Partner, DHG Healthcare 2015-16 Chair, HFMA 2016 Healthcare - PowerPoint PPT Presentation

Melinda S. Hancock, FHFMA,CPA Partner, DHG Healthcare 2015-16 Chair, HFMA 2016 Healthcare Landscapes January 29, 2016

Objectives of Today’s Presentation • Identify areas where finance professionals are being called to go beyond in an evolving healthcare environment. • Discuss what that means for you as individuals and for your organizations. • Describe resources that can help you meet the challenges of the current environment. 2

Go Beyond the Status Quo 3

Reform Across the Continuum 4

Dependency & Convergence There is crossover in:  Metrics  Spend  Models  Care Management 5

What is Driving the Pace? 6

Medicaid Expansion in the U.S. 7

Other State Reform Efforts 8

Summary of Innovation Models 9

ACOs by State: 2015 Source: Healthaffairs.org 10

Bundled Payments are Spreading Shaded Territories Represent CJR MSAs 11

BPCI Participants by Geography

BPCI Initiative Statistics (As of October) MODEL 2 MODEL 3 MODEL 4 TOTAL Unique Unique Unique Unique Type IDs Episodes IDs Episodes IDs Episodes IDs Episodes STAC 391 2,542 9 40 400 2,582 SNF 709 8,838 709 8,838 PGP 240 2,046 51 136 291 2,182 LTAC 1 7 1 7 IRF 9 17 9 17 HHA 101 517 101 517 Total 631 4,588 871 9,515 9 40 1,511 14,143 Participants Episodes 10,000 800 9,000 700 8,000 600 7,000 500 6,000 5,000 400 4,000 300 3,000 200 2,000 100 1,000 0 0 STAC SNF PGP LTAC IRF HHA STAC SNF PGP LTAC IRF HHA Model 2 Model 3 Model 4 Model 2 Model 3 Model 4

Phase II Episodes by Group Episode Frequency Major joint replacement of the lower extremity Simple pneumonia and respiratory infections Congestive heart failure Chronic obstructive pulmonary disease, bronchitis, asthma Hip & femur procedures except major joint Sepsis Urinary tract infection Acute myocardial infarction Medical non-infectious orthopedic Other respiratory Cellulitis Stroke Fractures of the femur and hip or pelvis Renal failure Esophagitis, gastroenteritis and other digestive disorders Cardiac arrhythmia Gastrointestinal hemorrhage Nutritional and metabolic disorders Lower extremity and humerus procedure except hip, foot, femur Gastrointestinal obstruction Diabetes Revision of the hip or knee Syncope & collapse Major bowel procedure Transient ischemia Medical peripheral vascular disorders 0 100 200 300 400 500 600 700 800 900 1000 Model 2 Model 3 Model 4

Phase II Episodes by Episode Length Post Acute Episode Length Selections 100% 90% 80% 70% 60% Model Model 2 2 & 3 Model 3 50% 40% 30% 20% 10% 0% STAC PGP SNF LTAC IRF HHA 30 Day 60 Day 90 Day

BPCI Activity: Texas

BPCI Activity: Texas Texas ranks 4 th in the country in BPCI participants and 9 th in the country in number of phase II episodes being MODEL 2 MODEL 3 MODEL 4 TOTAL tested in the program Unique Unique Unique Unique Type IDs Episodes IDs Episodes IDs Episodes IDs Episodes STAC 20 170 1 1 21 171 PGP 9 91 9 91 SNF 51 296 51 296 HHA 30 111 30 111 IRF 1 1 1 1 Total 29 261 82 408 1 1 112 670 Participants Episodes 60 350 300 50 250 40 200 30 150 20 100 10 50 0 0 STAC PGP SNF HHA IRF STAC PGP SNF HHA IRF Model 2 Model 3 Model 4 Model 2 Model 3 Model 4 Source: October BPCI Analytic File

BPCI Activity: Texas Episode Frequency Major joint replacement of the lower extremity Simple pneumonia and respiratory infections Sepsis Congestive heart failure Urinary tract infection Chronic obstructive pulmonary disease, bronchitis, asthma Stroke Hip & femur procedures except major joint Gastrointestinal hemorrhage Other respiratory Medical non-infectious orthopedic Acute myocardial infarction Revision of the hip or knee Renal failure Cardiac arrhythmia Nutritional and metabolic disorders Esophagitis, gastroenteritis and other digestive disorders Cellulitis Syncope & collapse Spinal fusion (non-cervical) Fractures of the femur and hip or pelvis Major bowel procedure Coronary artery bypass graft Other vascular surgery Diabetes Chest pain 0 10 20 30 40 50 60 70 Model 2 Model 3 Model 4

BPCI Activity: Texas Post Acute Episode Length Selections 100% 90% 80% 70% 60% Model 2 Model 3 50% & 4 40% 30% 20% 10% 0% STAC PGP SNF HHA IRF 30 Day 60 Day 90 Day

“For the hospital CEO or CFO out there who says, ‘I’m doing really well in fee-for- service so I’m just going to stick with it and it’s going to be OK,’ eventually it will not be OK, and I actually predict it will not be OK in a much shorter time frame than they might imagine.” Patrick Conway, MD, Deputy Administrator and Leader of the Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services 20

Your Comprehensive Value Resource hfma.org/valueproject 21

Go Beyond Traditional Roles 22

HFMA Is Reaching Out hfma.org/physician hfma.org/healthplan 23

Go Beyond Comfort Zones “Once we accept our limits, we can begin to go beyond them.” ~Albert Einstein 24

How Hospitals May Evolve 25

Major delivery shifts are in process, and more are on the way. 26

The Digital Health Journey 27

On a scale of 1 to 5, how well has your organization addressed price transparency (defined as patients’ out of pocket financial responsibility)? 28% 26% a) 1 – not well at all b) 2 21% 17% c) 3 d) 4 e) 5 – very well 8% a) b) c) d) e)

Transparency 29

Setting the Foundation for a Better Patient Experience hfma.org/dollars 30

Connect with HFMA and Each Other 31

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In Conclusion… 33

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