LeadingAge Iowa 2016 Spring Conference and Exhibitor Showcase

Transcription

1 LeadingAge Iowa 2016 Spring Conference and Exhibitor Showcase Session #402 Hospital Readmission Prevention: Wednesday, Brent T. Feorene, MBA, VP, Integrative Delivery Models Lori Aronson, MBA, NHA, Manager, Consulting Services Health Dimensions Group Today s Session Welcome & Introductions The Readmission Penalty: History, Status, and Outcomes New Penalties, Measurements, and Incentives Readmission Prevention Measures Partnership Along the Continuum Where is the Continuum Headed? Discussion Health Dimensions Group Page 1

2 Introduction to Health Dimensions Group 2 Brent T. Feorene, MBA Vice President, Integrative Delivery Models 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 Health Dimensions Group Page 2

3 Lori Aronson, MBA, NHA Manager, Consulting Services 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 4 Health Dimensions Group: What We Do Strategic Consulting Strategic planning and positioning Health care continuum alignments Market growth strategies PACE development Bundling implementation Senior service line development Post-acute medicine development Operational and Performance Improvement Clinical Financial and billing Regulatory compliance Reimbursement advisory Transaction advisory Business office support Operations re-engineering Management Solutions Strategic planning and positioning Turnaround management Transitional leadership Full-service management Acquisitions & divestiture Interim management Health Dimensions Group Page 3

4 The Readmission Penalty: History, Status, and Outcomes 6 Hospital Readmissions Reduction Program (HRRP) Legislative context shapes HRRP Patient Protection and Affordable Care Act (2010) was to provide everyone in America with affordable health care Faced stiff opposition To get it passed, programs had to be inserted that would reduce the total cost burden of the bill HRRP is one of those cost reduction programs HRRP is estimated to reduce Medicare payments by $7.1 billion (between ) Source: Health Dimensions Group Page 4

5 Components of Readmission Measures Target Population Medicare fee-for-service (FFS) beneficiaries aged greater than 65 years discharged from acute care or VA hospitals with principal discharge diagnosis of AMI, HF, or pneumonia Definition of Readmission Readmission occurs when patient is discharged from applicable hospital to non-acute setting and then is admitted to same or another acute care hospital within 30 days for any reason Exclusions to Readmission Definition Certain unrelated readmissions, such as transfers and planned readmissions, are excluded (e.g., some cardiac procedures with planned staging after period of recovery) 8 HRRP Program Conditions and Penalties In 2015, HRRP covered five conditions: Heart failure Acute myocardial infarction (AMI) Pneumonia Chronic obstructive pulmonary disease (COPD) Planned hip and knee replacement surgery In 2017, coronary artery bypass graft (CABG) surgery will be added Average penalty of $163,000 per hospital for 79 percent of hospitals expected to receive penalty Health Dimensions Group Page 5

6 Hospital Count and Penalty Range for ,098 or 60.2% 840 or 24.2% 429 or 12.3% 71 or 2% 39 or 1% 0% 0.9% 1% 1.9% 2% 2.9% 3% Source: HDG analysis of cms.gov files January National Averages for SNF-Initiated 90-day Episodes by Major Group 31.80% Acute Hospital Readmission Rate 33.20% 35.40% 30.50% 28.50% 27.30% 21.50% 14.60% Source: Dobson DaVanzo analysis of Medicare claims data (100% file - July 2009 through June 2012) Health Dimensions Group Page 6

7 Avoidable Readmissions Readmissions seen as indicator of quality of care Only valid when we know what percentage of readmissions were avoidable Review was done on 34 studies published between 1966 and 2010 looking at readmissions that were deemed avoidable Found that 24% were deemed avoidable Also noted that adults in U.S. received only 54.9% of recommended care Sources: Carl Van Walraven, MD MSc, Carol Bennett, MSc, Alison Jennings, MA, Peter C. Austin, PhD, Alan Forster, MD MSc. Proportion of hospital readmissions deemed avoidable: a systematic review. April vol183 no. 7 E391-E402 Elizabeth McGlynn, Steven Asch, John Adams, Joan Keesey, Jennifer Hicks, et al. The Quality of Health Care Delivered to Adults in the United States. NEJM 12 Readmission Factors Factors for Readmission Percentage Noncompliant with medications 69% Lacked knowledge of how to use therapy devices 51% Inadequate knowledge of medications 45% Unable to self-manage care 42% No follow-up physician visit 37% Post-discharge infection 31% Source: AARC webcast August Hospital to Home-efforts at Reducing Hospital Readmissions ; Greg Spratt, BS, RRT; Kimberly Wiles, BS, RRT; Becky Anderson, RRT Health Dimensions Group Page 7

