The Next Phase of Acute/Post Acute Partnerships: Not as Simple as - - PowerPoint PPT Presentation

The Next Phase of Acute/Post Acute Partnerships: Not as Simple as 30 Day Readmissions

Heather Kirby, Assistant Vice President of Integrated Care Delivery Frederick Regional Health System

Healthcare priorities today and tomorrow

• Nationally

 Population Health  ACO  Medicare Shared Savings Programs (MSSP)

• Maryland

 Reduction in Medicare spending by $320million

• Hospital
• SNF
• Home Care
• Hospice

 HSCRC – New Waiver  Move to Global Budget Revenue

Moving from ARR to GBR

ARR (Admission/Readmission Revenue)

• Attempt to combine volume based

revenue with quality based reimbursement

• Initial visit considered “Good”

volume

• Focus on reducing 30 day

readmissions for inpatients only

• Quality important but not

a primary driver of financial results

GBR (Global Budget Revenue)

• Capitated Revenue
• Good volume
• Bad Volume
• PAUs -

 Unnecessary admissions, ED

visits, Observation, revisits

• PQIs

 Chronic diseases that should

be treated better outpatient reducing the need for hospital services

Preventable Quality Indicators (PQIs)

• HSCRC and CMS define as ambulatory

conditions, which if treated appropriately in the outpatient setting should not require hospital care:

 HF  HTN  DM  UTI  COPD  Asthma  Pneumonia  Ruptured Appendix

The Road Ahead

Care Management of Yesterday

• ED/Hospital focus
• Volume based revenue
• 30 Episodes
• Discharge planning
• Community referrals
• No intentional follow up post

discharge

• Observation vs. Inpatient

Care Management 2015

• Bundled payments
• Quality based care affiliations
• Home based care
• Community focused
• Long term accountability for the

health of a population

• Transition planning/continued

support

• Right service in right setting
• End of life planning
• Employee Health Plan
• Wellness/Health Coaching

Care Transitions at FRHS

• Dedicated team focused patients most at

risk for readmission

• Focus on All Cause 30 Day Readmissions

 Heart Failure, COPD, Diabetes, Behavioral

Health

• Year 1 (FY 12) - RA Rate = 10.2%
• Year 2 (FY 13) - RA Rate = 9.03%

( 12%)

• Year 3 (FY 14) - RA Rate = 8.44%

(  7%)

• Year 4 (FY 15) - RA Rate = 8.00% and 9.68%

Readmission Rate Trend Overtime

Readmission Rates

8.07% 8.49% 7.70% 9.22% 8.00% 7.99% 8.34% 6.59% 8.52% 8.49% 9.09% 7.69% 8.92% 10.96% 8.93% 8.38% 7.72% 8.99% 9.21% 9.76% 9.63%

6.0% 7.0% 8.0% 9.0% 10.0% 11.0% 12.0%

Jul 2012 Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 YTD FY 14

Monthly FY 12 Goal FY 13 Goal FY 14 Goal

2015 Broadening our Focus

• Expanding Care Transitions to Integrated Care

Management

• Community based
• Segmenting our population

 5-10% highest risk  20-25% rising risk  70-75% low risk

• Identifying key tactics and partners to address

unique needs of diverse community needs

2015 Metrics

• 30 Day All Cause Readmission (potentially avoidable utilization)

 Revisits to the ED  Revisits as Observation  Observation revisits

• Preventable Quality Indicators
• HCAHPS
• Length of stay
• Transfers to other acute hospitals
• Post acute partner outcome metrics

Engaging Post Acute Partners

• Establish a relationship with Emergency Department
• Continuing Care Networks (quality, metrics, reports)
• Clinically Integrated Network



Shared Savings Programs



Bundled Payments



Purchased services

• Standardized care across the entire continuum
• Resource sharing, expertise, capital, technology
• Medication reconciliation across all settings
• Follow up phone calls
• Home visits
• The Conversation Project
• Use data to support continuing strategy or change

direction

Quality Based Alignment

• Post Acute Partner Outcomes

 30 Day All Cause Readmission

(potentially avoidable utilization)

• Revisits to the ED
• Revisits as Observation
• Observation revisits
• Quality outcomes related to Preventable

Quality Indicators

• CMS Compare scores (SNF and HHC)
• HH-CAHPS

The Challenge Ahead

• Flexible, nimble and data driven
• Increasing our comfort-”ability” with risk taking
• Patient / community needs driven
• Cultivating a creative, highly engaged environment
• Identifying and removing barriers
• Linking to partners – sharing the vision
• Shared best practices in a competitive environment

“When the winds

• f change blow;

Some build walls, others build windmills”

Chinese Proverb

Questions?

Heather Kirby hkirby@fmh.org 240-566-3679