UnityPoint Accountable Care Post Acute Care Development and Partnership Skilled Nursing Facilities. March 2018
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1 UnityPoint Accountable Care Post Acute Care Development and Partnership Skilled Nursing Facilities March
2 UnityPoint Accountable Care Footprint and Organizational Structure 2
3 UnityPoint Accountable Care Multi-state ACO/CIN Value-Based contracts 250,000 lives in Value Agreements 50%+ with downside risk = $1B+ 7,850+ Providers 5,542 independent 2,308 employed 45 hospitals Approximately 88,000 lives in Next Generation Model ACO 3
4 Organized System of Care 4
5 UnityPoint and Triple Aim 5
6 Developing a Post-Acute Care SNF Network 6
7 Why Skilled Nursing Facility Networks Matter 29,191 Post-Acute Care Facilities 15,263 are SNF Facilities (52%) 2.3 Million Medicare Covered Stays $27.2 Billion in SNF Spending SNF PAC Medicare Spending ($ in Billions) 15.1 Hospice LTCH Home Health IRF Source: MedPac, 2015/2017 Data Book 7
8 Opportunities to impact current landscape Little incentive for SNFs to adjust care delivery Fragmented approach to care delivery Variability in length of stay and cost of care Variation in quality and outcomes Lack of collaboration between acute and post-acute 8
9 Post-Acute Network Goals Improving the patient experience Disciplined approach in identifying partners High Performing Network Establish shared vision for performance Ensure network adequacy Partner on triple aim initiatives Measure and monitor outcomes 9
10 Post Acute Care Sub-Committee Innovation Network Criteria Strategy Standardization Quality monitoring and improvement Care Protocols QCIC Quality and Clinical Integration Council Post-Acute Care Sub- Committee ACO Board of Managers FNDC Finance and Network Development Committee 10
11 SNF Minimum Criteria 1. Capability to admit 7 days/week, with after hours options...(access) day hospital re-admissions rate metric (cost) 3. Average length of stay metric (cost) 4. CMS 5 star overall rating of 3 or better.....(quality) 5. Participates in on-going quality initiative led by regional OSC....(Quality) 6. Medical director aligned with UAC values and focus on triple aim..(alignment) 7. Agrees to self-report data that is not publically available...(collaboration) 8. Actively using INTERACT or comparable tools...(care Coordination) 9. Utilize EMR Link....(Care Coordination) hours RN coverage (16-hours on site)....(capabilities, Quality) 11. Utilization of advanced practitioner provider......(capabilities, Quality) 11
12 Post Acute Care Dashboard 12
13 Post Acute Care Dashboard 13
14 Value Proposition for SNFs Designated preferred partner Eligible for shared savings Participation in quality initiatives Access to waivers and ACO contracts Access to system resources 14
15 UAC SNF Network 95 SNFs in ACO $33 million in CMS payments 3028 Unique patients 3979 Total Admits In 2018, 85% are participating in shared savings/risk 15
16 Utilization of MCG Care Guidelines within Indicia for Case Management Implemented MCG care guidelines in July of Evidence-based guidelines to support correct PAC placement and length of stay Primarily utilized by select case managers/social workers in each region to track patients during SNF stay Validate clinical findings to support SNF level of care Document variances when goal length of stay is not met Track RUG codes to identify aberrancies in RUG utilization Multiple reports built for users to access as needed to track performance and outcomes MCG used in conjunction with RN Case Manager and ARNP rounding to reduce re-admissions and length of stay 16
17 Post-Acute Care Teams Discharge Planners SNF Navigators Physicians Nurse Practitioners Case Managers 17
18 Post Acute Care Network Brochure 18
19 Post Acute Care Network Brochure 19
20 Results and on-going steps 20
21 Pre-MCG Average Length of Stay (claims data) Start MCG Jan 2015 Feb 2015 Mar 2015 Apr 2015 May 2015 Jun 2015 Jul 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 Jul 2016 Aug
22 Post-MCG Average Length of Stay (Claims data) Narrowed length of stay variance to days
23 Average Length of Stay 27 Begin MCG Network Linear (Network) 23
24 Unplanned Readmissions 18.00% Unplanned Readmits % SNF Stay 2016 Unplanned Readmits % SNF Stay % 16.00% 14.00% 20.00% 12.00% 10.00% 15.00% 8.00% 10.00% 6.00% 4.00% 5.00% 2.00% 0.00% Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Network % Jan Feb Mar Apr May Jun Jul Aug Grand Total 19.77% 12.64% 14.21% 14.72% 13.83% 14.60% 14.00% 13.30% 24
25 ACO vs Non-ACO 30.0 Length of Stay $12,000 Cost per Stay $10,000 $9, $8,000 $7, $6, $4, $2, ACO Non ACO $0 ACO Non ACO 25
26 Conclusions Keys to Success Primary application administrator to provide education, trouble shooting, and encourage utilization of care guidelines SNF partners that are aligned with same goals and are on-board with achieving metrics Utilization of rounding by RN case managers and ARNP weekly in SNF s Participation in SNF med A meetings Involvement of ARNP in discussions with facilities about length of stay Next Steps Expand weekly rounding by RN Case Managers and ARNP at more facilities More involvement from ARNP in managing length of stay and medical necessity of services Continue to drive down length of stay by addressing encounters that did not meet goal length of stay Establish performance improvement plans for facilities that do not maintain minimum requirements 26
27 Questions? Thank You 27
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