8 Is the Penalty Working? Analyses by CMS and others suggest that average 30-day readmission rates falling, albeit slowly, to 17.8% during fourth quarter of 2012 after averaging 19% over previous five years, according to Congressional testimony by Medical Director Jonathan Blum in February 2013 In 2013 Medicare beneficiaries experienced roughly 100,000 fewer readmissions than in 2012 Between January 2012 and November 2014, 65,022 readmissions were avoided, generating $575M in savings* Unplanned hospital readmissions following elective hip and knee replacements fell 20% and 23%, respectively, between 2009 and 2013, among adults aged enrolled in Medicare Advantage plans provided by large U.S. insurance carrier** * ** 14 New Penalties, Measurements, and Incentives Medicare Spend Per Beneficiary (MSPB) Bundling Accountable Care Organizations (ACOs) Medicare Advantage Health Dimensions Group Page 8

9 Medicare Spending per Beneficiary (MSPB) Medicare s measure of hospital financial efficiency Average Medicare episode spend (Part A & Part B) for hospital patient compared to risk-adjusted national average Medicare spending episode includes: 3 days prior to hospital admission Acute care stay 30 days post-acute stay Impact of MSPB Requires hospital systems to understand post-acute providers costs and outcomes: Readmission rates Cost of care Length of stay Medical necessity of placement 3 days prior 30 days after discharge 16 Costs Vary by Initial Post-Acute Setting Average Medicare Episode Payment for MS-DRG 291 (CHF) by First-PAC-Setting for 30-day Fixed-Length Episodes ( ) $45,293 $20,318 $33,295 $23,679 Overall Average = $14,928 $13,470 $12,388 HHA SNF IRF LTCH STACH Community Notes: Dobson DaVanzo analysis of research-identifiable 5% SAF for all sites of service, , wage index adjusted by setting and geographic region, and standardized to 2009 dollars. Source: Dobson, A., et al. (2012, October). Medicare payment bundling: Insights from claims data and policy implications. Retrieved from American Hospital Association website: Health Dimensions Group Page 9

10 What Happened? Quick, while they are focusing on readmissions, we ll get them with MSPB!! They ll never see it coming!!! Ha-ha 18 The Traditional Continuum of Care Hospital Rehab Skilled Nursing Facility Long-term Acute Care Hospital Home Health Agency The Problems: Medicare dollars are spent at every phase of continuum Hospitals financially responsible for: All post-acute spending 40.3% of all Medicare spending Source: cms.gov, January Health Dimensions Group Page 10

11 Controlling Readmissions is Key to Success Cost of 30-Day Fixed Length Episode With and Without Readmission $29,803 No Readmission $32,262 Readmission $12,301 $23,527 $18,128 $23,034 $5,514 $14,977 $23,844 $19,243 $12,075 $8,492 MS-DRG 247 MS-DRG 470 MS-DRG 481 MS-DRG 192 MS-DRG 194 MS-DRG 291 DRG 247: Percutaneous cardiovascular procedure with drug-eluting stent w/mcc DRG 470: Major joint replacement or reattachment of lower extremity w/o MCC DRG 481: Hip and femur procedures except major joint w/cc DRG 192: Chronic obstructive pulmonary disease w/o CC/MCC DRG 194: Simple pneumonia and pleurisy w/cc DRG 291: Heart failure and shock w/mcc Source: Dobson DaVanzo (2012). Medicare Payment Bundling: Insights from Claims Data and Policy Implications 20 Unnecessary SNF and LTACH Admissions Taken from official government booklet on Medicare: Patients must require skilled care on a daily basis and the services must be ones that, as a practical matter, can only be provided in a SNF on an inpatient basis. * Why automatic SNF orders? Easiest option for transition of care Patient, family, and caregiver pressures Doctors report feeling ethically pressured to order SNF post-acute services *Source: Health Dimensions Group Page 11

