Integration of Resident Centric Software to Maximize Medicaid and Medicare Revenues-Bryan Starnes, Affinity Living Group

INTEGRATION OF RESIDENT CENTRIC SOFTWARE

TO MAXIMIZE MEDICAID AND MEDICARE REVENUES

What is on the Horizon?

• Increasing Federal and State Regulations throughout the Continuum of Care.

• Decreasing number of seniors with sufficient pension income or L-T care plans.

• Recognition for the Need for Solutions to Affordable Long Term Care.

• Increasing Investment in Technology to augment Operational Efficiencies.

• Increased need for qualified professionals in the industry at all levels.

• Outcome Driven Payment Models will replace the current Fee for Service Models.

• Integrated Health Care Delivery Systems will continue to evolve.

• Expect the Medicalization of Assisted Living as a fundamental Health Care Policy Change.

Increased Demand

• Tsunami is coming – a wave of population • Oldest of 79 million Baby Boomers turn 65 in 2020

Demographic Trends

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2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

18,000,000

20,000,000

2 0 1 0 2 0 2 0

2 0 3 0 2 0 4 0

2 0 5 0

5,751,299 6,597,019

8,744,986

14,197,701

19,041,041

85+ US POPULATION GROWTH

85+ US Population

Declining Pension and Insufficient Savings

• No pensions • Workers Enrolled in Pension Plans

• 1979: 28%

• 2012: 3%

The Vision of the Future

• Americans will Proactively Choose Senior Living

• There will be a need for Dynamic Senior Living Environments • Larger range in acuity levels and healthcare needs while keeping costs down

• A growing role for Accountable and Managed Care Organizations

• Increased Need for Healthcare Technology

How Will You Manage This Vision of the Future?

INTEGRATED HEALTH CARE DELIVERY SYSTEMS

• Integrated health care delivery platforms • Person-centered care

• Respectful of individual preferences, needs, and values; supported by active involvement of individuals and their families including clinical treatment decisions.

• Accountable Care Organization (ACO) • Seeks to tie provider reimbursements to quality metrics and reductions in the total cost for an

assigned population of patients. • Managed Care Organization (MCO)

• Combines the functions of health insurance, delivery of care, and administration for an assigned population of patients. These plans provide health care in return for a predetermined monthly fee and coordinate care through a defined network of physicians and hospitals (i.e., HMOs, PPOs).

• Coordinated Care Organizations (CCO) • Networks of all types of health care providers who have agreed to work together in their local

communities for people who receive health care coverage. Each CCO is run by a local board composed of healthcare providers and community members.

Increasing Interest in Affordability and Value

• In the next five to ten years baby-boomers will have less financial resources available than their parents and affordability will become increasingly important.

• As our industry grows and evolves, more people are recognizing the need and the value that affordable senior living provides. When you compare the cost of trying to offer at home what’s offered in a senior living community it is nearly impossible to replicate.

WHERE ADULT CARE HOMES (“ACH”) FIT IN THE CONTINUUM

Communities are designed for adults who are no longer able to live on their own safely. Residents require assistance with supervision, medications, activities of daily living, meals and housekeeping. Three meals per day are provided in a central dining room. Staff is available 24 hours per day for additional safety.

NC ACH communities reside at the inflection point of costly skilled nursing and post-acute care in the continuum. ACH communities span the intermediate nursing care spectrum of the continuum and are being paid half of what nursing homes are.

ACH Community Overview

Importance in Care Continuum

Unique to North Carolina Only

COST OF CARE FOR ACH

Overview Total Cost of Care Per Day • The cost to care for a resident in an assisted

living facility is less than the cost of incarceration in the state of North Carolina.

• Skilled nursing by comparison costs more than 200% per day than caring for a resident in an assisted living setting.

• The annual cost of one resident being cared for in skilled nursing setting vs. assisted living is more than $32,000.

$163.88

$83.92 $75.82

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$20.00

$40.00

$60.00

$80.00

$100.00

$120.00

$140.00

$160.00

$180.00

Skilled Nursing Prison Incarceration Assisted Living

Higher Acuity in Assisted Living: Risk or Reward?

Keep your staff realistic about their caregiving capabilities

Implement protocols to manage higher acuity residents

Build an Assessment Mentality-know what you are accepting

Partner with other health care organizations

to create the most cost effective setting.

.

More Wellness Programs and Preventative Care

• A focus on wellness will help facilities align themselves with the demands placed on acute care facilities and reduce readmission rates to Hospitals and Skilled Nursing facilities.

• There is a big opportunity and challenge to keep people healthy and out of hospitals. Senior Housing Communities will be a vital link in that chain, through proper planning, they can bridge the gap between home and the hospital.

• Data collection and predictive analytics will be focused on medication management, physician and occupational therapy, nutrition, and care plans. The healthcare industry is quickly shifting to help aging adults stay on top of their health and keep them out of a hospital bed.

Many Different Payment Models Exist

Bundled Payment

Medicare Spending

PREPARING FOR MANAGED CARE

Keys to Success in a Managed Care Environment: Data rather than anecdotes: Using data and

outcomes to drive quality, define performance, and guide operations.

Patient Centric Models: Integrating primary

care physicians directly into AL settings via a patient-centered medical home model.

Strategic Partnerships: Cultivating well-being through therapy-driven physical wellness programming and seamless access to other services through strategic partnerships and alliances.

