within 2
weeks
 We are cheaper

11. We are now competing for many of the same patients and
Home Health’s value proposition is strong
Home Health nationwide is being asked to do provide care
for highly acute patients-and the top HH providers are raising
the bar
HH is provided at a lower cost

12. Long term care is already providing care to highly acute patients and
does it very well
Up to three hours of combine rehab daily and more equipment
MD referral trends are slow to change
Home Health may be less costly, but can’t provide the same level of
care

13. Lasting change occurs at the clinician level
Hire Top Clinicians, keep them engaged and support them with
education
 $1000 per clinician/$265K for optional CE
Communicate the ‘Why’
Leaders step back, clinicians drive the change

14. ROI on education investment is significant
 VBP example
ROI by building upon our reputation as the top provider
 “We can take whatever you throw at us”
HH is seeking to become leader not just of Post Acute
but within the entire continuum

15. Raise the bar with higher acuity, showcase quality outcomes
and your organization can be…
Top referral source
Sought after partner with top end providers
Sought after partner in ACOs, CINs and other risk based contracts
 Quality mechanism is already in place, great outcomes follow