12 Medically Necessary SNF Admissions 2004 Wisconsin Study 50% Medically Necessary 50% Medically Unnecessary 50% 50% 22 PAC Plays Key Role in Medicare Spend per Beneficiary (MSPB) Medicare Acute Hospital Discharges 43% Sent to Post-acute Skilled Nursing 41% Home Health 37% Acute Rehab 10% Outpatient 9% With the bulk of post-hospital patients, SNF & HHA represent key settings for controlling total costs and managing outcomes Health systems often have limited control of costs and outcomes sent to nonaffiliated post-acute settings LTACH 2% Source: MedPAC Testimony, Health Dimensions Group Page 12

13 Medicare Bundled Payments for Care Improvement (BPCI) Demonstration Types of Services Included in Bundle Model 1 Acute Hospital Stay Only Model 2 Acute Hospital + Post-Acute Model 3 Post-Acute Care Only Model 4 Acute Hospital Stay + Readmissions Inpatient hospital and physician services Related post-acute care services Related readmissions Other services defined in the bundle (Medicare Parts A & B) Target to performance payment Retrospective Retrospective Retrospective Prospective Source: Cms.gov, August New CMS Bundling Program: Comprehensive Care for Joint Replacement (CJR) Finalized for April 1, 2016, implementation Mandatory Program Hospitals Bear Financial Risk Shared Savings Directly Tied to Quality Measures First mandatory demonstration, requiring participation from all hospitals in 67 metropolitan regions Hospitals must bear risk for hospital care and 90 days postdischarge for MS-DRGs 469 and 470 (major lower joint replacement) To qualify for realized savings, hospitals must meet specified quality measure performance targets CJR Mandatory Locations Source: Health Dimensions Group Page 13

14 Early Results: Medicare Bundling Will Change Post-Acute Care Utilization First CMS evaluation of BPCI for small number of ortho bundlers showed that institutional PAC (SNF, LTACH, IRF) fell by 30%; use of HHA stayed about same Recent letter to JAMA about NYU s Model 2 BPCI program shows 49% and 34% reductions in discharges to institutional PAC for cardiac valve and joint replacement episodes, respectively Two mature joint replacement bundling programs show 40% 50% drop in discharges to SNFs Caution: Early results are heavily influenced by ortho bundles and possible selection bias; nonetheless, the results and our experience indicates that bundling can drive market shifts Source: CMS Bundled Payments for Care Improvement (BPCI) Initiative Models 2-4: Year 1 Evaluation & Monitoring Annual Report, The Lewin Group, February Medicare ACOs Serving 48 States AK WA OR CA NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN KY NY PA MD WV VA ME VT NH MA CT RI NJ DE D.C. AZ NM OK AR TN NC SC HI MS AL GA TX LA Both MSSP and Next Generation ACOs (serving 9 states) Both MSSP and Pioneer ACOs (serving 1 state) MSSP, Pioneer, and Next Generation ACOs (serving 5 states) MSSP ACOs (serving 48 states) No Medicare ACOs (2 states) Source: CMS.gov, January 2016 FL Health Dimensions Group Page 14

15 Post-Acute Cost and Quality Control Attributed to ACO Savings 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 28 Medicare Advantage Is Growing Nationally? Medicare Advantage (MA) penetration grew by more than 30% in the last 5 years Growth concentrated in 15 states 48 counties have more than 25,000 Medicare-eligible persons and >50% MA penetration Despite enrollment growth, remains black box for many post-acute providers due to small scale by any one plan CMS announced Value-based Insurance Design (VBID) on September 1, 2015, to allow plans in seven states greater flexibility in benefit design Source: HDG analysis of cms.gov files as February Health Dimensions Group Page 15

16 Number of Enrollees (in millions) LeadingAge MN 2016 Institute and Expo Medicare Advantage Enrollment Baby Boomers start aging into Medicare Affordable Care ACT implementation Medicare Modernization Act implementation Year Source: Fiscal Year 2016 Budget in Brief, U.S. Department of Health & Human Services 30 When Will Your Market Shift from Volume to Value: All Health Care Is Local Pace of Change Fast Moderate Fast Moderate Moderate Slow Slow Market Factors Health system consolidation Risk contract prevalence ACO growth Dual eligible growth MLTC growth Catalytic market event Variation in cost of care Health Dimensions Group Page 16

