Positioning for Post-acute Care Collaboratives from a Marketing and Sales Perspective 1
BAYADA Home Health Care BAYADA Home Health Care, founded in 1975 by Mark Baiada in Philadelphia, is a private, familyowned home health provider. Headquartered in Moorestown, New Jersey. Over 328 local offices provide nurses, home health aides, therapists, and social workers to over 100,000 clients per year in 22 states as well as four countries. One of the few national providers that offers a full range of post acute home health services BAYADA is unique in providing a full spectrum of home-based services Medicare certified Home Health Short term, intermittent skilled visits. Care solutions for residents in senior living communities. Hospice End of life and palliative care for the Medicare population Personal Care Services Non skilled services provided by Home Health Aides for Activities of Daily Peds/Adult Private Duty Nursing Long term skilled nursing services provided in shifts Medication Management Telehealth Physician Housecalls Hospital Managed Services Pharmacy consultation and support Tele surveillance throughout the episode of care and beyond MD support in the home, collaboration with PCPs for transition back Support for health systems in developing or enhancing PAC services 2
Marketing Perspective Elizabeth Kleber, PhD, RN Partner expectations are changing Then Now HH Visits Traditional skilled Traditional skilled + non traditional 60 day Episode of Care 90 day and beyond Based on admit assessment POC Reset goals as acuity changes DC when goals met Discharge Surveillance beyond DC Limited interaction Healthcare Team Increased communication CM Chooses Referrals/Partners Quality Home Health only Focus of Partnership Innovative models of care Do what we are told Care Delivery Outcomes driven response 3
Best Practice Approach to Collaboration Surveillance Extended episode : 30 60 90 beyond Optimize the POC Set realistic goals based on identified barriers and areas for success Innovative models of care Facilitate Quality PAC network Prevent avoidable hospitalization SNF direct admit Tele surveillance Physician Housecalls Senior Living Solutions Strategic Relationship Management Ops Clinical Sales Transparency Data and analytics Using data to support outcomes EMR based real time Claims based historical trends Benchmarking Internal outcomes: how are we doing? Partner outcomes: what are their hot spots? Publicly reported outcomes: what do others see? Real time trending: how are we improving? 4
Understanding Provider Hot Spots Penalties APM participation Financial metrics Quality metrics Patient Satisfaction Utilization/ Payer Mix DC Patterns/ Volumes Demonstrating the impact of the PAC network LOS at hospital = 4.81 days (above state average of 4.77) Ave episode spend without rehospitalization = $20,699 Ave episode spend with rehospitalization $33,912 27% of BPCI episodes have a rehospitalization 25% return to different hospital 50% home with no PAC 48% of rehospitalization 17% DC to HHA 21% of rehospitalization 128 HHAs utilized 25% DC to SNF 23% of rehospitalization 100 SNFs utilized Avalere Health. 2017 5
Benefits of collaboration Before you say yes resource considerations Clinical: inpt LOS = HH acuity Specialty Programs SMEs, EBPs Education Tele health options Specialty Certification for Clinicians Centers of Excellence (HF, COPD) Care Coordination Dedicated Liaisons Care Navigators Case management Provider Protocols Monitoring and responding to quality metrics Centralized oversight of service utilization Legal Subject matter expertise Agreements/ contracts New Payment Models Incentive Pool contributions, Participation fees Data Sharing requests Transitional Care Management Transitional Care Managers Direct admit to SNF from HH Share/ develop best practices Facilitate appropriate use of services Data Access to databases Data integration/ EMR integration Meaningful reporting Outcome analytics Relationship Management Awareness of opportunity Introductions to key people RFP response and FU Accountability Ongoing quality improvement 6
