WHCA/WiCAL May 12, 2016 Post-Acute Care Provider Networks · focus on post-acute care and the senior population • Expertise in post-acute network development; physician practice
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• Senior-level health care executive with over 20 years’ experience consulting to a breadth of health care organizations on a variety of ambulatory and post-acute strategy and management issues
• Clients include health systems, academic medical centers, home health/home care agencies, SNFs, community service organizations, and managed care organizations
• Serves on the board of the American Academy of Home Care Medicine (AAHCM) and on the executive committee as treasurer
• Respected presenter and author; has written and spoken on a variety of strategic and management issues impacting health care, including editing and authoring grant‐supported publications on community‐based care management initiatives
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Brent T. Feorene, MBAVice President, Integrative Delivery ModelsBrent T. Feorene, MBAVice President, Integrative Delivery Models
• More than 15 years of experience in the health care industry, with a focus on post-acute care and the senior population
• Expertise in post-acute network development; physician practice development and operations; and Programs of All-inclusive Care for the Elderly (PACE), skilled nursing, and telehealth operations
• Provides assistance to post-acute health care organizations with operational assessments, strategic planning, program development, due diligence activities, and continuing care development
• As director of senior services at TriHealth, worked collaboratively with nursing and post-acute facilities in the Greater Cincinnati area to improve outcomes for patients throughout the care continuum
• Serves on Public Policy Committee of National PACE Association and presents nationally at industry events
What phase of bundled payment plan implementation is your health plan
currently in?
Bundled Payment Implementation Plans2Average Percentage of Hospital Revenues by 20181
Health Systems Health Plans
1Source: Health Enterprise Partners, “Seizing Opportunity in the Wake of Reform-Executive Perspective Survey, 2012”2Source: Avality, The Health Plan Readiness to Operationalize New Payment Models, April 2013. The study was administered by independent research firm Porter Research in the fourth quarter of 2012. Porter Research completed interviews with qualified participants of 39 health plans that represented more than 50% of total covered lives in the United States. Target participants included: quality management leadership, medical directors, and chief medical officers.
Currently Implemented
24%
Planning to Implement
34%
NoPlans42%
In the next 2 years, bundled payments will represent 35% of U.S.
Post-Acute Care Plays Key Role to Bending the Cost Curve
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Source: Medicare post-acute care reforms. Statement of Mark E. Miller. Executive Director, Medicare Payment Advisory Commission.Before the Subcommittee on Health. Committee on Energy and Commerce. U.S. House of Representatives. April 16, 2015.
Health systems often have limited control of costs and outcomes sent to nonaffiliated post-acute settings
Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) provides automatic 5% lump sum bonus to physicians (starting 2019) who receive a significant portion of their revenue from alternative payment models (such as bundled payment or ACOs) and, for those who do not, potentially rewards or penalizes physicians by up to +/- 9% depending on their Merit-based Incentive Payment System (MIPS) score
Medicare Physician Payments: Undergoing Value-Based Change As Well
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Intent is to drive physicians to value-based behavior through multiple pathways
1• Physician Alignment and Access that ensures immediate access
to office-based primary care or house calls as well as primary care management in acute and post-acute venues
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• Robust IT Platform and Just-in-Time Business Intelligence that provides cross-continuum information in real time for pre-acute, acute, post-acute, and home-based encounters
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• Risk-Adjusted Enterprise Care Management that includes stratifying population and tailoring care management as well as longitudinal management of beneficiaries
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• Developing Network of Post-Acute Providers for standardized, evidence-based care across the acute/post-acute continuum and seamless, optimal patient experience
• Banner Health Network, one of the remaining Pioneer ACOs, accounted for $29 million in total savings; the Montefiore ACO saved $18 million
• Officials at both organizations said performance was boosted by attention to PAC costs and quality
• Banner Health’s ACO developed preferred network of SNFs and recommends those facilities to patients, vetting local SNFs with questions on quality and culture
