whca/wical may 12, 2016 post-acute care provider networks · focus on post-acute care and the...

WHCA/WiCALPost-Acute Care Provider Networks

© 2016 Health Dimensions Group

May 12, 2016

© HDG 2016 May 12, 2016


Brent T. Feorene, MBA, Vice President, Integrative Delivery ModelLori A. Aronson, MBA, LNHA, Manager of Consulting Services

Health Dimensions Group

May 12, 2016

© HDG 2016 May 12, 2016 1

Today’s Session

Welcome & Introductions

The Health Care Continuum: A Shift to Value

Positioning as a Solutions Provider for Sustainability and Growth

Key Characteristics of Success

Discussion with Panel

© HDG 2016 May 12, 2016

Introduction to Health Dimensions Group

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© HDG 2016 May 12, 2016

• Senior-level health care executive with over 20 years’ experience consulting to a breadth of health care organizations on a variety of ambulatory and post-acute strategy and management issues

• Clients include health systems, academic medical centers, home health/home care agencies, SNFs, community service organizations, and managed care organizations

• Serves on the board of the American Academy of Home Care Medicine (AAHCM) and on the executive committee as treasurer

• Respected presenter and author; has written and spoken on a variety of strategic and management issues impacting health care, including editing and authoring grant‐supported publications on community‐based care management initiatives

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Brent T. Feorene, MBAVice President, Integrative Delivery ModelsBrent T. Feorene, MBAVice President, Integrative Delivery Models

© HDG 2016 May 12, 2016 4

Lori Aronson, MBA, NHAManager, Consulting ServicesLori Aronson, MBA, NHAManager, Consulting Services

• More than 15 years of experience in the health care industry, with a focus on post-acute care and the senior population

• Expertise in post-acute network development; physician practice development and operations; and Programs of All-inclusive Care for the Elderly (PACE), skilled nursing, and telehealth operations

• Provides assistance to post-acute health care organizations with operational assessments, strategic planning, program development, due diligence activities, and continuing care development

• As director of senior services at TriHealth, worked collaboratively with nursing and post-acute facilities in the Greater Cincinnati area to improve outcomes for patients throughout the care continuum

• Serves on Public Policy Committee of National PACE Association and presents nationally at industry events

© HDG 2016 May 12, 2016

Health Dimensions Group: What We Do

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Strategic Consulting

• Strategic planning and positioning

• Health care continuum alignments

• Market growth strategies• PACE development• Bundling implementation• Senior service line

development• Post-acute medicine

development

Operational and Performance Improvement

• Clinical• Financial and billing• Regulatory compliance• Reimbursement advisory• Transaction advisory• Business office support• Operations

re-engineering

Management Solutions

• Strategic planning and positioning

• Turnaround management

• Transitional leadership• Full-service

management• Acquisitions &

divestiture• Interim management



May 12, 2016

© HDG 2016 May 12, 2016

You now know me…but we need to know one another, too!

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© HDG 2016 May 12, 2016

“If you think you can run your company the next ten years the way you ran it the last ten years, you are out of

your mind…”

- Roberto GoizuetaFormer CEO Coca-Cola

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© HDG 2016 May 12, 2016 8

85% of Medicare Fee-For-Service (FFS) payments tied to quality or value by 2016;

90% by 2018

30% of Medicare FFS to be in “Alternative Payment Methods” by 2016;

50% by 2018

Broad-based private Health Care Transformation Task Force self-imposed a goal to shift 75% of contracts to value-based

methods by 2020

2015 Saw Rampant Goal Setting for Value-Based Purchasing



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© HDG 2016 May 12, 2016

Commercial Plans

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38%35%

27%

Fee-for-Service BundledPayments

Capitated orother paymentsw/insurance risk

Early Mid Late Unsure

Bundled Payment Implementation Progress2

What phase of bundled payment plan implementation is your health plan

currently in?

Bundled Payment Implementation Plans2Average Percentage of Hospital Revenues by 20181

Health Systems Health Plans

1Source: Health Enterprise Partners, “Seizing Opportunity in the Wake of Reform-Executive Perspective Survey, 2012”2Source: Avality, The Health Plan Readiness to Operationalize New Payment Models, April 2013. The study was administered by independent research firm Porter Research in the fourth quarter of 2012. Porter Research completed interviews with qualified participants of 39 health plans that represented more than 50% of total covered lives in the United States. Target participants included: quality management leadership, medical directors, and chief medical officers.

