Optimizing Operations through Data Collection and Dissemination Raymond Belles, Jr. Managing Consultant rbelles@bkd.com
Learning Objectives Define the changing healthcare landscape Identify trends in home health and hospice Medicare spending across the continuum of care Outline strategies for data use in identifying market opportunities and driving lower Medicare spending
Define the Changing Health Care Landscape
Environmental Factors Home Health Payment Reform Alterative Payment Models Accountable Care Organizations Value Based Purchasing BPCI Advanced Payment Model Conditions of Participation Updates 2018 Patient Rights Training and Organization requirements Quality Assessment and Performance improvement (QAPI) Home Health Grouping Model 30-day pay periods Removes therapy utilization as a payment driver Budget Neutrality Technical Expert Panels 2020 Start Date
CMMI Alternative Payment Models Accountable Care BPCI Primary Care Transition Medicaid and CHIP Acceleration Models Speed Adoption of Best Practices ACOs Model 1 Advanced Primary Care Initiative Reduce Avoidable Hospitalizations State Innovation Models Beneficiary Engagement Model Advanced Payment ACOs Model 2 Comprehensive Primary Care Initiative Financial Alignment Incentive for Medicare and Medicaid Frontier Community Health Integration Community Based Care Transitions ACO Investment Model Model 3 FQHC Advanced Primary Care Practice Strong Start for Mothers and Newborns Health Care Innovation Rounds Health Care Action and Learning Network Next Generation ACO Model 4 Graduate Nurse Education Medicaid Prevention of Chronic Diseases Health Plan Innovation Initiative Innovative Advisors Program Pioneer ACO CJR EPMs/CR Transforming Clinical Practice Medicaid Emergency Psychiatric Demonstration Medicare Care Choice Model Million Hearts BPCI Advanced (Model Go Live 10/01/2018) Comprehensive Primary Care Plus
Alternative Payment Models Fostering Change From Episodes to Episode Risk based Model Retrospective reconciliation for hospitals Target price Inclusions/exclusions Anchor stay +90days post-discharge Collaboration dependent
Center for Medicare & Medicare Innovation Source: CMMI Website
Center for Medicare & Medicare Innovation Improve the Patient Experience TRIPLE AIM Improve Outcomes Lowering the Cost of Care Source: CMMI Website
Identify Trends in Home Health and Hospice Medicare Spending across the Continuum of Care
Medicare Spending Home Health Market Analysis Hospital Discharge Patterns Target Pricing vs Spending Physician Analysis Focus on Collaboration Narrowing Networks
What Is the Market Story Medicare Spending
Medicare Spending Home Health Discharge Patterns
Medicare Spending Hospital Target Pricing
Medicare Spending Hospital Discharge Patterns
Medicare Spending Physician Analysis
HHA Strategies to Identify Market Trends Improve the Patient Experience TRIPLE AIM Improve Outcomes Lowering the Cost of Care
HHA Strategies to Lower Medicare Spending Improving the patient experience Patient Engagement leading to Self Management Medication Management Pharmacy Partnership Effective Communication on Patient Terms Interdisciplinary Collaboration Improving outcomes Interoperability vs Barriers to Sharing Data Chronic Care Management Social Determinants Streamlined Care Delivery Models Lower Spending Operational Efficiencies Eliminate Waste/Duplication Improve Interoperability
Balancing Quality and Spending
Environmental Factors Hospice Increase Quality Reporting Hospice item Set (HIS) Hospice Quality Reporting Program (HQRP) Hospice Compare Payment Reform Medicare Care Choices Model o o o Increase access to supportive care services provided by hospice Improve quality of life and patient/family satisfaction Inform new payment systems for the Medicare and Medicaid programs Physician Assistants Serving as Attending Physicians January 1, 2019 Hospital DRG Adjustment for Early Discharge Discharges on or after October 1, 2018 MedPAC Evaluation of Impact March 2021
Medicare Spending Hospice Market Analysis Hospice Utilization Physician/Hospital Discharge Patterns Target Pricing vs Spending Focus on Collaboration
Medicare Spending Hospice Utilization
Medicare Spending Hospice Discharge Patterns Longitudinal View - 180 Days Before Death With Hospice ALOS
Medicare Spending Hospice Re-Hospitalization Longitudinal View - 180 Days Before Death With Hospitalizations
Hospice Medicare Spending 180 Days Before Death
Hospice Strategies to Identify Market Trends Increase access to supportive care services Improve quality of life and patient/family satisfaction Lowering the Cost of Care
Hospice Strategies Increase access to supportive care services Lack of knowledge What the data saying about the community Hospital/Community presence response time Improve quality of life and patient/family satisfaction Ensure the family is involved in the process On-going education HIS/CAHPS/Hospice Compare Lower Spending Data Belongs to everyone in the organization Longer Periods of Hospice service = Lower overall spending (?) Collaboration
Balancing Quality and Spending
Outline Strategies for Data use in Identifying Market Opportunities and Driving Lower Medicare Spending
Build A Data Centric Organization Core Values of A Data Centric Organization Data Belongs to everyone in the organization Data Is an Asset Buy - in from top down Transparency and information sharing is KEY Data quality is a number one quality Setting KPIs are critical to success Be Data Harvesters Practice an Analytic Culture Sanchita Lobo, The 8 Core Values of A Data Centric Organization, Analytics Training.com, May 2017 (http://analyticstraining.com/2017/core-values-of-data-centric-organisation/
Trusted Data Data that is drawn from carefully selected sources, transformed in accordance with data s intended use, and delivered in formats and time frames that are appropriate to specific consumers of reports and other manifestations of data. By Philip Russom Director, TDWI Research Data Management