Comprehensive Care for Joint Replacement Model Bundled Payments: Strategies for Success and Lessons Learned Comprehensive Care for Joint Replacement Model July 21, 2016 Audio available through computer speakers OR by dialing (800) 683-4564 PIN: 900012
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Comprehensive Care for Joint Replacement Model
Bundled Payments: Strategies for Success and Lessons Learned
Comprehensive Care for Joint Replacement Model
July 21, 2016
Audio available through computer speakers OR
by dialing (800) 683-4564 PIN: 900012
Webinar Agenda
• Welcome
• Strategies for Success and Lessons Learned
o Tamara Cull, National Director, Population Health Account Management, Catholic Health Initiatives
• Q&A
• Participant Resources
• Upcoming Events
Comprehensive Care for Joint Replacement Model
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Bundled Payments: Strategies for Success and Lessons Learned
CMMI:CJR Learning System Event: July 21, 2016
Tamara Cull, National Director, Population Health Account Management
Tamara Cull, DHA, MSW, LCSW, ACM is currently the National Director of Population Health Account Management for Catholic Health Initiatives with leadership responsibility for Value Based Programs and Operations. Prior to this role at CHI, Dr. Cull served for over 20 years in acute hospital settings as the System Director of Care Management. Dr. Cull holds a Doctorate Degree in Health Administration from Medical University of South Carolina and a Master’s Degree in Social Work.
Disclosure
I have no actual or potential conflicts of interest in relation to this program and/or presentation.
At A Glance
.1-. "'r Catholic Health Initiatives
Operations in 19 States
Population Health Management Key Components
Acceleration of Value-Based Programs: The Future
Announced by HHS: Expect Other Payers and Employers to Follow
-
·-
Size
P'opulation ( provi derscan on tv participate in one a
these programs)
Conditio~n
Episode
<51000 Medica1re FFS Beneficia1ries
S,OOG-15,000 Med FFS Ben efi da1ries
15,000+ Medica1re FFS Beneficiaries
151000+ Medicare FFS Beneficiaries
I ·~cos" I 3 Medicare Shared Savings Program
4 Advance Payment
, Model 5 Pioneer ACO Model
6 Bundled Payment for Care Improvement Initiative
7 Comprehensive Care for Joint Rep~acements
s Accountab~e Health Communities
9 Oncology Care Model
~· catholic HeaJith Initiatives
Value-Based Care Programs for Medicare
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Value-Based Payment
Alternative Payment Models
ACO's, BPCI and CJR, MSSP, PCMH, APII
.. ~ ""f Catholic Health Initiatives
Population Health Management (Full Risk)
Defining Value-Based Payments
CHI’s Population Health Strategy
CHI is committed to Population Health for our mission, ministry and legacy.
Who does Population Health impact? CHI Inter-related Components
Communities…
• Need care focused around value, not drive volume
CHI Employees…
• Due to unsustainable healthcare cost trends
Physicians…
• Clinically, this is the right thing to do for our patients
Clinically Integrated Network (CIN) is a connection of providers (hospitals, PCPs, SCPs, home health, etc…) organized to meet the clinical needs of a population
– Focus on access
– Aligned incentives to address cost, quality and experience
Care Management is the approach to population health, working to support capabilities to improve total quality and cost of care
– New roles: RN Population Health Coaches, Population Health Coordinators (SW), RN Transition Coaches
– Focus is to follow the patient, not the provider
– Patient-centric motivation; understanding the patient’s goals
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CHI Clinically Integrated Networks
Arkansas: Arkansas Health Network Cincinnati: TriHealth Chattanooga: Mission Health Care Network Colorado: Colorado Health Network Houston/E Texas: CHI St. Luke’s Health System Iowa: Mercy Health Network Kentucky: Kentucky One Health Partners Nebraska: UniNet Roseburg: Architrave Tacoma: Rainier Health W North Dakota: PrimeCare Select CIN
Patient
Urgent Care
Employed PCPs
Other Physicians
Pharmacy
Home Health
Hospital Hospice
Behavioral Health
Labs
Employed Specialists
PostAcute Providers
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Focus Areas
Area of Focus Population Health Management Components
Prevention
High Risk Individuals
Transitions/Readmissions
Acute Care • • •
Utilization Management Acute Case Management Compliance