Currently Implemented

24%

Planning to Implement

34%

NoPlans42%

In the next 2 years, bundled payments will represent 35% of U.S.

health systems’ revenue

24% of health plans currently implementing

bundled payment contracts

© HDG 2016 May 12, 2016

• Medicare’s measure of hospital financial efficiency

• Average Medicare episode spend (Part A & Part B) for hospital patient compared to risk-adjusted national average

Medicare Spending per Beneficiary (MSPB)

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• Medicare spending episode includes:

– 3 days prior to hospital admission

– Acute care stay

– 30 days post-acute stay

• Impact of MSPB

– Requires hospital systems to understand post-acute providers’ costs and outcomes:

• Readmission rates

• Cost of care

• Length of stay

• Medical necessity of placement

3 days prior 30 days after discharge

© HDG 2016 May 12, 2016

Medicare FFS Acute Hospital

Discharges

42% Sent to Post-Acute

42% Sent to Post-Acute

SNF

20%

Home Health

17%

Acute Rehab

4%

LTACH

1%

Skilled nursing represents a key

setting for controlling total

costs and managing outcomes

Skilled nursing represents a key

setting for controlling total

costs and managing outcomes

Post-Acute Care Plays Key Role to Bending the Cost Curve

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Source: Medicare post-acute care reforms. Statement of Mark E. Miller. Executive Director, Medicare Payment Advisory Commission.Before the Subcommittee on Health. Committee on Energy and Commerce. U.S. House of Representatives. April 16, 2015.

Health systems often have limited control of costs and outcomes sent to nonaffiliated post-acute settings



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• By 2025, nearly 1 in 5 U.S. residents will be elderly

• In 2015, nearly 500,000 seniors in U.S.; by 2060, will be nearly 100,000,000

• Of those seniors, nearly 25% are dual eligible

• Dual eligibles have higher incidence of disease

Senior/Dual Population Force Move Toward Value-Based Care

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Disease Non-Dual Prevalence Dual Prevalence

Alzheimer’s 9% 19%

COPD 10% 17%

Diabetes 25% 36%

Heart Failure 15% 19%

Source: Medicare.gov

© HDG 2016 May 12, 2016

Both MSSP and Next Generation ACOs (serving 9 states)

Both MSSP and Pioneer ACOs (serving 1 state)

MSSP, Pioneer, and Next Generation ACOs (serving 5 states)

MSSP ACOs (serving 48 states)

No Medicare ACOs (2 states)

464 Medicare ACOs Serving 48 States

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CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID

WY

OK

KSCO

UT

TX

NM SC

FL

GAALMS

LA

AR

MO

IA

VA

TN

IN

KY

IL

MI

WV

WA

OH

PA

NY

VT

ME

CT

NJ

D.C.

WINH

MA

RI

DEMD

NC

AK

HI

Source: CMS.gov, January 2016

© HDG 2016 May 12, 2016

SNF & HHA Value-Based Purchasing:Both Will Affect Payments by 2018

• SNF VBP will lead to rewards and penalties initially based on “30-day all-cause, all-condition hospital readmission measure”

– Confidential reporting first, then incorporated into payments

– INTERACT is becoming de facto industry standard suite of tools for readmissions prevention

• HHA VBP new mandatory program in 9 states* where HHAs get up to +/- 3% payment adjustment based on scores

– Payment adjustment eventually ramps up to +/- 8%

– Scoring based on 6 process and 15 outcome measures, including new advance care planning measure

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*States are: Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington

Both programs will need to figure out how to reward improvement versus attainment in measures



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Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) provides automatic 5% lump sum bonus to physicians (starting 2019) who receive a significant portion of their revenue from alternative payment models (such as bundled payment or ACOs) and, for those who do not, potentially rewards or penalizes physicians by up to +/- 9% depending on their Merit-based Incentive Payment System (MIPS) score

Medicare Physician Payments: Undergoing Value-Based Change As Well

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Intent is to drive physicians to value-based behavior through multiple pathways

© HDG 2016 May 12, 2016

Value-based Movement: Redefining the Value Statement

Medical care delivery in patient’s residence

Alternative for follow-up visit to busy PCP office with

access and scope limitations

Integrated, collaborative care in a SNF using

physicians and advanced practice providers

Offering ED physicians clincally appropriate options

to inpatient admission

Acute Care

MedicalHouseCalls

EDDiversion

ComplexCareClinic

ALF

Home Care Technology

Care Transitions

Psycho-social

Support

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HomeHealth

SNF

Offering a high-quality, lower-cost alternative to SNF

CareManagement

Providing skilled care in patient’s residence

Offering an Integrated Solution to Population Health Management

© HDG 2016 May 12, 2016

Clinical Integration Examples:Provider + Risk + Scale = Transformation

Multi-Hospital

System & Physician Groups

Accountable Care

Organization

Medicare Advantage

Plan

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Multiple Post-Acute

Providers

Vendor or Risk Taker with Bundles

Managed Care

Contracting



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Readiness for Value-Based Transformation

