LeadingAge Ohio Achieving Alignment Between Hospitals & Post Acute Providers Renee Cummings CEO, Access Companies Bryce Henson VP of Value Based Care www.accesselite.com Janine Stackhouse, BA LNHA Associate Vice President Post-Acute Services Aultman Hospital To develop dynamic, preferred market relationships delivering extraordinary, interconnected and holistic care in a rapidly changing, value focused environment. 1
Our PAC Profile PAC Network OH (2020 IN-MI-NC-GA-TX) 50+ non-aligned SNF/HH (2019 Goal 100+) Administrative Services Model (ASO) Membership Organization- Federal Trade Commission (FTC) approved Message Model of Contracting No provider ownership or ownership liability No exclusive contracting Flexible, customized to each Member services GOAL- Market preferred hospital and payer relationship status. How will we achieve market preferred hospital and payer relationships? Big Data Performance Outcomes Reporting- Map to Market (M2M) Strategic Performance Initiative. Stars Survey Deficiencies Quality Staffing Processes Infrastructure Efficiencies- Connecting the dots to more easily identify admin/clinical solutions via aligned payer and hospital processes. Contracting- Flexible negotiation between parties to create lasting relationships. Volume- Growth and scale create stronger business relationships. Care Coordination- Collaborative, transparent care drives patients to most appropriate setting for them. 2
o Cleveland Clinic o Aultman o Duke University Medical Center o Henry Ford Center o Ohio State University Medical o Premier Health Partners o Promedica o TriHealth o University of WI Medical Center There are common threads with all hospital PAC initiatives. In the course of doing business over the last 18 months, we ve identified: Hospitals report ACO, CJR, BPCI or Payer Risk Drives PAC business relationships and processes. Most PAC Initiative activities escalated 2-3 years ago. Typically the onset begins with large SNF Coalitions focused on clinical education. Key clinical/admin processes are quickly identified necessary to drive more cohesive care alignments. Most frequently publicly available information is used for first preferred network. Selections and activities are strongly reliant on the hospital s CM experience with the PAC provider. Care is used to assure the PTs Consumer Choice, but scale is clearly realized by collaborative PAC providers. What criteria do hospitals use for preferred status? 1. Collaboration around admissions and aligned processes. (Coalition meeting participation/activities.) o Discharges to the PAC provider must be timely, responsive and effective. o Shared process development is a critical component of the preferred provider. This may involve many hours of process/workflow dialogue and activity at the operational/clinical staff level with no assurance of referral volume increase. o Quarterly meetings/scorecards by SNF/hospital are presumed. 2. Returns to Hospital -OR- SNF Length of Stay. 3. Publicly reported information- 4 STAR Expectation, Survey, Quality, Staffing. 4. MD/NP collaboration and PT monitoring/visits weekly basis in SNF. 3
What about hospitals in value based payment models? 1. Collaboration around shared processes. (Coalition meeting participation/activities.) They have your data! FAR the most prevalent, this may involve many hours of process/workflow dialogue and activity at the operational/clinical staff level with no assurance of referral volume increase. o Quarterly meetings/scorecards at SNF/hospital are presumed. 2. Returns to hospital within 60/90 days -OR- SNF Length of Stay. 3. Publicly reported information- 3 STAR Minimum, Survey, Quality, Staffing SNF Utilization: Entire Episode o ACO o BPCI o BPCI Advanced o CJR o OCM o Risk Contracts Number of Episodes Average Medicare Average Length Payment Readmission rate directly Provider with Utilization of Stay to SNF from SNF SNF 1 164 18 $7,719.19 (37) SNF 2 133 21 $9,179.11 (17) SNF 3 116 22 $8,659.13 (19) SNF 4 94 25 $10,083.12 (13) SNF 5 52 18 $8,521.18 (12) SNF 6 37 27 $11,195.10 (4) SNF 7 23 40 $16,063.11 (3) 4. Ease of referral/admission from hospital. (Timely response.) 