Regulatory and Contractual Considerations Potential Fraud & Abuse Violations Stark Law Physician Self Referral concerns Anti Kickback Statute (AKS) Concerns relating to kickbacks provided to clients or other providers in order to entice utilization Data Sharing Concerns Exchange of PHI implicates HIPAA Performance Standards, Reporting Requirements, and Quality Measures Tracking Success will be affected by ability to track and meet Quality/Performance Measures Need to confirm you can provide the required data Risk Arrangement Determine the type of risk you are entering into may affect payment Sales Perspective Karen McGinnis, BSN, RN 7
Market / Industry Trends Patient centered care Best Practices Integrated care Inter disciplinary focus Coordinated transitions Measurable results Outcomes oriented Reimbursement dependent on outcomes Ask the right questions Bundle responsibility / oversight Care coordination and central oversight Claims data and current analytics (does it match our research) Perception of home health Key barriers and rehospitalization reasons Process for selecting the next site of care Communication and timely notification 8
Know the story. Coronary Artery Bypass Graft Facility Market Area Rehospitalization adds $27,000+ in cost! Percent of episodes with a rehospitalization 22% 16% Length of stay at initiator 7.44 8.92 Average episode payment $ 37,143.73 $ 43,465.70 Average payment for episode with a rehospitalization $ 58,453.66 $ 60,534.61 Average payment for episode without a rehospitalization $ 31,055.18 $ 40,317.86 Avalere Health. Bundled Payment Calculator, reflecting CMS claims Q2 2015 Q3 2016. https://vantagecps.avalere.com Relationship Management Redefine Common Practice for selecting the next site of care Risk stratification for the Right Care in the Right Location Foster consistency in communication and coordination Transitional care teams, key contacts, hardwired touchpoints Set expectations for patient and physician engagement Self management during and after post acute services 9
Industry challenges impacting successful relationships Improvement is difficult to sustain Administrative and clinical processes are often equally broken Need capable provider working with capable provider Reimbursement challenges disrupt focus Clinical and financial instability creates new priorities Poor/ inconsistent outcomes impact clinical and financial stability Multiple priorities lead to lack of focus Process errors lead to poor or inconsistent outcomes Lack of focus leads to process errors Improved Outcomes support Successful Relationships CARE COORDINATION Early Identification of Need and Risk IMPROVES OUTCOMES Rehospitalization % Focus on Engagement, 60 90 day, leakage Factors Impacting Hospitalization Throughput LOS PAC Utilization with Process DRG / Coordination for optimal utilization Reduce variability Alternatives to hospitalization 10
Case study: Large Urban Academic Medical Center Provider Profile: Urban setting Non-profit 925 beds No hospital owned PAC services 2 campuses Process change- Implement on-site HH TCM within CM department to facilitate HH referrals Measure of success- decrease ACH, increase use of HH Concerns: Hospital CMs do not prioritize DC planning High- risk patients sent home with no PAC services The easiest PAC provider gets the referral Readmissions are high Losing readmissions to other hospitals (leakage) Review Needs for Accuracy of Process Embed HH TCM in CM Department Ongoing Performance Management Using Data to provide insight Promoting Improvement 11
Outcomes Initial Goal: Show a decrease in ACH rate resulting from an increase in HH referrals Additional expected hospital impact: Decrease overall costs due to earlier hospital DC by using HH services Decrease overall ACH by targeting pts with high volume DRGs with poor outcomes Increase hospital revenue by targeting pts with penalty focused DRGs Results: Data shows decreased ACH, increased use of HH Next Steps: What are the financial and clinical outcomes of the partnership? What is the impact on the hospital and HHA? How do the outcomes inform upstream and downstream processes? Continuous monitoring and process development Best Practice: Key Strategies Rethink Common Practice for Optimal Care Clarify Goals and Improve Communication Clear process for care transitions Consistency in Execution and Follow up 12
Elizabeth Kleber: ekleber@bayada.com Karen McGinnis: kmcginnis@bayada.com Collaboration happens only when people can see the interconnection of their actions toward a shared purpose General Stanley McChrystal 13