“There are risks and costs to action. But they are far less than the long-range risks of

comfortable inaction”.John F. Kennedy

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1• Physician Alignment and Access that ensures immediate access

to office-based primary care or house calls as well as primary care management in acute and post-acute venues

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• Robust IT Platform and Just-in-Time Business Intelligence that provides cross-continuum information in real time for pre-acute, acute, post-acute, and home-based encounters

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• Risk-Adjusted Enterprise Care Management that includes stratifying population and tailoring care management as well as longitudinal management of beneficiaries

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• Developing Network of Post-Acute Providers for standardized, evidence-based care across the acute/post-acute continuum and seamless, optimal patient experience

What Are ACOs Doing Now?

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© HDG 2016 May 12, 2016

Characteristics of Most Effective Hospital/Post-Acute Care Partnerships

• Physician integration—physician participation in care across settings

• Agreed-upon clinical protocols• Clearly defined expectations

Clinical Collaboration

Clinical Collaboration

• Regularly established forum for communication and performance improvement; for example, joint operating committee

CommunicationCommunication

• Hospital volume concentrated in small number of post-acute providers to allow for increased clinical collaboration

ConcentrationConcentration

• True partnership around improving patient outcomes and reducing utilization

• Process to review and improve care on an ongoing basis

PartnershipPartnership

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• Banner Health Network, one of the remaining Pioneer ACOs, accounted for $29 million in total savings; the Montefiore ACO saved $18 million

• Officials at both organizations said performance was boosted by attention to PAC costs and quality

• Banner Health’s ACO developed preferred network of SNFs and recommends those facilities to patients, vetting local SNFs with questions on quality and culture

• Shaun Anand, Banner Health Network chief medical officer, said improvement in PAC was significant contributor to ACO’s results

• Montefiore ACO worked with SNFs to avoid hospitalization, where possible, by finding alternatives for services that could be delivered elsewhere, such as blood transfusions

Post-Acute Cost and Quality Control Attributed to ACO Savings

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Baseline Data

Euclid Hospital Results

Year 2013 2013 2014

Quarter Q1 Q4 Q1 Q2 Q3

Medicare A/B Patients* † 72* 65† 61† 66† 79†

Cauti Rate* 5.2 0 0 0 0

LOS* 3.40 2.90 2.67 2.87 3.01

Readmission* 5.0% 2.0% 1.6% 2.7% 2.0%

Discharge Disposition Home/HHC*

39% 71% 75% 70% 68%

Discharge Disposition SNF* 56% 28% 25% 30% 31%

HCAHPS Overall Rating* 73% 88% 78% 84% 85%

Cleveland Clinic Model 2 BPCI Results for Major Joint Lower Extremity

Sources: * Cleveland Clinic; † 2014 Q3 CMS Reconciliation Report 2058-002

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• Goals:

– Increase discharges to home

– Decrease hospital length of stay

– Improve pre-operative care

– Achieve functional outcome quicker

• How did they do it?

– Through tight relationship with hospital-owned HHA, developed clinical protocols and education for staff, aides, patients, and families

– Developed relationship with SNF with 7 days/week access to physicians, trained staff, and customer-friendly facility

Montefiore’s Model 2 BPCI Results for Major Joint Replacement Similar to Cleveland Clinic

Source: Ehrlich, Developing an Elective Joint Replacement Program, 2015

Program InitiationProgram Initiation



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• Poor communication among primary providers, specialists, health and community providers, patients, and families

• Failure to catch problems early

• Failure to address psychosocial issues

• Lack of coordinated, longitudinal care management

• Ineffective transitional care management

• Insufficient management of multiplemedications

• Deviations from evidence-based care

Fragmented Care has Historically DrivenHigh Costs and Resulted in Poor Outcomes

24Source: Academy Health 2012

© HDG 2016 May 12, 2016

Robust care redesign that targets avoidable hospitalizations in all settings and transitions

Know outcomes and costs to the DRG level

Prepare the patient and family for the next level of care and get them there as quickly and safely as possible

Risk stratify using data analysis and customizing intensity of interventions

Four Key Elements to Transforming Care

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© HDG 2016 May 12, 2016

Care Coordination Throughout the Episode and Across

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Design Principles

• Evidence-based components

• Person-centered

• Components that can interchange with payor requirements

• Scalable over time and settings

Core Components

• Patient & family engagement

• Risk stratification

• Transition management

• Medication reconciliation

• Chronic disease and geriatric syndrome management

• Interdisciplinary team support

• Follow-up and interconnectivity



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Greater impact on outcomes than health behaviors, clinical care, physical environment, and genetics

