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Post-Acute Networks Why Are Health Systems Developing Them?
John Barkley, MD, FCCP
Atrium Health
Angela Orsky, DNP, LNHA, RN
Greenville Health System
Innovation and Excellence in Advanced Illness at End of Life 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, NC
Agenda
• Rationale for post-acute networks
• Creation and management of post-acute networks
• Strategies for hospice & palliative care providers to engage health systems
Innovation and Excellence in Advanced Illness at End of Life
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* denotes enterprise-wide data or PE plus some regional data
Size and Scope
28+urgent care locations*
$9.77 billionnet operating revenue*
25+cancer care locations*
47hospitals across
three states*
65,000+employees*
350+primary care practices*
35emergency
departments,
including
freestanding*
7,400+licensed beds*
Who We Are Today
16,000+Nurses*
$1.87 billionin community benefit and
uncompensated care in 2016
$5.1 millionIn uncompensated care and
community benefit every day
Continuing Care Scope of Services
Innovation and Excellence in Advanced Illness at End of Life
• An integrated network and full continuum solution for post acute service needs
• Services provided at 73 locations
• Average Daily Census > 14,000
• > 525,0000 outpatient visits
• >70,000 Unduplicated Patients
• >2,600 teammates
Value - The Why
• Government, commercial payers & employers are transferring risk to providers, and demanding accountability
• Payment for quality & cost effectiveness outcomes
• Current trajectory is unsustainable – economically & politically not viable
Innovation and Excellence in Advanced Illness at End of Life
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Innovation and Excellence in Advanced Illness at End of Life
National Landscape – Market Pressures
1. Aging Population
2. Chronic Conditions
Innovation and Excellence in Advanced Illness at End of Life
National Landscape – Market Pressures
15.5%
16.0%
16.5%
17.0%
17.5%
18.0%
18.5%
19.0%
19.5%
20.0%
20.5%
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
National Health Expenditures, per capita4. Not Fiscally
Sustainable
3. Significant Spend Increases
National Health
Expenditureas a % of
GDP
Value-based Care
Innovation and Excellence in Advanced Illness at End of Life
BPCI-AValue-basedpurchasing
MACRA
CMS Quality ReportingPrograms
Medicare Advantage
ACOs BPCI
Commercial PayorRisk Contracts
Self-insuredEmployers
CMS Payment PenaltyPrograms
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Patient Protection and Affordable Care Act (ACA)Enacted March 23, 2010
Make affordable health insurance available to more citizens through the creation of
subsidies.
Expand the Medicaid Program
to cover adults with an income
below 138% of the federal poverty
level.
Support innovated medical care
delivery methods designed to lower
costs of health care generally.
Go
als
of
the
AC
A
Innovation and Excellence in Advanced Illness at End of Life
CMS=Centers for Medicare & Medicaid Services; DRA=Deficit Reduction Act; IOM=Institute of Medicine; MMS=Medicare Prescription Drug, Improvement and Modernization Act; QI=Quality Improvement;
Health Care and Education
Reconciliation Act of 2010 amends PPACA
Mar 30, 2010
Patient Protection and Affordable
Care Act (PPACA) establishes and
maintains quality-
related initiatives
Mar 23, 2010
CMS adds Outpatient Data
to Hospital Compare Website
Jul 8, 2010
EHR Registration
begins
Jan 3, 2011
CMS to launch Physician
Compare Website
Jan 3, 2011
HAC Expanded to Medicaid
Jul 1, 2011
Physician Resource Use
Reporting to begin
2012
20132011 2012 20142010 2015
Payment Reductions for
Readmissions to begin
Oct 2012
Medicare VBP to begin
2013
EHR Meaningful Use must be
achieved or Medicare
Reimbursement
PenaltiesJan 2015
CMS goal to have EHR
interoperable
2014
Value Based Payment
Modifier to Physician Fee
Schedule
Jan 2015
Readmission rate penalty
2013
Public Reporting and Penalties
relating to HAC begins
2014
ACO Launched
2012
Shift to Focus on IncentivizingQuality & Efficiency
Innovation and Excellence in Advanced Illness at End of Life
ACOs and Covered Lives
Innovation and Excellence in Advanced Illness at End of Life
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ACO Types
• Pioneer ACO
• Medicare shared savings programs
• Next generation ACO
• ACO Investment Model
• Advanced Payment ACO Model
• Comprehensive ESRD Care Initiative
• Oncology Care Model
• Comprehensive Primary Care (CPC+) Model
Innovation and Excellence in Advanced Illness at End of Life
What is an Accountable Care Organization?
