12/10/2012 1 Innovations in Elder Care Jennie Chin Hansen, CEO, RN, MS, FAAN American Geriatrics Society Warren Wong, MD, FACP National Medicare Strategy, Kaiser Permanente Session C2 The presenters have nothing to disclose 12/11/2012 1:30 PM Session Objectives Be able to describe initiatives that emphasize alternatives to traditional patient and disease focused care delivery. Provide perspective on a shared and actionable vision for Older Adults with Complex Needs. Plan activities within their own work environments
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12/10/2012
1
Innovations in Elder Care
Jennie Chin Hansen, CEO, RN, MS, FAAN
American Geriatrics Society
Warren Wong, MD, FACP
National Medicare Strategy, Kaiser
Permanente
Session C2
The presenters have nothing to disclose
12/11/2012
1:30 PM
Session Objectives
Be able to describe initiatives that emphasize alternatives to traditional patient and disease focused care delivery.
Provide perspective on a shared and actionable vision for Older Adults with Complex Needs.
Plan activities within their own work environments
12/10/2012
2
Evolving Directions in Framing Health and Care of Older Adults
A directional shift from reimbursement of volume towards outcome.
Focus on improving quality, safety and value.
Recognize the importance of addressing cost outliers.
There are more concrete population health initiatives that go beyond the hospital and facility settings
Health care payors and providers are learning to expand their consideration of “patient” to “older adult”
Examples of Innovative Practices
Long Term Quality Alliance
Coalition with example of best practices
CMS-Center for Innovations and Other ACA Enabled Efforts
Partnership for Patients
Independence at Home
ACA Section 3024
Hospital at Home
Stanford Coordinated Care
Chronic Care, Employer Based Systems
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Long Term Quality Alliance (LTQA)
Begun late 2010
Influenced by December 2010 article published in the Stanford Social Innovation Review (Winter 2011) explored a new “Collective Impact”(Kania and Kramer) approach to community change
Cross sector membership committed to quality of care transitions and stewarding resources
• Evolved from landlord role to advocate monitoring health and
coordinating services help resident stability-
• 1 year outcome-22% falls reduction, 19% reduced risk reduction of
those of moderate risk; physically inactive residents reduced by
10%
• July 2011-112 housing projects added
• Estimated $40million w health care
Savings to Medicare
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LTQA Initial Best Practices
Community Resource Identification and Coordination to ease
transitions form home to hospital-
Created NC Alliance for effective Care Transitions-30 org
stakeholders to coordinate aging and long term care services and
supports
1. 6 counties assisted for CC Transitions Program
2. Coordination of Aging and Disability Resource Centers (ADRCs)
3. Support for 14 films-”Caring Matters” for caregivers
Carol Woods Retirement Community
The Triple Aimfor the Older Adult
Better Care
Better
Health Lower Costs
Maintain best function and
engagement in home and
community: prevention, self
care, coordination
Hospital-Quality and Safety
•ACE-Acute Care for Elders
•Transitions Programs-Naylor,
Coleman, Boost, Project Red
•NICHE
•Value Based Purchasing
•Partnership for Patients
Save $$$ for
consumer/family, payors,
society-Medicare,
Medicaid
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Community Based Care Transitions Program (CCTP)-Section 3026
Provide Payment for Care Transitions Services to Improve Health and Reduce Readmissions
An Engine & Asset to Connect Hospitals and Communities to Help Patients
47 Sites in Place with Many More on the Way
Buttressed by HENs, QIOs, AAAs, ADRCs and Many Other Resources to Reduce Readmissions
The Community-Based Care Transitions Program (CCTP, ACA Section 3026)
Now 47 Sites: CBOs with 200+ hospitals
serving 185,500 beneficiaries in 21 states
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There has never been a time like this in U.S. Health Care: unique confluence of forces for change
1. There is unprecedented Federal action and coordination, including CMS payment reform and innovation.
2. Physicians and other health professionals need to be front and center in these efforts: We need your more active involvement to get this right.
Council of Medical Specialty Societies: McGann and Wagner Nov 2012 CMS
Partnership for PatientsTen Priority Areas of Focus
1. Adverse Drug Events
2. Catheter-Associated Urinary Tract Infections
3. Central Line Associated Blood Stream Infections
4. Injuries from Falls and Immobility
5. Obstetrical Adverse Events *
6. Pressure Ulcers
7. Surgical Site Infections
8. Venous Thromboembolism
9. Ventilator-Associated Pneumonia
10. Reducing ReadmissionsSource: CMMS 2012
* Only area that would not relate to older adults
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Innovation Center PortfolioLong-Term Care Involvement in Many Areas
Primary Care Transformation●●●● Comprehensive Primary Care Initiative (CPC)●●●● Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration●●●● Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration●●●● Independence at Home Demonstration●●●● Graduate Nursing Education Demonstration
Bundled Payment for Care Improvement●●●● Model1: Retrospective Acute Care ●●●● Model 2: Retrospective Acute Care Episode & Post Acute●●●● Model 3: Retrospective Post Acute Care●●●● Model 4: Prospective Acute Care
c ●●●● Partnership for Patients
●●●● Community-Based Care Transitions●●●● Million Hearts ●●●● Innovation Advisors Program● Health Care Innovation Challenge
Initiatives Focused on the Medicaid Population●●●● Medicaid Emergency Psychiatric Demonstration●●●● Medicaid Incentives for Prevention of Chronic Diseases●●●● Strong Start Initiative
Dual Eligible Beneficiaries●●●● State Demonstration to Integrate Care for Dual Eligible Individuals●●●● Financial Models to Support State Efforts to Integrate Care●●●● Demonstration to Reduce Avoidable Hospitalizations of Nursing Facility Residents
Source: CMMS 2012
There has never been a time like this in U.S. Health Care: unique confluence of forces for change
1. There is unprecedented Federal action and coordination, including CMS payment reform and innovation.
2. Physicians and other health professionals need to be front and center in these efforts: We need your more active involvement to get this right.
Council of Medical Specialty Societies: McGann and Wagner Nov 2012 CMS
12/10/2012
8
Header
Hospital at Home®: Disseminating an Innovative Health
Service Delivery Model into Practice
Bruce Leff, MDProfessor of MedicineJohns Hopkins University Schools of Medicine & Public Health
Hospital at Home slides source: Bruce Leff, MD 2012
Hospital Safety Pre IOM
Hospitalat Home®
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12/10/2012
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Hospitalat Home®
Hospital Safety Over Time – Post IOM
� 10 NC hospitals, annual review of charts ‘02 to ‘07, n=2341� 588 harms = Rate: 25.1 / 100 admits
� Harms:
� 2.9% permanent
� 8.5% life threatening
� 2.4% caused or contributed to death
� Harms from procedures, medications, nosocomial infections, other therapies, diagnostic evaluations, falls
� No change over time in rate of harms
NEJM 2010;363:2124
• 61% chose HAH care• HaH is feasible and efficacious• High-quality care• Fewer complications• Higher satisfaction • Lower costs of care
Ann Intern Med. 143:798-808, 2005. J Am Geriatr Soc. 54:1355-1363, 2006. J Am
Geriatr Soc. 2008;56(1):117-23. Am J Manag Care. 15:49-56, 2009. J Am Geriatr
Soc. 2009;57(2):273-8. Medical Care, 47(9):979-85, 2009.
Less CG stress
Better function
High provider satisfaction
Hospitalat Home®
12/10/2012
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HaH at Presbyterian Health SystemHaH for PHS health plan pts1st year of HaH