5. MD/NP collaboration and PT monitoring/visits weekly basis in SNF. Tell your story! BPCI Financial Outcomes Total Medicare Payments $16,348,743 Actual Claims $14,900,366 Cost Savings $1,448,377 % Savings 9.04% Accepts all referrals inclusive of high acuity Admits/discharge 24/7 Therapies (PT,OT,ST) 7 days per week Accepts ventilator dependent New trachs Dialysis Secure behavioral/dementia units Bariatric capabilities NP on site Wound care specialist Isolation rooms TPN/Nutritional Private rooms Aquatic therapy Resort like setting Barber shop Beauty shop Restaurant style dining Movie night 4
August 29, 2018 IHI Triple Aim Initiatives Value Based Reimbursement Models Bundled payment models Shared savings plans Increased Data Sharing By 2018 50% of all Payments will be through an Alternative Payment Model Transparency in public reported data End users are more informed about healthcare and choices In 2015 Aultman Hospital utilized 92 post acute providers. IHN hospitals utilized over 120 providers 5
The IHN hospitals formed a narrow post-acute network with high-quality partners to: help reduce outcomes variability facilitate meaningful collaboration with community physicians on care transitions and other initiatives that are not possible with a wider range of stakeholders share best practices across continuum, including acute care, rehab, SNF, homecare and hospice 11 Hospitals IPAN, LLC AC3/IHNC3 Managing Board Quality & Operations Committee Coordinator Quality Subcommittee Utilization Subcommittee Advance Care Planning Subcommittee Transitions of Care & Bundles Subcommittee 12 6
Owned or operated by an IHN hospital system Hold a 4 or 5 Star Rating on Overall Medicare Compare Hold a 4 or 5 Star Rating on Quality Medicare Compare Participate in not less than 80% of designated LLC meetings Current Member of AC-3 Geographic Location Local Direction Inpatient Rehabilitation Skilled Nursing Facility Home Health Care Hospice X X X X X X X X X X X X X 13 Utilization Subcommittee Preferred Provider Lists and Patient Education about IPAN for informed decisions about post acute care Provider Capability Lists Level of Care Decision Guide to improve MSPB Resources to improve clinical skills of staff caring for medically complex patients in collaboration with Aultman College Advance Care Planning Subcommittee Palliative Care Education to SNFs to improve utilization to prevent readmissions and increase patient satisfaction Palliative Care Guide to educate patients about available services 7
Discharge Planner IPAN Bus Tour 45 employees across HDS participated Visited 6 facilities Tour & Presentations Staff education during drive time Feedback from employees and facilities extremely positive % SNF D/C to IPAN 51.5 59.4 2018 YTD 60.5% 2016 YTD 2017 YTD D/C to IPAN Quality Subcommittee Physician Discharge Summary and Interdisciplinary Plan of Care using SBAR format for hand off communication to improve patient satisfaction and safety Cortext for physician to physician communication of critical patient information Transitions of Care & Bundles Subcommittee Delirium Pathway to identify and manage delirium to prevent readmissions and improve patient outcomes NICHE Courses for Geriatric Nursing Certification 8
Goal is to improve Post Acute Care in our service areas % Readmission Penalty 2015 2016 2017 Alliance.18.43.65 Aultman 1.02.66.42 Pomerene.08 0.06 Union 1.04.29.31 Maximum Penalty 3% 20.3 21.7 17.1 8000 6000 4000 2000 0 6410 5381 SNF Spend 30 Days From Acute Discharge 4327 3891 6155 4491 4878 4664 Alliance Aultman Pomerene Union 2015 2017 IHN Weighted average based on Medicare volume shows 10% reduction National spend dropped 8% Readmissions to $3,004 IPAN Non IPAN Ohio Continued Work ahead. IPAN IHN Post Acute Network 9
Renee Cummings, CEO AccessCo ReneeC@accesselite.com 614-345-5001 x 250 Bryce Henson, VP of Value Based Care AccessCo BriceH@accesselite.com 614-345-5001 x 208 Janine Stackhouse BA, LNHA Associate Vice President Post Acute Services Aultman Hospital Janine.Stackhouse@aultman.com 330-479-4800 Q&A 10