Post Acute Care Strategies Do we Own? Buy? Partner? Jan Hamilton-Crawford, FACHE Vice President of Operations

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2 Post Acute Care Strategies Do we Own? Buy? Partner? Jan Hamilton-Crawford, FACHE Vice President of Operations

3 3 Shared Definitions

4 Connecting the Dots

5 CHRISTUS Continuing Care

6 CHRISTUS Continuing Care Post Acute Expertise Locations: Texas Louisiana Georgia Iowa Arkansas Operates / Manages: 3 IRFs 13 LTCHs 6 Home Health 7 Hospice

7 Adopting a Patient-Centered Approach to Scale

8 8 Stepwise Process for Building a Clinically Integrated Model Mix well and the outcome is a Clinically Integrated Model that allows CHRISTUS to provide Population Health Management

9 9 Stepwise Process for Building a Clinically Integrated Model Improved Quality Outcomes Evidenced Based Guidelines Standardized Quality Metrics Across Enterprise Remote Monitoring Wellcentive Population Health Tools/Predictive Modeling Patient & Family Centered Care Patient Centered Medical Homes Virtual Tools & Web Portals Family & Community Engagement Connecting Care throughout the Continuum of Care Engaged Physicians & Providers Improved Knowledge & Workflow through EHR, Population Tools & Super Warehouses Identification of gaps in care Ability to focus care and resources where needed Compensation Models

10 What does this all mean for Post Acute Care? The Sisters started our Ministry in the community (not inside hospital walls). In some ways we are coming full circle. Post Acute Care is a very important part of the continuum. Opportunities exist for tighter integration as other delivery components develop. Key focus on markets where there is a clinical integration/population health play. We don t have to own all parts of the delivery system, as long as the need is met and we can lend our expertise as needed (i.e. St. Catherine). Need to anticipate and plan for scenarios with respect to changing reimbursement (HH and LTACHs). Change before we have to.

11 Partner Example

12 St. Catherine Hospital Campus Map Hospital 2. MOB 1 3. MOB 2 4. MOB 3 & MD Anderson

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14 Adopting a Patient-Centered Approach to Scale

15 Houston Methodist St. Catherine Today LTACH Phase I: 36 Beds Demonstration Period Managed Care Contracting Physician Alignment Staff Recruitment Transition from TJC to DNV Accreditation PolicyTech Growth of Outpatient Services and Integration with HMW Imaging PT/OT Conversion to Methodist IT System Campus Space Planning Gift Shop Corporate HIM Growth Opportunities Leased Space Equipment Asset Management

16 Houston Methodist St. Catherine Future OPPORTUNITIES: Wound Care: Projected 3rd Quarter 2014 Hyperbaric: Projected 1st Quarter 2015 LTACH Specialty Procedures SNF (24 Beds): Projected 3rd Quarter 2015 OP Cardiac/ Pulmonary Rehab ED- Extension of HMW License Corporate Services IT Revenue Cycle Inpatient Rehab in Collaboration with HMH Sleep Medicine GeroPsych Hospice JV GI Laboratory Reference Laboratory

17 Houston Methodist St. Catherine Long-Term Acute Care Hospital

18 Long-Term Acute Care Key Objectives 1. Raise the Bar for Quality Post Acute Care Services Patient Satisfaction Survey (PRESS GANEY) Employee Engagement and Satisfaction Clinical Outcomes 2. 6-Month Demonstration Period for LTACH Licensure ALOS: Data Submitted to Novitas June 30th Billing August 1 st Physician Recruitment and Retention 3. Staff Growth 4. System-Wide Engagement Case Management CMPI ICU & Medical Leadership from all HM Hospitals

19 Long-Term Acute Care Key Objectives 1. HMSTC Marketing/Referral Development Patient Testimonial Collateral Clinical Liaison Incentive Program 2. Develop Outcome Metrics to Demonstrate Value to Commercial Payors LTACH Specific Managed Care Contracts Ventilator Weaning Rate, Wound Healing, Zero Nosocomial Infections 3. Define Cost Savings Delivered to Houston Methodist Hospitals Network

20 Timeline of Legislative Changes

21 Major Changes to Reimbursement Only two types of patients will qualify for reimbursement at LTAC rates: Critical care patients: Patients whose prior short-term acute care stays included at least 3 days in an ICU or CCU Ventilator patients: Patients who have been assigned an LTAC DRG requiring more than 96 hours on a ventilator (MS-LTC-DRG 207) Patients must be admitted to the LTAC immediately following discharge from an inpatient hospital stay Patients with a rehabilitation or psychiatric principal diagnosis will no longer be eligible for reimbursement at the LTAC rate

22 Major Changes to Reimbursement All other patient cases will be reimbursed at the site-neutral payment rate. This will be the lower of: The inpatient prospective payment system (IPPS) comparable per diem rate, plus any appropriate outlier payments 100% of the estimated cost for services Two year transition period in which cases that do not meet one of the two LTAC criteria will be paid at 50% of the LTAC rate, and 50% of the IPPS rate Change is expected to greatly reduce Medicare spending in the LTAC sector

23 Potential Issues Currently only one main source of referrals Steady stream of patient referrals will be necessary to support the growth of the medical mall High need for strong physician buy-in within the Houston Methodist system

24 Clinical Staff By-In Involve physicians in plans for future growth to obtain full buy-in from clinical staff Employ an excellent clinical liaison to forge relationships amongst local healthcare providers

25 Multitude of Factors Impacting Hospitals Focus on Post-Acute Care Regulatory Pressures Post-acute spending under scrutiny Sector specific payment reforms Push towards greater accountability Payer Involvement Growth in managed care activity Utilization management, patient steerage Post-acute acquisitions Referrer Scrutiny Analyzing post-acute performance data Narrowing post-acute referral networks Monitoring post-acute service utilization Consumer Demands Increasing patient medical complexity Enhanced service, amenity expectations Desire to age in place

26 CHRISTUS Continuing Care QUESTIONS