• MSSP Definition: • “…a legal entity that is recognized and authorized under applicable State, Federal, or Tribal
law, is identified by a [TIN], and is formed by one or more ACO participant(s) that is (are) defined at § 425.102(a) and may also include any other ACO participants described at §425.102(b).” 42 CFR § 425.20.”
• Functional/Operational Definition: • Partnerships among health care providers to coordinate and deliver high quality, cost
efficient health care services to defined populations
• Purpose: • Promote accountability for Medicare FFS beneficiary population
• Improve the coordination of FFS items and services
• Encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery
• Promote higher value care
Innovation and Excellence in Advanced Illness at End of Life
Value to Physicians Value to Payers Value to Health Systems
Affiliation with the ACO brand and
strategy
Redefine provider relationship from
combative to collaborative
Aligned independent practices and
physicians
A more powerful voice in health plan
relationships
Extensive, stable and top-tier network for
products
Spread Health System reach (and risk)
across broader population and
geography
Demonstrate, improve and be rewarded
for clinical quality
Collaboration in improving value for
beneficiaries , members and customers
Communication venue with independent
“affiliates”
ACO governance, leadership and input
roles
Transition from FFS payment; address
cost and quality
Demonstrate value to payers,
businesses, and community
Participate in development of
• Value-based compensation models
• Evidence-based care etc.
Shift resources from Medical
Management to other areas (benefit
design, etc.)
Strategy to assess and assure quality
practitioners support hospitals
Innovation and Excellence in Advanced Illness at End of Life
ACO Value Proposition
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How to Share in Savings
Innovation and Excellence in Advanced Illness at End of Life
Meet the Minimum
Savings Rate for Assigned Beneficiaries
(2-3.9%)
Meet the Quality
Performance Standards for
Assigned Beneficiaries
Maintain Compliance
and Eligibility within the MSSP ACO Program
If all requirements
are met within the MSSP, the ACO will share in savings with a rate of up to
50%
BPCI Advanced
• Voluntary bundled payment model that ties physician & hospital payments to quality and cost of services provided under a 90-day clinical episode (“bundle”)
• Actual FFS spend vs. target price determines gainsharing
• Multiple waivers of fraud and abuse and anti-kickback laws
Innovation and Excellence in Advanced Illness at End of Life
BPCI-A
• 29 Inpatient episodes
– Ortho
– Cardiac
– Pulmonary
– CVA
– GI
– Renal
– Infection
• 3 Outpatient episodes
– PCI
– Defibrillator implantation
– Back & neck
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Continuing Care
Innovation and Excellence in Advanced Illness at End of Life
One in Five Acute Patients Discharged to
Post-Acute
What is Continuing Care?
9%
50%
LTACH
IRF
SNF
$39,493 per episodeALOS 26.2 Days
$17,995 per episodeALOS 12.9 Days
$12,165 per episodeALOS 27.4 Days
$2,677 per episodeHome Health
1%
2%$11,510 per episode
Hospice
Innovation and Excellence in Advanced Illness at End of Life
38%
Why is Continuing Care PerformanceImportant?
0% 20% 40% 60% 80% 100%
Heart Failure
Cardiac Bypass
Hip and Knee
Stroke
Episode Cost
Hospital MD Post Acute Readmit
Post Acute Spending Represents
20-25% of all Medicare Expenditures
73%
27%14% 14%
3%0
20
40
60
80
PAC Acute DX(Tests)
PX RX
Regional Variation -Spending
Medicare Would Save
$10 BillionAnnually if Patients used the
Appropriate Post Acute Setting
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What Challenges Exist Today?
