Down the Rabbit Hole… C2C DATA & THE LA JEWISH HOME Molly Forrest, CEO – President LA Jewish Home April 4, 2017
Medicare, Social Security & Medicaid Changes +65 Aging Today “Martin Short” & Tomorrow + 75 “Tina Turner” +85 “Clint Eastwood” April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 2
“20% to 30% of health spending is waste that yields no benefit to patients… much is done that does not help patients at all, and many physicians know it” - Don Berwick, New York Times, December 3, 2011 April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 3
Does this Sound Like Our World? “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going to Heaven, we were all going direct the other way.” Charles Dickens, Tale of Two Cities April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 4
DHSS Secretary, Tom Price, has Authority … To release ACA waivers & rule changes as administrative actions… Takes time & public comments must be heard Make administrative changes as key tools Undermine the ACA marketplace by to change the health-care system actions such as: • Introduce work requirements for • Change the requirement that most Medicaid recipients, including poor & Americans pay a penalty for not having disabled insurance. • Ease the coverage of certain services, • End subsidies that insurers get (could such as contraception quickly cause the individual insurance • Water down the ACA requirement that markets to crater) most insurers provide a specific raft of • Offer federal approval to state proposals benefits, such as maternity and mental- health care. for Medicaid changes within state borders (i.e., setting of premiums, cost- *If insurers are allowed to offer sharing, lifetime caps on benefits, less generous benefit packages, many subsidies to high-risk medical believe this would lower premiums beneficiaries, establish high-risk pools ) April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 5
HEALTH CARE REFORM VS INSURANCE REFORM OF OBAMACARE CARE Reform Continues: Lower Cost, Better Outcomes & Improved Health Manage Population Health Better patient care and experience TRIPLE AIM Manage the Episode (Traditional Sources) Better Lower population costs health Yesterday: Fee for Service April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 6
Post-Acute Care (PAC) & Coordination Is Key to Managing HC Needs & Costs How the LA Jewish Home Can Meets the Need in 2017 & Beyond RED are Post Acute Discharges Back to Hospital (readmissions) – average 18% Acute Hospital 10% 9% LTAC 1% 53% 22% BLUE Are Hospital 3% IRF Discharges To Post 57% 18% Acute Settings (PAC) 17% SNF 40% of Hospital Patients 5% 29% Transfer to PAC 15 % LA JH Provides Home Health GREEN indicate transfers 2% between PAC settings 2% Hospice Eisenberg Keefer Acute Psychiatric Hospital BCSC or PACE & “a La Carte” Medical Home Connections to Care – The One-Call Personal Counseling & Assistance April 4, 2017 AJAS Conference 7
Navigating Asteroids: Skilled Nursing Moves With Changing Times With Technology VBP VPB → Penalties & 21 st reporting Incentives Century on NHC begin Cures Act IMPACT IMPACT Act: CMS Act: APIs 10.1.18 1) Med Rec COPs 10.1.16 2) Transfer of Final information & Care FHIR VBP → preferences Readmission Regulatory ONC/Technology data gathering Skilled 2016 2017 2018 Nursing Mandatory QAPI Market Facility Bundled Payments: Forces Operations CJR & Outcome Cardiac Management → Analytics ACOs Pace of Transitions INTERACT APM of Care Precision Increasing Medicine: Genotyping Labor Shortage 8
Data Standardization 1 “Site Neutral” Payments 2 IHSS HHA In-Patient (OASIS) Rehab (PAI _ Hospice Patient (Direct Data Assessment Feed ) Instrument) AS “SPECIALTY” INSURANCE PLANS, PACE OPERATES WITH AND PAYS “SITE NEUTRAL” “GLOBAL PAYMENTS” In-PT LT- Acute Hospital SNF (MDS) (Care Tool) GLOBAL PAYMENTS HCC-RAF MD Assessments & other (Rx, Lab, X-Ray) 1 – Data Standardization = Individual Conditions and Requirements for Care. 2 – “Site Neutral Payments” = 2020 “Money Follows the Person” 3 – “ Value Based Purchasing”
