WIXLIB

How to be a Strategic Partner withAcute Care Systems and PayersJim Newbrough, CEO Menorah ParkCarol Irvine, Abramson Center for Jewish LifeLou Woolf, CEO Hebrew Senior Life

How to be a Strategic Partner withAcute Care Systems and PayersWhy Do They Want (or need) toPartner with Post-Acute Care?

Shifting Care to Lower CostSettingCare ContinuumHospitalLTACIRFSNFHome HealthHospiceALOS: 5.4 daysALOS: 26.6 daysALOS: 13.1 daysPPS: 13.2 visitsALOS: 60 DaysAverageEpisode: 9,460AverageEpisode: 38,600AverageEpisode : 18,000ALOS: 27.1daysAverageEpisode : 3,000AverageEpisode : 8,700AverageEpisode: 11,000Shift to Appropriate Lower Cost SettingCost Savings Range between 7,000- 35,000Per Continuing Care EpisodeSources: MedPAC, Medicare Payment AdvisoryCommission. (2015). March Report to theCongress: Medicare Payment Policy.Washington, DC. and Watson Policy Analysis.3

Medicare Patients UseMultiple Post-Acute Settings1st DischargeSetting2nd DischargeSettingSNF42.9%Home Health4.2%Acute Rehab3.2%64.3%LTACH60.2%19.5%MedicareFFS HospitalDischarges41.4 %to PACSources: MedPAC, Medicare Payment Advisory Commission.(2015). March Report to the Congress: Medicare PaymentPolicy. Washington, DC. and Watson Policy Analysis.Medicare 5% Standard Analytical File for 2012 and 2013.June 201516.8%1.1%4

Post Acute Care (PAC) bythe NumbersUp to40%FACTSSPENDINGDETAILS*SOURCE: NaviHealth 10billionOver8%Spending VariationDrugs Over-utilization of Amount saved by MedicareSNF daysannually ifpatients utilize 25% of SNFthe appropriateadmits could goPAC settinghomeThe rate at whichMedicarespending forSNF, LTC, andHome Healthgrew annuallyfrom 2001 - 2012

How Do Post Acute Care ProvidersSucceed in a Value-Based World? Quality – this is a given, baselineVertical Integration and partnershipsEnhancement of Cross-Continuum capabilitiesAlignment with H&HS and Health PlansUnderstanding when and how to take risk (andreward)

Models for PartnershipJoint Quality Improvement Information exchange Joint training Quality tracking Preferred provider Affiliation agreementsStrategic Contracts Pay for performance,bundles, total cost Under-reimbursedservice purchasing(e.g. telehealth,heart failureeducation, caretransition services.Asset Operation Staffing contracts(e.g. contracttherapy services) Joint ventures Managed servicesagreements Asset acquisitionSource: Advisory Board Post Acute Collaborative 20177

Menorah ParkExcellence in Caring8

About Menorah Park Integrated Senior Living Community in Ohio serving over1000 clients/day on single campus. Not for profit home, largest stand-alone nursing facilityin the State with 355 dually licensed (MA/MC) beds. 1 Independent living residence with 193 units 2 Assisted living residences with combined 260 units Home Health, Hospice, Ambulance, Adult Day Care Outpatient land and water-based therapy program. Center 4 Brain Health and Dementia Care Program 80 million in annual revenue.Excellence in Caring9

What H&HS Focus On Through-put issues ED is crowded Observation status Discharges Readmission penalties Reported by physician Reducing overall cost of care Shorter lengths of stay Meaningful Use Dollars 10% Summary of Care Preparing for Risk ValueExcellence in Caring10

What You Should Know BeforeYou Meet with H&HS LeadersClinical Quality Metrics1. Adverse Event Rate2. CMS Star Rating3. Patient SatisfactionSource: Advisory Board Post Acute Collaborative 2017Excellence in Caring11

What You Should Know BeforeYou Meet with H&HS LeadersEfficiency Metrics1. Readmission Rate2. Average Length of Stay3. Average Time to Admission4. Average Time to Initial Physician VisitSource: Advisory Board Post Acute Collaborative 2017Excellence in Caring12

