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

Melinda S. Hancock, FHFMA,CPA Partner, DHG Healthcare 2015-16 Chair, HFMA

January 29, 2016 2016 Healthcare Landscapes

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.

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Go Beyond the Status Quo

3

Reform Across the Continuum

4

Dependency & Convergence

There is crossover in:

• Metrics
• Spend
• Models
• Care Management

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What is Driving the Pace?

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Medicaid Expansion in the U.S.

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Other State Reform Efforts

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Summary of Innovation Models

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ACOs by State: 2015

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Source: Healthaffairs.org

Bundled Payments are Spreading

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Shaded Territories Represent CJR MSAs

BPCI Participants by Geography

BPCI Initiative Statistics (As of October)

100 200 300 400 500 600 700 800

STAC SNF PGP LTAC IRF HHA

Participants

Model 2 Model 3 Model 4

Type Unique IDs Episodes Unique IDs Episodes Unique IDs Episodes Unique 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 MODEL 2 MODEL 3 MODEL 4 TOTAL

1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000

STAC SNF PGP LTAC IRF HHA

Episodes

Model 2 Model 3 Model 4

Phase II Episodes by Group

100 200 300 400 500 600 700 800 900 1000

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

Episode Frequency

Model 2 Model 3 Model 4

Phase II Episodes by Episode Length

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% STAC PGP SNF LTAC IRF HHA

Post Acute Episode Length Selections

30 Day 60 Day 90 Day

Model 3 Model 2

Model 2 & 3

BPCI Activity: Texas

BPCI Activity: Texas

10 20 30 40 50 60

STAC PGP SNF HHA IRF

Participants

Model 2 Model 3 Model 4 50 100 150 200 250 300 350

STAC PGP SNF HHA IRF

Episodes

Model 2 Model 3 Model 4

Texas ranks 4th in the country in BPCI participants and 9th in the country in number of phase II episodes being tested in the program MODEL 2 MODEL 3 MODEL 4 TOTAL

Type Unique IDs Episodes Unique IDs Episodes Unique IDs Episodes Unique 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

Source: October BPCI Analytic File

BPCI Activity: Texas

10 20 30 40 50 60 70

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

Episode Frequency

Model 2 Model 3 Model 4

BPCI Activity: Texas

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% STAC PGP SNF HHA IRF

Post Acute Episode Length Selections

30 Day 60 Day 90 Day

Model 2 & 4 Model 3

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Patrick Conway, MD, Deputy Administrator and Leader of the Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services

“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.”

Your Comprehensive Value Resource

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hfma.org/valueproject

Go Beyond Traditional Roles

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HFMA Is Reaching Out

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hfma.org/physician hfma.org/healthplan

Go Beyond Comfort Zones

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“Once we accept our limits, we can begin to go beyond them.”

~Albert Einstein

How Hospitals May Evolve

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

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The Digital Health Journey

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On a scale of 1 to 5, how well has your

• rganization addressed price transparency

(defined as patients’ out of pocket financial responsibility)?

a) b) c) d) e)

26% 21% 8% 17% 28%

a) 1 – not well at all b) 2 c) 3 d) 4 e) 5 – very well

Transparency

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Setting the Foundation for a Better Patient Experience

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hfma.org/dollars

Connect with HFMA and Each Other

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In Conclusion…

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