Utilization of technology to measure and predict outcomes.

Economies of scale and company footprint in a specific state and/or region will dictate who is partnered with and terms of the arrangement.

DATA AND OUTCOMES

SCALE AND FOOTPRINT

NORTH CAROLINA AND OTHER STATES ARE SHIFTING TO A MANAGED CARE MEDICAID MODEL

RESIDENT CARE

Resident

Marketing Leads, Referrals,

Admissions

Census

Medication

Administration

Activities of Daily Living

Electronic Medical Record

Government Mandated

Documentation & Billing

Revenue Cycle Management

Business Intelligence

OVERVIEW MatrixCare’s platform provides a full spectrum approach for

a resident-centric care model. MatrixCare’s also mitigates risk by delivering consistent and

accurate data, preventing liabilities such as medication error. MANAGED CARE - ALG PLANNING FOR THE FUTURE MatrixCare will be an integral component to obtaining

Managed Care contracts: MCO referrals contingent on outcomes Reimbursement will rely on data driven initiatives Providers with large economies of scale and market

presence will have the most advantageous negotiating position with MCOs when determining rates

CENSUS

ASSESSMENT ALG has developed a proprietary assessment tool for evaluating incoming residents

needs and predicting future resident needs. MatrixCare’s database of over a million lives will allow Affinity access to predictive

analytics that enables Affinity to not only create care plans based on a resident’s current condition, but plan for and prepare the resident’s family for what’s to come.

RESIDENT MANAGEMENT Automatically create service plans from assessments. Customize assessments and sub-assessments to manage state or community specific regulations. Schedule, track, and analyze assessments. Automate billing changes based on assessment level changes. Document and track resident and/or employee related incidents and injuries.

MEDICATION ADMINISTRATION

PHARMACY CENTRIC MODEL CareAssist helps increase the accuracy of prescriptions and

streamlines communication with your pharmacy using Pharmacy Centric Order Entry. The intuitive eMAR functionality increases medication administration efficiencies while decreasing errors.

Physician Orders sent directly to

Pharmacy

Pharmacy fills orders and ships

to the facility

Facility takes delivery of order

and checks order

Med-Tech at facility

dispenses to resident

SMARTLINX – HUMAN CAPITAL

Employee

Complex Schedules:

Ensure required staffing

provided

Monitor overtime with real time data

Ensure staff meet

certification & credentialing requirements

Find shift replacement

with the Schedule Optimizer

Employee HR files and record

keeping

Punch-in with biometric

verification clocks

Monitor ACA compliance

Enhance communication

through APPs and text

messaging

OVERVIEW One of the most important assets in Seniors Housing is

Human Capital. Smartlinx simplifies the management of human capital

through an integrated platform. Smartlinx assists operators in managing talent, creating

and optimizing schedules, and enables management to track trends in real time through on-demand access to effective software.

PURPOSE Reduce unnecessary overtime and excess staffing. Ensure regulatory compliance with staffing. Credentialing and certification checks. HR and record keeping. Transparency and staff communication.

COST MANAGEMENT OVERVIEW DSSI links Senior Living communities to their unique supply

chains, delivering unparalleled procurement cost savings, supply chain optimization and contract compliance.

FEATURES Group Purchasing Organization (“GPO”) – Affinity is a

member of an elite GPO consisting of 25 of the largest healthcare providers in the country banded together to leverage lower contracted food costs and other supplies.

DSSI is a clearing house platform for suppliers and end users which gives Affinity the capability of controlling food order guides to match our menus with the lowest costs possible.

DSSI allows budget controls for facilities to see real time dashboards of MTD and YTD budgets and expenses by supply GL codes.

DSSI feeds approved supplier invoice info directly into our accounting platform (Yardi) for real-time GL posting and accurate income statements at a fraction of the labor costs of individual accountants.

Compliance

Price Auditing

Automation

Formulary

IT

VALUE PROPOSITION

MAINTENANCE SOFTWARE

Scheduling and Tracking Establish, monitor, and execute and meter based preventative maintenance tasks.

Work Order Management Comprehensive work order management with asset-level tracking capabilities, advanced routing, and adaptive status reporting.

Inventory Basic Inventory has records with just the essential fields and consumption tracking. Automatically link parts used with assets when you close a work order.

Graphical Reporting Easy to read reports that allow the user to accurately asses how each facility is functioning and identify improvements and cost savings.

Maintenance Advisor Dashboards

Create customizable dashboards that allows you to link videos, photos, documents, and websites to your Dashboard as well.

Mobile App Manage, initiate, and complete work orders wirelessly from a handheld device.

MENU PLANNING SOLUTION OVERVIEW Grove Menus is a menu development software company

that comes with a registered dietician. This platform enables Affinity to produce a 5 week rotational menu with products in a specific facilities budgeted price range.

FEATURES Menus – specifically written to control costs within a

facility’s budget. Ordering lists – allows facility to take delivery on the

exact amounts of food needed for the week, adjusted for the recipes chosen and production amount.

Analytics – program gives an estimated cost per serving for each recipe, and then gives an estimated total for each meal and each day.

Prep/Pull Sheet – reminds you what meats to be pulled, and which items to prepare the day before production.

Recipes – scale to the resident count and desired number of servings.

Compliance – helps to ensure that residents dietary needs and specifications are met.

Outcome - Affinity Raw Food PRD is below the industry average.

• And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, whether the storm is really over