Consideration of Social Determinants of Health

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Sources: Tarlov AR. Public policy frameworks for improving population health. Ann NY Acad Sci 1999; 896:281-93; Schroeder, S. We Can Do Better. N Engl J Med 2007;357

Behavioral Patterns

40%

Genetic Predisposition

30%

Social Circumstances

15%

Environmental Exposure

5%

Health Care 10%

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“A recent California study found that in the fourth week of the month, low-income individuals had a

27% greater risk of hospital admission for hypoglycemia than the first week of the month citing insufficient end-of-month funds for food.”

“A recent California study found that in the fourth week of the month, low-income individuals had a

27% greater risk of hospital admission for hypoglycemia than the first week of the month citing insufficient end-of-month funds for food.”

Source: Common Wealth Fund, May 2014

80% of physicians in study concludedthat addressing patients’ social needs is as critical

as addressing their medical needs

Consideration of Social Determinants of Health (continued)

© HDG 2016 May 12, 2016

VBP Creates Opportunities and Challenges

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• Attendance at ongoing meetings in conjunction with reactive communication is a necessity

• PAC facilities must regularly report quality metrics to ensure continued eligibility in affiliation networks

• Acceptance tracking generates data for future conversations between hospitals and PAC facilities

• Standardization of referral protocols ensures rapid placement of patients in appropriate PAC settings

Standardized Referral

Protocols

Patient Acceptance

Tracking

Require Ongoing

Communication

Clinical Quality

Reporting

Four Essentials of PACN Relationships

© HDG 2016 May 12, 2016

Not Taking Risk May Not Be an Option in the Future

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Discussion

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Assisting LTC Providers to Flourish in Value-Based Arrangements

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Value-Based Preparedness Scorecard

Preferred provider to hospital, bundler, or ACO

Active implementation of protocol to prevent avoidable hospitalizations

Measurement of outcomes in comparison to peers

Able to view to clinical information from upstream providers

Electronic medical record capable of 2-way exchange of clinical information

Routine risk stratification of admissions

Standardized care pathways

Comprehensive discharge planning and follow-up process

Clinical leadership buy-in

Basic Advanced

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Very Advanced: Gainsharing arrangement; taking risk under bundling; value-based contracting with Medicare Advantage or SNP

© HDG 2016 May 12, 2016

Know your “upstream” providers and payors needs

• Benchmarked metrics

– Discharge volumes, length of stay(by DRG), readmission penalties, Medicare spending per beneficiary

• Program participation

– ACO (Pioneer, MSSP, Next Generation), BPCI, CJR

• Managed care

– Medicare Advantage: Market penetration of primary payors

Position Yourself as a Solution

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• Focus operational strategies on building care coordination infrastructure

• Have or willing to build/buy capability to manage at-risk or high-cost patients

• Ability to communicate their value proposition as a solutions provider

• Capable or moving towards an ability to manage risk

Strategic Pivots/Repositioning: Solutions Provider

© HDG 2016 May 12, 2016 37

• Are you prepared to differentiate yourself as a preferred partner?

• Know your performance history through benchmarked metrics

You May Not Be Bundling….But,You May Be In Someone Else’s

Length of stay, costs, readmissions rates, costs (by key diagnosis)

Data

Patient safety (wounds, falls, infections), patient satisfaction; star ratings still count

Quality

Care transitions, care pathways, INTERACT

Process

© HDG 2016 May 12, 2016

• To prepare for value-based care, define your value proposition in three key areas and then reach out to value-based payors:

Define Your Value Proposition

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Ability to Manage Readmissions Capabilities to manage the patient aggressively in situ, including telemonitoring and medical management strategies, all within expected norms

Patient Outcomes (Versus Inputs) Relative to Peers Performance better than your peer group on key outcomes

Episodic Management CapabilitiesCapacity to manage seamlessly across multiple settings, effectively communicate with the bundler



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• Demonstrated access and quality outcomes

– Data proving low 30-day hospital readmission rate, across your post-acute episode (SNF-HHA, LTACH-SNF, IRF-HHA)

– Low readmission rates during and following post-acute episode

– Immediate admissions; competencies for high-acuity, medically complex patients; solutions for difficult-to-place patients

– Appropriate use of hospice

How Hospitals and Payors are Selecting Post-Acute Partners

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© HDG 2016 May 12, 2016

• Integration with primary care physicians (PCPs)

– Embedding PCPs into post-acute and senior services

– Communication, reporting, solutions for patientswith non-medical needs

• Care management

– Care transitions (between all settings); care navigation beyond episode

How Hospitals and Payors are Selecting Post-Acute Partners (Continued)

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© HDG 2016 May 12, 2016 41

• Other measures and metrics may also impact payment—depending on MCO, ACO, or potential partner

– State survey scores

– CMS five-star rating

– Clinical indicators

• Acquired pressure ulcers

• Falls

• Restraint usage involving CMS quality indicators (e.g., NQF’s 21 Measures)

– Employee satisfaction/ turnover

– Facility leadership/senior staff tenure

Additional Measures

We should additionally expect that reporting time frames will grow closer to real-time!