Home Health?
“Post acute looks like an archipelago of little islands with no
bridges. Consumers are at a loss about which island to approach,
with poor transportation and communication options.”
- Physician Interview, Deloitte
Decreased Payments to PAC
• SNF – patient driven payment model (PDPM) -October 2019
• Home health – Patient-driven groupings model (PDGM) – January 2020
• Post-acute site neutral payments – 2021
• Hospice – future cuts???
Continuing Care Networks
Innovation and Excellence in Advanced Illness at End of Life
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The Continuum of Care –Rethinking Post Acute
Fragmented
Seamless Episode of Care41 Days
$
Reh
ab
Home
Acute Care SNF
Home Health
$6 Days
$20 Days
$30 Days
Each component across the continuum of care serves a unique role in achieving the goal of returning to health
Innovation and Excellence in Advanced Illness at End of Life
Key Components of Strategic Management
1. Risk Stratification
2. Cross-Continuum Care Management
3. Network Management
4. Post Acute Service Evolution
Innovation and Excellence in Advanced Illness at End of Life
1. Risk Stratification
High Risk
Moderate Risk
Low Risk
• Begins with discharge planning and assessment:
Right Place, Right Time, Right Cost
• Data driven process
• Requires elevating communication, coordination, and navigation across settings
• Goal is to manage higher risk patients to proactively intervene prior to readmission or ED visito e.g. flags for missed appointments, blood
pressure, etc.
Key Factors:Socioeconomic
Complex Chronic
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Innovation and Excellence in Advanced Illness at End of Life
2. Cross Continuum Care Management
Mu
lti-
Dis
cip
linar
y Te
am
Triage
Place
Track/ Monitor
Identify
Manage
Risk Stratification
Care Pathways (Projected)
Attribution (Medicaid, ACO, BPCI, MA)
Discharge to Highest Value Network
Optimal Post Acute Placement/DWD
Advanced Discharge Planning
Via Population Health Platform
Via Virtual Monitoring/Exception/Trend
Care Management Interventions
Hospice and Palliative Care Involvement
Active SNF Patient Management (LOS)
Connecting back PCP/Complex Chronic
3. Network Management
• Education and Best Practice Sharing
• SNF Collaborative, Home Health Collaborative
• Medical Directorships
• Focus on Readmissions and ED Visits
• Identify and Select the Right Partners using Data
• Preferred Network
• Continuous Engagement of Physicians and ACPs in Quality Improvement
• Focus on Episodic Cost, Quality and Experience = Value
Options For Discharge Network for Value
Innovation and Excellence in Advanced Illness at End of Life
4. Post Acute Service Evolution
Sharing Risk with PAC Partners
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Atrium Health SNF Network
To improve outcomes and overall Medicare spend
To establish the largest, best network
To focus on partnership and shared accountability
To proactively address opportunities for improvement
We want to partner with facilities that
share a Vision and Commitmentto Quality
Innovation and Excellence in Advanced Illness at End of Life
All Facilities
Tier 1(30-50)
Tier 2(20-29)
Tier 3(1-19)
Score (0-50)
Will receive patient placements
Will receive patient placements; will engage with CHS around opportunities
Will receive patient placements only if specifically requested by a patient
Meets Network Criteria
Star Rating 3 or Above
2 or Below
SNF Preferred Network Design
Innovation and Excellence in Advanced Illness at End of Life
Metric Source Weight Top Performer Acceptable Needs Improvement
Readmission Rate O/E Premier 40% < 0.9 < 1.1 > 1.1
% Medicare/ MA Placements
CHS 2017
25% < 80.0% < 90% > 90.0%
Market Payment Ratio
CMS(2016)
35%<1 SD Below
Market AverageMarket Average
(+/- 1 SD)>1 SD Higher than Market Average
Weighted Score 30.0 – 50.0 20.0 – 29.9 0.0 – 19.9
SNF Network Performance Metrics