What You Should Know BeforeYou Meet with H&HS LeadersAlignment Metrics1. Clinical Capabilities andSpecialty Lines2. Current Referral Volume3. Technology CapabilitiesSource: Advisory Board Post Acute Collaborative 2017Excellence in Caring13

Be Transparent AboutYour NeedsAdmissions are good, but they take time.Shorter LOS means less reimbursement.Balance good / bad business.Share in the risk, share in the reward ( ).Want to be more than a preferredprovider. Want to be THE Provider. Co-Brand if possible. Ask them to invest in new programs. Excellence in Caring14

Case StudyMenorah Park CardioPulmonary Rehab ProgramExcellence in Caring15

Case StudyMenorah Park CardioPulmonary Rehab Program Joint committee formed in November 2015 12-15 individuals from both UH and Menorah Park Goal – to establish an 8-12 bed Post-AcuteCardiopulmonary Rehabilitation Program on the campusat Menorah Park. Develop a tailored rehabilitation program for individualswith acute or chronic cardiac and pulmonary conditions. Modeled after Jewish Home in NYC and NYU Medical. Program would be a “bridge” between acute care stayand discharge to home.Excellence in Caring16

Case StudyUH Service Provision included: Cardiologist and Pulmonologist dedicated toprogram. Creation of care protocols – acute to home health Staff training in care pathways Coordination team to oversee the programMenorah Park to provide: Room renovation with new rehab cardio equipment Installation of telemetry monitoring equipment Dedicated cardiac nurse Development of a kosher cardiac diet.Excellence in Caring17

Case StudyMenorah Park CardioPulmonary Rehab ProgramUnique features of this program: Joint care pathways between hospital and SNF Joint staff training (home health, SNF, Rehab, HospitalStaff) Dedicated Cardiologist, Pulmonologist, RN ProgramManager Rehab telemetry monitoring equipment Bridges gap between hospital, SNF and home health.Excellence in Caring18

Case StudyMenorah Park CardioPulmonary Rehab ProgramProgram Results to Date: Since August 2016, admitted 95 patientsLow rehospitalization rate 7%High patient satisfaction scoresIncreased referrals to home health program.Earlier identification for Palliative CareMonthly meetings to discuss program results.Excellence in Caring19

Case StudyMenorah Park CardioPulmonary Rehab ProgramBenefits to Menorah Park: Increased overall referrals from UH to sub-acute Developing other niche programs to include neurostroke, neuro-psych, ED intercept. Built strong relationship with Cardiologist andPulmonologist. Increased referrals to other programs (LAC).Excellence in Caring20

Case StudyMenorah Park CardioPulmonary Rehab ProgramWhat could we have done different: Asked UH to help with infrastructure costs. Set KPI goals initially and monitored each month Set quality goals, not operations goals. Cardiologist should have been better positionedgeographically. Should have brought UH Homecare to the table at thetime of development.Excellence in Caring21

Strategic Partnering with Acute CareSystems and Payerswww.abramsoncenter.org22

Abramson Senior CareComprehensive Chronic CareManagement Across SettingsHome and sFacility-BasedSolutionsResidential Care andAssisted LivingNorth WalesHome Care ServicesMedicare Certified andPrivate Duty; CareInnovations HomeMonitoringGeriatricCare Managementand Primary CareHouse CallsHospice & PalliativeCare ServicesEnd-of-Life CareMedical Adult DayCareNE PhiladelphiaConcierge Medicineand SNFist ServicesDialysisMain LineHealthy Brain andMemory ClinicTransitional CareUnitsNorth Wales and LankenauHospitalMain LineHome-basedAbramson Care Advisors andCare Transitions ProgramMaintaining or Returning Patients “Home”Right Place, Right Time, Right Cost

Top 10%: Our Sweet Spot24

Today’s Focus: TCU Strategies for Partneringwith Acute Care Systems and PayersTwo PartTCU StrategyDistinguish as Best in Class:Quality and Total EpisodeCostAccess to TCU and SeniorServices throughoutPhiladelphia and Integrationwith Key Health Systems25