17 Readmission Prevention Measures 32 Reducing Readmission Rates: Six Common Strategies Partnering with community physicians and physician groups Creating preferred networks for post-acute services Making nurses responsible for medication reconciliation Arranging for follow-up visits before discharge Sending discharge summaries to primary care physician Assigning staff to follow up on test results after discharge Health Dimensions Group Page 17

18 Cedars-Sinai Enhanced Care Program Interfacility transfer report sent to SNF, includes inpatient physician/ nursing notes Cedars-Sinai NP evaluates SNF patient within 24 hours postdischarge Inpatient Discharge SNF Admission NP Visit Weekly Follow-up SNF medication list sent to Cedars-Sinai pharmacy team for medication reconciliation within hours Cedars-Sinai NP visits SNF weekly to check patient Case in Brief: Cedars-Sinai 850-bed hospital system in Los Angeles, CA Cedars-Sinai analyzed readmission rates and found that patients at SNFs had higher-than-average readmission rate Cedars-Sinai delivers care transitions services to 8 SNFs in their market free of charge to prevent readmissions; NP manages care between Cedars-Sinai, SNFs, and attending MD for each patient 25% Reduction in readmissions from participating SNFs 50% Participating patients with drug-related issue identified Source: Boudreau, Emily, How Cedars-Sinai Made SNFs Its Readmissions Reduction Partner, Care Transformation Center Blog, The Advisory Board Company, March 4, Ultimate Goal: Care Management Across Continuum Longitudinal care management is not core skill for most health systems or health plans Home PCP Hospital Post Acute Care Continuum Home Hospital s Historical Attention Span Health Dimensions Group Page 18

19 Innovations Must Develop Lifelong Models of Longitudinal Care Begins before illness warrants hospitalization Seamlessly moves back into community Continues when hospitalization is necessary Source: After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries, D. Goodman et al, September 28, Return on Investment (ROI) for Targeted Care Coordination Programs ROI Estimates for Five Care Transition/Coordination Programs Serving Medicare Beneficiaries Program Care Transition Intervention (Group Visit) Annual Cost Per Member Annual Savings Per High-Risk Member ROI Per Year PMPM Savings $678 $4, % $ Transitional Care Model $1,492 $5, % $ Care Transition Intervention $999 $2, % $ GRACE $2,201 $4, % $ Project RED $373 $ % $10.05 Source: Effective Management of High-Risk Medicare Populations, Sally Rodriguez et al, Avalere Health LLC, September Health Dimensions Group Page 19

20 Care Transformation Partnership Along the Continuum 38 Care Transformation Path Lead with Care Transformation: Build care management model Implement care model broadly Obtain value-based payment once model is proven Lead with Payment Transformation: Accept risk-based contracts Grow number of covered lives Adapt care model in targeted and measured steps Source: Adapted from slide produced by The Advisory Board Company, 2012 Payment Transformation Health Dimensions Group Page 20

21 Shifting from Volume to Value Tying payment to performance is the future If you can lower costs and deliver quality, you have a play in the game But you must get IN the game Lower Cost Improved #LAISpring2016 and not everyone is getting in HDG The Case for Understanding Your Value Proposition Affordable Care Act creating shifting landscape toward value-based care and mandates managing patient populations across entire care continuum, prompting hospitals to work more closely with post-acute providers Hospitals face Medicare penalties for high readmission rates Acute providers are establishing narrow networks of post-acute partnership in effort to improve quality of care and manage costs Tactics for improving care between acute and post-acute partners include warm handoffs that involve actual conversations not just exchange of paperwork between clinicians on both sides New staffing models, including use of SNFists and nurse care navigators, are gaining ground Post-acute providers must understand where they fit into this changing environment and how best to communicate this to potential partners Health Dimensions Group Page 21

22 Characteristics of Most Effective Hospital/Post-Acute Care Partnerships Clinical Collaboration Communication Physician integration physician participation in care across settings Agreed-upon clinical protocols Clearly defined expectations Regularly established forum for communication and performance improvement; for example, joint operating committee Concentration Hospital volume concentrated in small number of post-acute providers to allow for increased clinical collaboration Partnership True partnership around improving patient outcomes and reducing utilization Process to review and improve care on an ongoing basis 42 Position Yourself as a Solution Know your upstream providers and payors needs Benchmarked metrics Discharge volumes, length of stay (by DRG), readmission penalties, Medicare spending per beneficiary Program participation ACO (Pioneer, MSSP, Next Generation), BPCI, CJR Managed care Medicare Advantage: Market penetration of primary payors Health Dimensions Group Page 22