Innovation and Excellence in Advanced Illness at End of Life
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SNF Network Scorecard
GG Peak Resources Gastonia Y 1 Gaston West 3 5 1 93.8% 0.92 0.000 36.2 1 16
YY Belaire Y 1 Gaston West 2 3 3 89.4% 1.20 0.000 33.0 5 47
FFF Brian Center Gastonia Y 2 Gaston West 4 5 3 75.0% 1.20 0.666 27.8 17 68
JJJ Cleveland Pines Y 2 Cleveland West 3 5 2 88.5% 1.03 0.614 27.7 30 261
R Lincolnton Rehab Y 2 Lincoln West 3 4 2 91.0% 1.09 0.594 26.5 10 111
FF White Oak Manor - Kings Mountain Y 2 Cleveland West 5 5 4 100.0% 0.86 0.697 26.4 0 48
AA Peak Resources Cherryvi lle Y 2 Gaston West 4 4 98.8% 1.08 0.660 23.8 2 172
White Oak Manor - Shelby Y 2 Cleveland West 2 3 2 98.0% 0.95 1.163 19.4 4 203
XX Brian Center Lincolnton Y 2 Lincoln West 4 4 3 96.8% 1.00 0.867 22.8 7 218
J Peak Resources Shelby Y 2 Cleveland West 5 5 2 94.9% 0.89 1.145 21.3 8 157
N Gastonia Care and Rehab Y 2 Gaston West 3 3 3 84.2% 1.10 1.000 22.7 3 19
HH Carol inas Care Health and Rehab Y 3 Gaston West 3 4 2 93.3% 1.21 1.365 13.9 7 104
M Cardinal Healthcare N Lincoln West 1 1 1 87.8% 1.35 0.937 18.8 6 49
Stanley Total Living Center Y 3 Gaston West 2 5 3 100.0% 1.53 1.000 12.2 0 36
Source CMS CHS CMS Premier CHS CHS
Met Time Period Through January 2018 12 M Feb 18 CY 2016 YTD Oct 2017 2017 2017
Code Facility NameQuality
> 3Tier County Market Overall Quality Staffing
% Medicare/MA
Market Payment Ratio
O/E ScoreNon Medicare
AdmitsTotal
Admissions
Innovation and Excellence in Advanced Illness at End of Life
Greenville Health SystemPost-Acute Care
Medicare Shared Savings Program
Hospice Performance
Innovation and Excellence in Advanced Illness at End of Life 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, NC
Innovation and Excellence in Advanced Illness at End of Life
7 Campuses
6 Acute Care
2 Specialty Hospitals
3 Long-Term Care Facilities
1,537 Licensed Beds
9 Outpatient Facilities
More than 200 Practices
Home Health Agency
Hospice Agency
Number of Providers:
1,100+ Employed Physicians
300+ Advanced Practice
Providers
The University of South Carolina
School of Medicine – Greenville
(graduated first class – May 2016)
9 Residencies and 7 Fellowships
Division of Research – partnership
with Clemson University
ACO/Clinically Integrated Network
Not-for profit academic health care delivery system (now part of SC Health Company)
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SC Health Company
Innovation and Excellence in Advanced Illness at End of Life
Are You Committed?
Innovation and Excellence in Advanced Illness at End of Life
Integrated Post-Acute Network
Innovation and Excellence in Advanced Illness at End of Life
Source: The ChartisGroup
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Network Priorities
Innovation and Excellence in Advanced Illness at End of Life
Health System Network Analysis
• Criteria for selecting a network participant:
Innovation and Excellence in Advanced Illness at End of Life
Geographic Location Financial/Quality Performance Diversity of Services Financial Stability
Bi-Directional Collaboration
GHS Clinical Priorities
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Enhance Experience
Improve Health Status
Reduce Variations in Care
Eliminate Disparities
Data Driven Decisions
Care Model Transformation
Highly Reliable Organization
Value Based Care
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Care Model
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Care Model
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
MyHFN PreferredPartners
• 30 Skilled Nursing Facilities
• 8 Home Care Facilities with multiple locations
• 16 Hospice providers with multiple locations
• 4 Inpatient Hospice Houses
Care Management Engagement
• Dedicated Care Manager
• Onsite rounding with patient and staff
• Care Transitions between care settings
• Education & Training (i.e. Sepsis, COPD, etc.)