Post-Acute Care: (PAC) The Hottest Area in Health Care • ALL STAKEHOLDERS see role PAC will play Inpatient margins shrinking Reimbursement “incentives” increases pressure on “ALL” Inpatient providers to partner with PAC providers Healthcare efficiencies driven by scale & integration Mergers & Acquisitions abound • Effective PAC limits downside for ALL Hospitals, Doctors, Healthcare Plans Government • CMS & Health planners see PAC revenues will far exceed inpatient revenues ! • Improving Medicare PAC Transformation Act of 2014 CHRISTOPHER J. DONOVAN, Health Care Law Today, March 24, 2014
Areas Which Have the Most Positive Influence on Partnerships Develop OR join with Shared Risk or Providers Shared Savings Organizational Success Arrangements Extend an Existing M a rket Care Through Models Growth Cost Care Reform Requires an Anticipation of a Control change in financial performance – It is not as profitable to Share savings versus 100% of Fee for Service payments April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 11
The LAJH Continuum: Comprehensive Elder Care Options Evolving Enterprise Point of Entry Across Greater Los Angeles Inpatient Connections to Care Solutions Community Short-Term Residential Care Solutions Skilled Care Assisted Living Post-Acute Eisenberg Village Reseda, CA Grancell Campus Fountainview at Gonda Hospice & Palliative Eisenberg Village Home Care Services Playa Vista, CA Reseda, CA Care Services Medicare Certified End-of-Life Care c Behavioral Long-Term Health Care Skilled Care PACE Geriatric Alzheimer’s Dementia Traditional Custodial Care Community Clinic Grancell Campus Eisenberg Village Grancell Campus Eisenberg Village Eisenberg Village Inpatient Geri-Psych Reseda, CA Reseda, CA Reseda, CA Grancell Campus Care Transitions Returning Patients “Home” Right Place, Right Time, Right Cost 1 2
“ THE DIFFERENCE IS THAT OF ATTITUDE… Ideas, like people, flourish when they are welcomed and embraced. ” Barbara J. Winter Leadership Three Management Analytical Capabilities • Descriptive: what has happened • Predictive: what will happen, given past data Prescriptive: Combines predictive + proactive solutions • To address problem/non — productive areas based on anticipated events FOCUS ON POSSIBLITIES April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 13
CEO Responsibilities for the Organization Strategically Thinking of Organizational Success Risk Management Forecasting Regulatory Fiscal Management: Identify where the Compliance Cost: PPD or DX market is moving, assess organizational performance at optimal levels & if Market Opportunities needed, adapt Quality Measures -Differences organizationally to -Alignment meet it Labor Relations, Population Health Allocation & Costs Analytics April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 14
Who says an Elephant Can’t Dance? What are the goals? • Modernizing Operations • Heavy Dependence on Data, Data, Data Identification Accumulation Development Benchmarking Exchanging with Others! ~Partners, participants & payers • Integrating services with others – joint ventures, partnerships, mergers, acquisitions • Alternative Payment Models (APMs) Sharing Costs of Care • Sharing Revenues from Care • Sharing Savings from Care April 7, 2017 AJAS Data & Analytics You Need to Run Your Business 15
StratusLink ™ “Unlocked” data from the Home’s 21 systems into a fully integrated centrally available user interface 360° Visibility into Our Patients and Our Organization – Access, Control, Visualize, Analyze & Share MATRIX ACHIEVE MDS AOD PACE CARE ON-LINE EVAL CASAMBA REHAB ALLSCRIPT S KRONOS “NET TIME & PR SMART” ORACLE Financial General Ledger
Grancell Village SNF Resident Breakdown by Diagnosis January 12, 2017 Atrial Fibrillation Cerebral Vascular Accident (and associated diagnoses) 41% 41% 40% Chronic Kidney Disease Chronic Obstructive Pulmonary Disease Percentage of Residents Congestive Heart Failure Heart Disease 26% 25% 24% Diabetes Mellitus 18% Parkinson's Disease 17% 15% 13% Depression Psychiatric Diagnosis (excluding Depression) 6% Other Diagnoses CDC (Center for Disease Control) 2012 data shows nursing home depression at 48.5%. According to the Kaiser Foundation, 31% of nursing home residents had psychiatric conditions such as schizophrenia or mood disorder.
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