23 Which Post-Acute Vendors Will Win? Large, market/geographic dominate providers Hospital-based providers that are valued by their system Providers with aligned interest of payors and referring partners Lowest-cost provider Focused on same quality metrics as partners Proven partner with verifiable data 44 Strategic Pivots/Repositioning: Solutions Provider Focus operational strategies on building care coordination infrastructure Have or willing to build/buy capability to manage at-risk or high-cost patients Ability to communicate their value proposition as a solutions provider Capable or moving towards an ability to manage risk Health Dimensions Group Page 23

24 You May Not Be Bundling.But, You May Be In Someone Else s Are you prepared to differentiate yourself as a preferred partner? Know your performance history through benchmarked metrics Data Quality Process Length of stay, costs, readmissions rates, costs (by key diagnosis) Patient safety (wounds, falls, infections), patient satisfaction; star ratings still count Care transitions, care pathways, INTERACT 46 Value-Based Transformation Checklist Become highly knowledgeable about value-based payment (VBP) transformation occurring in your market Obtain data and develop analytic capacity to support articulation of your organization s value proposition Undergo clinical and operational transformation by implementing standardized care pathways and protocols for reduction of avoidable hospitalizations Engage referring health systems and at-risk payors about your value proposition Define path to implement VBP arrangements for majority of your payors Health Dimensions Group Page 24

25 Can You Push Their Buttons? Managed care organizations and commercial payors will pay attention in four key areas: Length of Stay Time frames typically less than that of fee-for-service (20% 30% less) Unnecessary Hospitalization Managing the patient aggressively in situ Patient Outcomes Performance better than your peer group on their scale Multi-Level Service Capacity to manage seamlessly across multiple settings 48 How Hospitals and Payors are Selecting Post-Acute Partners Demonstrated access and quality outcomes Data proving low 30-day hospital readmission rate across your post-acute episode (SNF-HHA, LTACH-SNF, IRF-HHA) Low readmission rates during and following post-acute episode Immediate admissions; competencies for high-acuity, medically complex patients; solutions for difficult-to-place patients Appropriate use of hospice Integration with primary care physicians (PCPs) Embedding PCPs into post-acute and senior services Communication, reporting, solutions for patients with non-medical needs Care management Care transitions (between all settings); care navigation beyond episode Health Dimensions Group Page 25

26 Networks: Metrics for Getting In Common Criteria for Selection High Volume Discharges Patient Experience Case Managers/Physicians Experience ACO Network Physician/NP in SNF Hospital Readmissions SNF Length of Stay, Cost 50 Additional Measures Other measures and metrics may also impact payment, depending on MCO, ACO, or potential partner State survey scores CMS five-star quality rating Clinical indicators Acquired pressure ulcers Falls Restraint usage involving CMS quality indicators (e.g., NQF s 21 measures) Employee satisfaction/ turnover Facility leadership/senior staff tenure We should additionally expect that reporting time frames will grow closer to real-time! Health Dimensions Group Page 26

27 Networks: Metrics for Staying In Metrics for SNFs Expectation Patients who 'probably' or 'definitely' would recommend SNF to others > 90% Patients readmitted for all causes, all diagnoses from SNF to acute care setting in 30 days or less from discharge from acute care setting Within 72 hours of SNF admission, number of patients referred to emergency department (ED) < 10% < 10% Patients discharged from SNF to home with home safety evaluation > 80% Patients discharged from SNF to home with evaluation for home health agency (HHA) services > 80% SNF ALOS 27.2 days > 80% Patients who are under care of hospice at time of death > 80% 52 Partnership Requires an Immediate Focus on Measurement and Delivering Quality Today MDS quality indicators Nursing Home Compare Home Health Compare CASPER reports Resident satisfaction surveys Staffing ratios Employee turnover Nursing home survey Occupancy rates Waiting list Under Reform and Beyond 1. Reduced hospital readmissions 2. Patient experience/perception of care 3. Better/measureable patient outcomes and functional outcomes 4. Manage/reduce/know costs 5. Rates of community discharge 6. Care management Health Dimensions Group Page 27