Quality Monitoringand Reporting
• Site specific metrics
• Quality reporting to Quality & Care Model Committee
• Improvement Action Plans
GHS in MSSP
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
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GHS in MSSP
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Network “Value”
• Hospitals/ACOs are “new buyers” of service to:
– Improve hospital mortality rates
– Improve hospital length of stay
– Reduce overall Medicare spend
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Value-Based Purchasing
Data Considerations
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
• Medicare Shared Savings Program (Track 1 – 2016 & 2017 performance years)
• Assigned MSSP beneficiaries
• Source: Claims and Claim Line Feeds (CCLFs)
Definitions:
• Allowed $ per Service/Stay – Allowed amount per continual service period/stay
• Average Visits/ALOS – Average number of continual visits in service period or days
• 30 Day Readmit Rate – Number of qualified readmissions within 30 days of
discharge divided by total number of discharges
• Case Mix Index – hospital relative resource use index
• Quality Score – average of 7 hospice compare quality measures
• Service Count – Number of continual service periods/stays
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GHS Post-Acute Care Utilization
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
14.9%
1.4% 2.3%
25.3%
56.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Home Health Hospice IRF SNF Home - Community
Pe
rce
nt
Uti
liza
tio
n
Current Performance
*Not adjusted for patient expiring in PAC setting
40% of Medicare Patients Use Post-
Acute Services
GHS Post-Acute Care Spend
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
$2,797
$7,720
$19,413
$9,439
$7,804
$0
$5,000
$10,000
$15,000
$20,000
$25,000
HomeHealth
Hospice IRF SNF
All
ow
ed
$ p
er
Serv
ice
/Sta
y
Current Performance System Average
*Not adjusted for patient expiring in PAC setting
GHS Post-Acute Care ALOS
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
10.1
16.3
14.7
22.9
18.1
0.0
5.0
10.0
15.0
20.0
25.0
HomeHealth
Hospice IRF SNF
Ave
rage
Vis
its/
ALO
S
Current Performance System Average
*Not adjusted for patient expiring in PAC setting
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Hospice Performance
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Post-Acute ProviderAllowed $
per Service/Stay Average Visits/ALOS Service Count30 Day
Readmit RateCase Mix
IndexAverage
Quality Score
Provider 1 $5,596 7.44 116 0.0% 1.99 98.74%
Provider 2 $6,786 14.21 72 2.8% 1.37 99.73%
Provider 3 $7,299 7.20 61 0.0% 1.86 98.46%
Provider 4 $7,800 13.22 51 0.0% 2.64 88.46%
Provider 5 $11,004 30.44 50 6.0% 1.60 99.31%
Provider 6 $8,622 21.07 30 10.0% 2.02 96.77%
Provider 7 $7,786 21.28 25 4.0% 1.87 87.76%
Provider 8 $5,595 5.96 25 0.0% 1.82 86.90%
Provider 9 $7,016 7.13 23 0.0% 2.31 98.26%
Provider 10 $8,005 19.36 22 4.5% 1.47 92.41%
*Not adjusted for patient expiring in PAC setting
Hospices scored 93% or higher on 6 of 7 measures (2016)
Hospice High Performer
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Post-Acute ProviderAllowed $
per Service/Stay Average Visits/ALOS Service Count30 Day
Readmit RateCase Mix
IndexAverage
Quality Score
Provider 2 $6,786 14.21 72 2.8% 1.37 99.73%
Provider 3 $7,299 7.20 61 0.0% 1.86 98.46%
Provider 4 $7,800 13.22 51 0.0% 2.64 88.46%
Provider 5 $11,004 30.44 50 6.0% 1.60 99.31%
Provider 6 $8,622 21.07 30 10.0% 2.02 96.77%
Provider 7 $7,786 21.28 25 4.0% 1.87 87.76%
Provider 8 $5,595 5.96 25 0.0% 1.82 86.90%
Provider 9 $7,016 7.13 23 0.0% 2.31 98.26%
Provider 10 $8,005 19.36 22 4.5% 1.47 92.41%*Not adjusted for patient expiring in PAC setting
Provider 1 $5,596 7.44 116 0.0% 1.99 98.74%
