Webinar Objectives. Coordination of Care Initiative Home Health Gap Collaborative Informational Webinar

Transcription

1 Coordination of Care Initiative Home Health Gap Collaborative Informational Webinar February 14, 2018 Webinar Objectives Discuss the analysis findings for home health referrals, post hospital discharge, in Minnesota Identify the home health referral/uptake gap and the effects Understand how to participate in a statewide virtual collaborative to reduce the home health gap. 2 1

2 Polling Question: What type of organization are you representing? a) Home Health Agency b) Hospital c) Skilled Nursing Facility d) Other 3 Coordination of Care Initiative Background 4 2

3 Coordination of Care Initiative Goals Improve quality of care for Medicare beneficiaries who transition among care settings Reduce 30-day hospital readmission rates and admission by 20% by 2019 Increase the number of days at home Establish sustainable, transferrable transition practices across the spectrum of care 5 Coordination of Care Communities 6 3

4 Readmissions 7 Community Readmissions per 1,000 Beneficiaries Comparison -Trends 8 4

5 Community Progress Toward CMS Initiative Readmissions Goals 9 Situation (The problem) There s a huge gap between the number of patients referred to home health services by the discharging hospital and the number who actually receive services. Those patients that are referred but do not receive home health services have a significant higher readmission rate. 10 5

6 Background of the Home Health Gap Problem 11 Background Data 12 6

7 Background Data cont. 27.0% 13 Background Data cont. 14 7

8 Background Data cont. 15 Assessment Polling Question: Does your organization track the number of referrals that actually receive services? a) Home Health -Yes b) Home Health No c) Hospital Yes d) Hospital No e) Other Yes f) Other - No g) N/A doesn t apply to my organization 16 8

9 Assessment Polling Question: What percentage do you think actually receive home health services? a) 0-25% b) 26 50% c) 51 75% d) % e) N/A doesn t apply to my organization 17 Assessment Discussion What reasons are you aware of that contribute to a home health referral that does not result in home health services? (Notify operator by pushing # sign or type in the chat window) 18 9

10 Assessment (Home Health Survey) Polling Question: Is it a priority for your organization to address the home health gap? a) Yes b) No, not this time c) N/A doesn t apply to my organization 19 Assessment (Home Health Survey) Polling Question: What is your organization doing to address the gap? a) Working on our own processes b) Working with our hospital/home health partners c) Other d) Nothing at this time e) N/A doesn t apply to my organization 20 10

11 Recommendation Develop a collaborative partnership with referring organizations and home health agencies to address the issue of the home health gap. 21 What: Statewide Home Health Gap Collaborative Who: Home health agencies, hospitals, others interested, including patients/families How: Virtual format using workgroups (no in-person meetings) When: Now 22 11

12 Home Health Gap Collaborative Goals Identify issues and barriers for receipt of home health services Discover best practices at hospitals and home health agencies on collaborative approaches to increasing the acceptance and use of home health services following a hospitalization Develop best practice tools for spread throughout the state to increase the uptake of home health services and reduce readmissions 23 Next Steps Sign up to participate Multiple people from organizations can participate Two brainstorming sessions to identify and prioritize the issues and barriers Two different times select the time that works for you Once issues are prioritized, workgroups will form and meet (virtually) to address the issues Workgroups will identify best practices and resources addressing their assigned issues Resources will be shared 24 12

13 Brainstorming Sessions Wednesday, March 7, 1:00 2:30 pm Monday, March 12, 10:30 am 12:00 pm After the call, all persons indicating desire to join the collaborative will receive an from Janelle Shearer at Stratis Health with links to register for the brainstorming sessions. 25 Contact Info Janelle Shearer, Stratis Health Angie Pokharel, MHA Kathy Messerli, MHCA

14 This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MN-C