LeadingAgeNY Annual Meeting May 24, 2017 1 Bundles of Joy: VillageCare as a Model 3 BPCI Episode Initiator - Journey toward Full Risk Randi Roy, Chief Strategy Officer Shaun Ruskin, VP, Business Development and Post Acute Services The Future of Value-based Care 2 1
VillageCare, with 40 years of service to New York, served approximately 25,000 individuals in 2016 3 Managed Care Plans (8,000+ members) Post-Acute Nursing Facility (1,600 patients discharged home annually) Health Home, Housing and other community programs (13,000 + members) VillageCare offers three discrete service lines 4 Post Acute Care Rango Technology for Treatment Adherence Village Center for Rehab & Nursing Community Supports Managed care VillageCare Health Home Managed Long Term Care Plan 2
Overview of Post-Acute Facility: VCRN 5 New modern facility; built 2010 1,600+ admissions per year Rehab offered 7 days per week Full medical staff including onsite NPs 16hrs per day Advanced Care Unit, clustering highest acuity patients Nursing to patient ratio is 1:13 Ability to admit 7 days per week Only BPCI Model 3 post acute facility in NYC Lowest Rehospitalization Rate of Peer Facilities 30 days UPPER EAST SIDE GOUVERNEUR ISABELLA THE NEW JEWISH HOME THE RIVERSIDE AMSTERDAM MARY MANNING WALSH VCRN 17.0% 16.9% 18.8% 21.1% 21.2% 23.7% 24.9% 24.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Source: Rehospitalization rate from CMS Nursing Home Compare CMS 5 Star facility 2010 2017 7.6% : 30 day In house Rehospitalization Rate (Equip) History of decision to pursue BPCI 6 Hedging our bets Healthcare shift toward Value Based Payment arrangements Learning how to Manage Risk Skin in the game, referral source appreciation Marketing benefits Experience with NYU s Model 2 bundle Pioneers in NYC, 2013 Partnering to manage utilization and rehospitalization protocols with Major Joint Replacement and Cardiac Valve 3
Implementation 7 Selecting our partner with CMS Remedy Partners, Awardee Convener Choosing our bundles with Remedy Partners Historical Data Hiring a Post Acute RN Managing patients throughout the entire episode, Day 1 through Day 90 Monitoring Reporting mechanism to ensure success Care Redesign: Transitional Care 8 Created a Transitional Care Program Hired an RN with population health training Created protocols and workflows Upon admission During stay Upon discharge Utilized an IT platform Began post discharge calling program: Focused on 5 keys areas Assessing performance and refining processes Congestive Heart Failure example 4
Post-Discharge Transitional Care 9 PCP and Specialist appointments scheduled within 5 7 days? Questions: Transportation? Someone to attend with you? Medication management? Questions: Do you have the ability to purchase and obtain the medication? Caregiver support/ home care arrived? Questions: Is there a recognition of caregiver strain? Has the DME arrived? Questions: Do you know how to use it? CHF example Barriers to self care? Questions: Can the individual buy food, pay bills, take care of themselves? Partnership for Home Care 10 VNSNY Partnering with a Certified Home Care Agency to deliver high quality of care Continuity of care from hospital, to SNF, to Home Post Acute Pathways to reduce avoidable rehospitalizations; Weekly and Monthly communication to discuss individual patient issues, lessons learned, and best practices Innovative ideas to deliver high quality of care at a lower cost; sharing of claims data Review of Key Performance Metric on quarterly basis 5
Marketing and Relationships 11 Only Model 3 SNF in all of NYC that elected to participate in the BPCI initiative Upside Get out of jail free card Downside Referral sources wanting to manage their own bundles Demonstrates that we have skin in the game, and can be penalized just like our hospital partners Marketing differs contingent on the hospital s bundle voluntary or mandatory participation Model 2 hospitals Comprehensive Care for Joint Replacement (CJR) Program Performance Major Joint 12 $22,000 $21,500 $21,000 MLJ Bundle Performance Reductions in LOS (3 days) and readmissions (12 to 10) from first three quarters to last four quarters 195 total episodes Episode Cost $20,500 $20,000 $19,500 $19,000 $18,500 $18,000 First 3 Qs Average Episode Cost Last 4 Qs 6
Congestive Heart Failure (CHF) 13 Congestive Heart Failure Important to referral partners Opportunity for patient education and palliative care Implemented Care Redesign during SNF stay Targeting for Admission diversion Post-Anchor Inpatient 10% Outpatient 2% Home Health 9% Post-Anchor Part B 11% CHF Skilled Nursing Facility 68% Program Performance - CHF 14 $40,000 $35,000 Congestive Heart failure $37,508 $30,000 $25,000 $20,000 $15,000 $20,544 $10,000 $5,000 $- w/o Readmit Average Episode Cost with Readmit 7
Overall Program Performance vs. all Remedy Model 3 programs *NPRA as % Program Size (Net of CMS 3%) 15 Other APMs 16 Targeting 80% of revenue in VBP by 2020 Case rates with United and Emblem Allows for pre authorization to take patients directly Another contract pending Looking at ACOs Participating in risk arrangements with hospital partners 8
Ongoing Management 17 Working with Remedy Partners Receiving, analyzing, and understanding our data Dropping bundles that are not viable Using data for Marketing Efforts Marketing for specific diagnosis Driving volume to successful bundles Monitoring and Reporting Reporting Mechanism to ensure this program makes sense, and aligns with organization s strategy Plans for the Future 18 Population health initiative Organization wide effort to share best practices across service lines Continue to quantify our value as partner Disease specific team and pathways Improve patient quality of life; reduce readmissions Implemented nurse led team, family champion contract, joint education materials with hospital and home care agency Full Post Acute risk with home care partner VNS VBP across the organization Advanced BPCI 2018 9
19 How Can We Reach $1 Million Impact? Visibility Requires Quality Impact on a Large Scale Cost Savings Opportunity Single Occurrence Cost Assumption Needed to Reach $1 Million Hospital Readmissions $13,333 75 Readmissions avoided ED Diversion $1,062 942 ED visits prevented One-Day Reduction in SNF Length of Stay $480 2,083 Days eliminated 1) Per month. 2014 The Advisory Board Company advisory.com 29490B Healthcare Cost and Utilization Project, Statistical Brief #172: Conditions with the Largest Number of Adult Hospital Readmissions by Payer, Agency for Healthcare Research and Quality, 2014, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-conditions-readmissions-payer.pdf; Florida Office of Program Policy Analysis and Government Accountability, Profile of Florida s Medicaid Home and Community-Based Services Waivers, 2012, http://elderaffairs.state.fl.us/doea/evaluation/profile%20of%20florida's%20medicaid%20home%20and%20community- Based%20Services%20Waiver%20OPPAGA%2012-03.pdf; Vaidya A, 8 Statistics on the Average Cost Per ED Visit, Becker s Hospital CFO, May 31, 2013, http://www.beckershospitalreview.com/finance/8-statistics-on-the-average-cost-per-ed-visit.html; Post-Acute Care Collaborative interviews and analysis. One last thought.. 20 10