Hospice Low Performer
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Post-Acute ProviderAllowed $
per Service/Stay Average Visits/ALOS Service Count30 Day
Readmit RateCase Mix
IndexAverage
Quality Score
Provider 1 $5,596 7.44 116 0.0% 1.99 98.74%
Provider 2 $6,786 14.21 72 2.8% 1.37 99.73%
Provider 3 $7,299 7.20 61 0.0% 1.86 98.46%
Provider 4 $7,800 13.22 51 0.0% 2.64 88.46%
Provider 5 $11,004 30.44 50 6.0% 1.60 99.31%
Provider 6 $8,622 21.07 30 10.0% 2.02 96.77%
Provider 8 $5,595 5.96 25 0.0% 1.82 86.90%
Provider 9 $7,016 7.13 23 0.0% 2.31 98.26%
Provider 10 $8,005 19.36 22 4.5% 1.47 92.41%
*Not adjusted for patient expiring in PAC setting
Provider 7 $7,786 21.28 25 4.0% 1.87 87.76%
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Diagnosis Grouping
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
28.4%
27.3%
13.9%
11.6%
19.0%
27.2%
18.7%
11.0%
18.0%
25.1%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
Cancer
Cardiac
Respiratory
Dementia
Other
Percentage National Percentage
Visit Distribution
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
- Provides clear understanding of distribution of number of visits/length by provider- Account for outliers and provides context by provider
Data Interaction
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
X-axis: Average Visits/ALOSY-axis: 30 day Readmit Rate
Size: # of ServicesColor: Allowed $ per Service/Stay
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Data Interaction with Quality
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Color: Allowed $ per Service/StaySize: Average Visits/ALOS
X-axis: 30 day Readmit RateY-axis: Average Quality Score*
*Quality scores based on latest Hospice Compare data from data.medicare.gov
Future Analytics
Innovation and Excellence in Advanced Illness at End of Life The Carolinas Center’s 42nd Annual Hospice & Palliative Care Conference – September 2018 – Charlotte, ,NC
Strategic Approaches forHospice & PC Providers
Innovation and Excellence in Advanced Illness at End of Life
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Data Sources
• Understand the health system’s problems to solve
– Corporate goals including focused populations
• Resources
– www.hospitalcompare.hhs.gov
– http://www.leapfroggroup.org/compare-hospitals
– https://www.ibm.com/watson-health/services/100-top-hospitals
– Statewide health data organizations
– State and regional coalitions
– Private/proprietary data for purchase
Innovation and Excellence in Advanced Illness at End of Life
Data Sources
• Evaluate your data/impact by potential “solutions”
– Diagnosis
– Provider
– Site of care
– Cost
– Mortality
– Readmissions
Innovation and Excellence in Advanced Illness at End of Life
Knowledge
• Know the literature
– What has approaches have proven effective in patients with advanced illness?
• ACP
• Home-based palliative care
• Care management
– Health systems may or may not know this information
Innovation and Excellence in Advanced Illness at End of Life
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Action
• Health systems/ACOs not looking for a sales pitch –need solutions
• Engage wherever you can
• Create targeted outcomes with leadership
– Hospice LOS by provider group
– Number of ACP conversations
• Think scale – not looking for “one-off” solutions
Innovation and Excellence in Advanced Illness at End of Life
Questions
• What do you know about your health system partners including their employed physicians?
• What do you know about your own organization and performance?
• What do you know about non-health system PAC partners? SNFs/HH/IRF/LTACH?
• Who can you start a dialogue with?
• Do you have business model beyond days of care?
Innovation and Excellence in Advanced Illness at End of Life