Already met usual qualityindicators: facility, largeprivate rooms, amenities,separate gym for TCU, 24/7medical management,staffing, 5-Stars, admissionsfrom the ER, etc. Current focus: the AbramsonApproach and Total EpisodeCostBest in Class:Quality and TotalEpisode Cost26

Best in Class: The Abramson Approachand Total Episode CostReduced ALOS in TCUStandardized EvidenceBased Care PathwaysResearch-BasedPerson-Centered CareInstrument andImplementationLowest RegionalRehospitalization RateRoad to Recovery27

Results Showing Best in Class TCUReduced TCU ALOS 18.0 days (2017) vs. PA 21 daysEvidence-Based Care Pathways CHF protocol with Jefferson Health System Wound protocol via physician and certified wound careRN UTI protocol from Infectious Disease Society of AmericaLowest Rehospitalization Rate in Region 15.5% vs PA 20.3%28

Road toRecovery QIO Initiative thattargets 12 dayspost-SNF Discharge survey forgoals at home Built around lifestyle choices toreducerehospitalizations Results: 1.56%rehospitalizationsvs. 6% baseline29

Partnering with Health Systems andPayers: Phase 1 and Phase 2Phase 1 Top provider in narrownetworks; for example:– Jefferson Health: Monthlymeetings; sharing of qualitymetrics; sharing educationalmaterials and communicationtools– DVACO: Quarterly providermeetings and education;sharing of report card/qualitymetrics; utilizing theirpreferred providers for HHAreferralsPhase 2 Access and Integration Abramson-owned TCUwithin Lankenau MedicalCenter, part of Main LineHealth Supported by robustAbramson home care,hospice, Geriatric CareManagement in Main Line Concierge medicine andoutpatient Healthy Brain andMemory Center on campus ofBryn Mawr Hospital, MainLine Health System30

Phase 2: Access and Integration ofAbramson Services with Health SystemStep 1Management Contract for 22-bed TCU in Lankenau Medical CenterStep 2Ownership Transfer of TCUand Space Lease/Purchased Services/Affiliation Agreement with Lankenau HospitalStep 3Renovate (50/50 split costs), Add 13 Beds, Wrap-Around Abramson Post-TCU Services31

Access and Integration in the Future Access: TCU, home care,Geriatric care management intwo major geographic areas ofPhiladelphia; expandinggeographic presenceelsewhere Integration: Abramsonmanages post-acute care (TCU,home care) for LankenauMedical Center We have a replicable TCUownership and integrationmodel for other hospitals andhealth systems32

Hebrew SeniorLifeandStrategic Partneringwith theHealth System33

The Massachusetts Healthcare Landscape and FundingEnvironment are Changing

Hebrew SeniorLife – At A Glance 113 year old organization 2,600 employees serving 3000 seniors across 8 campuses andcommunities, and in-homes 1,500 units of senior living (independent and assisted) 775 beds of long term chronic care, sub-acute, and rehab care 223 million in projected FY18 annual revenue Medical staff with 40 physicians and nurse practitioners Affiliated with Harvard Medical School Largest aging research institute in a clinical care setting 700 - 900 clinical professionals trained annually Boston Globe Top Employer – last two years

Hebrew SeniorLife

HSL Communities

What are our Aims?

HSL Strategic Partnering Initiatives Preferred Provider Relationships Quarterly Meetings: Metrics, SWOT Tailored Objectives & Metrics Physician Groups Hospitals Specialty Hospitals Health Systems Total Cost Management Post-Acute Patient Progression (LOS)Post-Acute cost per dayDischarge DispositionPost Discharge Rehab & Home CareRehospitalization Conversion Rate Optimization Clinical Pathways (Spine & Joints)

HSL Strategic Partnering Initiatives Patient Tracking System Open Medical Staff / ACO Attending Physician Collaborative Lean / Six Sigma Care Transitions Improvement Information Management / Access to Data Medicare 3-Day SNF Waiver (Reduce Anchor Admissions) Pulmonary LTAC Focus Other Long Stay Patients Specialized Population Health Management (Dementia Patients) ACO Membership Bundled Payments