28 Post-Discharge Tracking is a Key Component of Your Community Discharge Process 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 54 Assessment Evaluate your ability to add value Clinical services Operational Talent Competitors Payors Vendors Access to investment capital Health Dimensions Group Page 28

29 Surviving Outside of the Preferred Network Become a valued customer Medical directors Rounding physicians, nurse practitioners, and physician assistants Laboratory and phlebotomy services Oxygen and durable medical equipment Home health and hospice Find your specialty and set yourself apart, e.g., wound care, psychiatric support, or chronic illness management Stay focused and engaged: improve outcomes, quantify your value, and share your value proposition with stakeholders 56 It s a Whole New World Dynamic New Relationships, New Partnerships, New Players Health plans are purchasing physician groups Hospitals are purchasing health plans Your referral sources can become your competitors Your referral sources can become your partners Networks and integrators are emerging Health Dimensions Group Page 29

30 Where is the Continuum Headed? 58 Value- and Outcome-Based Payment Growth Health and Human Services set goals for Medicare fee-for-service (FFS) payments linked to quality and alternative payment models in 2016 and 2018 targets All Medicare FFS FFS linked to quality Alternative payment models Source: Fact-sheets/2015-Fact-sheets-items/ htm 30% 85% 50% 90% Health Care Transformation Task Force Several of the nation s largest health care systems and payors, joined by purchasers and patient stakeholders, have committed 75% of their business into value-based arrangements by 2020 Source: Health Care Transformation Task Force website, accessed October 21, Health Dimensions Group Page 30

31 Billions 2022 Goal: Minimum 50% of Total Medicare PAC Provider Payments Bundled $40 $35 $30 $25 $20 $15 $10 $5 $0 Reduce Spend by 2.85% BPCI Voluntary Pilot Began Second Round of BPCI Mandatory Geographic Ortho Bundling All Post-acute Care Providers Source: Budget of the United States Government, FY 2016; 60 Value-Based Movement: Redefining the Value Statement Offering an Integrated Solution to Population Health Management Medical care delivery in patient s residence Providing skilled care in patient s residence Home Care Home Health Care Transitions Alternative for follow-up visit to busy PCP office with access and scope limitations Medical House Calls Complex Care Clinic Acute Care Psychosocial Support ED Diversion Offering ED physicians clincally appropriate options to inpatient admission SNF Integrated, collaborative care in a SNF using physicians and advanced practice providers Care Management ALF Technology Offering a high-quality, lower-cost alternative to SNF Health Dimensions Group Page 31

32 What Does this Mean for a PAC Provider? VBP is both challenge and an opportunity High-performing providers will get in preferred networks based on quality and cost; others may get left out Avoiding hospitalizations is major area of opportunity Medicare has developed know-how and data infrastructure and will accelerate VBP implementation; other payors already following suit Scale matters certain markets will reach tipping point quicker than others due to interactive effect of payment initiatives and providers ability to scale their care redesign 1. Value-based movement 2. Social determinants of care 3. Engaged intervention (NTOCC) 4. Integrated care partnerships 5. Strategic pivots/repositioning 62 Senior/Dual Population Force Move Toward Value-Based Care By 2025, nearly 1 in 5 U.S. residents will be elderly Nearly 50,000,000 seniors in U.S. in 2015; by 2060, nearly 100,000,000 Nearly 25% of those seniors are dual eligible Dual eligibles have higher incidence of disease Disease Non-Dual Prevalence Dual Prevalence Alzheimer s 9% 19% COPD 10% 17% Diabetes 25% 36% Heart Failure 15% 19% Source: :Medicare.gov Health Dimensions Group Page 32

33 A Health Care Neighborhood for Those with Advanced and Chronic Illness Behavioral Health Complex Care Clinic Home Care, Private Duty & DME Adult Day Care Skilled Nursing Facility Telemedicine/ Telemonitoring Geriatric Assessment & Consultation Patient-Centered Health Care Neighborhood Area Agency on Aging & Other Community Agencies Palliative Care Clinic/Hospice House Calls 64 The Acute Care Bridge to Improving the Health and Outcomes of Individuals Transitioned to Post-Acute Providers Health Dimensions Group Page 33

34 Questions? 66 Presentation Title Health Dimensions Group Page 34