• Shaun Anand, Banner Health Network chief medical officer, said improvement in PAC was significant contributor to ACO’s results
• Montefiore ACO worked with SNFs to avoid hospitalization, where possible, by finding alternatives for services that could be delivered elsewhere, such as blood transfusions
Post-Acute Cost and Quality Control Attributed to ACO Savings
Greater impact on outcomes than health behaviors, clinical care, physical environment, and genetics
Consideration of Social Determinants of Health
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Sources: Tarlov AR. Public policy frameworks for improving population health. Ann NY Acad Sci 1999; 896:281-93; Schroeder, S. We Can Do Better. N Engl J Med 2007;357
• To prepare for value-based care, define your value proposition in three key areas and then reach out to value-based payors:
Define Your Value Proposition
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Ability to Manage Readmissions Capabilities to manage the patient aggressively in situ, including telemonitoring and medical management strategies, all within expected norms
Patient Outcomes (Versus Inputs) Relative to Peers Performance better than your peer group on key outcomes
Episodic Management CapabilitiesCapacity to manage seamlessly across multiple settings, effectively communicate with the bundler
• Expand or evolve patient and family education to include discharge directions or suggestions specific to their condition
• Follow-up with discharged patients (or family members) via telephone to assess their status and determine if they’ve seen their primary care physician
• Partner with a home health agency to provide post-SNF discharge care
Post-Discharge Tracking is a Key Component of Your Community Discharge Process
• VCU Health is one of Virginia’s key regional referral centers and serves as the region’s only Level 1 trauma center for adults and children; the Medical Center represents the flagship of VCU Health, spanning from central Virginia into northern North Carolina
• VCU Health serves the community and region as both a leading academic medical center and community safety-net hospital
• Like many academic medical centers and health systems across the country, VCU Health is embracing the challenges of delivery reform stemming from the Affordable Care Act, including the need to:
– Implement population health management initiatives
– Focus on overall patient experience and overall societal health
– Participate in consolidating markets and not be marginalized
– Continue to support teaching and research missions
54Source: Manatt/Assoc. of American Medical Colleges, November 2013
VCU Health engaged the ongoing assistance of Health Dimensions Group (HDG) to make recommendations regarding development of a skilled nursing facility preferred network and centralized care coordination model; HDG’s work focused in four key areas:
1. Review VCU Health skilled nursing facility (SNF) needs, and guide preferred partnership development
2. Review VCU Health’s current and planned care coordination initiatives, future needs, and readiness for advancing integration of care
3. Research and assess integrated medical care management models
4. Identify gaps and opportunities through internal feedback
This presentation details findings of our work and specific recommendations and advisement for VCU Health
Through partnership and collaboration, VCU Health seeks to improve the care continuum for patients discharged from the VCU Health Medical Center to skilled nursing and long-term care providers. The improvement will be achieved through a
seamless and integrated patient experience and will meet the objectives of providing safe, timely, efficient, effective,
equitable, and patient- and family-centered care. This new structure will enhance the strong work being performed both at VCU Health and at nursing homes across the community, and
will better enable the network to meet the objectives of enhancing population health and driving down the cost of care.
Through partnership and collaboration, VCU Health seeks to improve the care continuum for patients discharged from the VCU Health Medical Center to skilled nursing and long-term care providers. The improvement will be achieved through a
seamless and integrated patient experience and will meet the objectives of providing safe, timely, efficient, effective,
equitable, and patient- and family-centered care. This new structure will enhance the strong work being performed both at VCU Health and at nursing homes across the community, and
will better enable the network to meet the objectives of enhancing population health and driving down the cost of care.
Through this engagement, the following have been established collaboratively between HDG and VCU Health to promote best practice design and optimal return on investment (ROI) of the network:
• Provider agreement, including uniform indigent contracting component
• Ongoing provider oversight structure
• Network member requirements
• VCU Health obligations and commitment to members
Beyond ImplementationDiscussion regarding ongoing oversight and enhancement of the network, including early wins, lessons learned, and partnership benefits thus far