• • •
LACE/ProjectRED Continuing Care Network/SNFists RN Transition Coaches
• • •
Advanced Pop Health Analytics Coaches & Pop Health Care Coordinators Patient Centered Med Home
• • •
Basic Analytics (such as registries) RN Pop Health Coaches Patient Centered Med Home
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CHI’s BPCI Journey: 2015 Forward
July 1, 2015 October 1, 2015 April 1, 2016
• 14 Hospitals in Phase • 14 Hospitals in Phase 2 2 (up/down financial • Ortho, Spine, Cardiac, and risk) Medical Service Lines
• Ortho, Spine and ‒ 12 Total Joint Replacement
Cardiac Service Lines ‒ 1 Non-Cervical Spinal ‒ 12 Total Joint Fusion
Replacement ‒ 4 CHF
‒ 2 CHF ‒ 1 Sepsis
‒ 1 Non-Cervical Spinal Fusion
‒ 18 Total Bundles at CHI
‒ 15 Total Bundles at CHI
• Launch of Comprehensive Care for Joint Replacement (CJR)
• An additional 21 CHI facilities at risk (17 not in BPCI now) ‒ 29 Total Joint
Replacement ‒ 1 Non-Cervical Spinal
Fusion ‒ 4 CHF ‒ 1 Sepsis ‒ 35Total Bundles at
CHI
Next Mandatory CMS Bundle for 2017? Cardiac Focus
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Ortho Care Model Redesign
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Traditional cost center approaches generate silos
Redesigning care has required strong collaboration across CHI teams
Development of CHI Care Model for Transformation in Joint Care
• Care Redesign developed for the identification and documentation of joint replacement best practices
– Performance assessment tool and metrics have been developed for teams to identify needs for improvement
• Population Health team have built successful tools and training that have been instrumental current participants in the bundled payment programs
• A partnership among these groups will allow us to create, design, and implement tools and processes and provide support to aid in the implementation of the (CJR)
Population Health Team
National Orthopedic-
Spine Service Line
Clinical Process Excellence
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We are charged with understanding the patient’s full experience in order to impact overall quality of care
1-Design Select DRG, condit ion or process by opportunity, need and consensus Review data Develop CR Design Team and dyad/triad leadership Establish " l OODay Improvement Cycle Plan
management • Nurse Navigators: Starting at acute care with follow-
up to 120 post-episode; 24 hour call back available • Integrated Care Management model • Workflow management tool • Post-Acute: CCN network/relationships critical to
succeed • Engaged Physician Leadership/ Active Steering
Committee • Patient Engagement
Key Learnings Engaged physician leadership is key to success—
physicians must change their practice patterns for success in this model
Decreased utilization of post-acute services was largest revenue reduction for the programs
Data/Information must be paired with staff – data without staff (or vice versa) won’t work
Care Management/Navigation beginning at pre-op and continuing through entire episode of care is required; Patients must have access to providers 24/7 to prevent ED use and hospital readmissions
Robust patient optimization/education program to identify issues/set expectations early was critical to early identification of potential
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CHI’s BPCI Experience: Overall
October 2013-December 2015: CHI Results--Overall
Achieved CMS Savings
Achieved Internal Cost
Savings
Decreased Readmissions
Decreased SNF
Utilization and Length of
Stay
Improved Physician
Satisfaction
Improved Patient
Satisfaction
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Physician Success Factors
• Value-Based Care Models Require Physician Collaboration ‒ Must be able to demonstrate collaboration ‒ Verification of collaboration is likely (on all sides)
• Partner with high quality hospitals and ACO’s ‒ High Quality = High Value (Financial Impacts) ‒ Labor required in these models
• Coordination of Care Across the Entire Care Continuum ‒ Acute, Post-Acute, and ACO Partners Impact YOUR success in these
models ‒ Sharing of Tools and Lessons Learned
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Questions?
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.1-. "'r Catholic Health Initiatives Population Health Population Health 28
Participant Resources
• The CJR model final rule can be viewed athttps://federalregister.gov/a/2015-29438