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Networks: Metrics for Getting In

Common Criteria for Selection

Patient Experience

Case Managers/Physicians’ Experience

Hospital Readmissions

SNF Length of Stay, Cost

High Volume Discharges

ACO Network Physician/NP in SNF

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© HDG 2016 May 12, 2016 43

Metrics for SNFs Expectation

Patients who 'probably' or 'definitely' would recommend SNF to others > 90%

Patients readmitted for all causes, all diagnoses from SNF to acute care setting in 30 days or less from discharge from acute care setting < 10%

Within 72 hours of SNF admission, number of patients referred to emergency department (ED) < 10%

Patients discharged from SNF to home with home safety evaluation > 80%

Patients discharged from SNF to home with evaluation for home health agency (HHA) services

> 80%

SNF ALOS ≤ 27.2 days > 80%

Patients who are under the care of hospice at time of death > 80%

Networks: Metrics for Staying In

© HDG 2016 May 12, 2016

• Cost management

– Low-cost provider with best outcomes

– Data on your costs of post-acute episode by condition

– Care monitoring and management for at-risk elders

• Health information technology (HIT)

– Electronic health record (EHR) connectivity with hospital, physicians, and other providers

– May be via health information exchange (HIE)

• Ability to share risk

– Shared savings/risk, payment bundles

Proven Value Will Be Key: How Hospitals and Payors Will Select Post-Acute Partners: Tomorrow

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© HDG 2016 May 12, 2016

• Expand or evolve patient and family education to include discharge directions or suggestions specific to their condition

• Follow-up with discharged patients (or family members) via telephone to assess their status and determine if they’ve seen their primary care physician

• Partner with a home health agency to provide post-SNF discharge care

Post-Discharge Tracking is a Key Component of Your Community Discharge Process

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© HDG 2016 May 12, 2016

• Network alignment and development

• Care transformation

• Care teams/Interdisciplinary teams

• Technology

Analytics

EHR

Reporting

eSNF

Telehealth

• Engaged physicians

Future Investment

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© HDG 2016 May 12, 2016

Evaluate your ability to add value

Clinical services

Operational

Talent

Competitors

Payors

Vendors

Access to investment capital

Assessment

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© HDG 2016 May 12, 2016

• Large, market/geographic dominate providers

• Hospital-based providers that are valued by their system

• Providers with aligned interest of payors and referring partners

− Lowest-cost provider

− Focused on same quality metrics as partners

• Proven partner with verifiable data

Which Post-Acute Vendors Will Win?

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© HDG 2016 May 12, 2016

Future Success Requires an Immediate Focus on Measuring and Delivering Quality

Today…

• MDS quality Indicators

• Nursing Home Compare

• Home Health Compare

• CASPER reports

• Resident satisfaction surveys

• Staffing ratios

• Employee turnover

• Nursing home survey

• Occupancy rates

• Waiting list

Under Reform and Beyond

1. Reduced hospital readmissions

2. Patient experience/perception of care

3. Better/measureable patient outcomes and functional outcomes

4. Manage/reduce/know costs

5. Rates of community discharge

6. Care management

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© HDG 2016 May 12, 2016 50

• Become a valued customer

– Medical directors

– Rounding physicians, nurse practitioners, and physician assistants

– Laboratory and phlebotomy services

– Oxygen and durable medical equipment

– Home health and hospice

• Find your specialty and set yourself apart such as wound care, psychiatric support, or chronic illness management

• Stay focused and engaged: Improve outcomes, quantify your value, share your value proposition with stakeholders

Surviving Outside of the Preferred Network



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© HDG 2014 May 12, 2016

New Relationships, New Partnerships, New Players

• Health plans are purchasing physician groups

• Hospitals are purchasing health plans

• Your referral sources can become your competitors

• Your referral sources can become your partners

• Networks and integrators are emerging

It’s a Whole New World Dynamic

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© HDG 2016 May 12, 2016

Questions?

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© HDG 2016 May 12, 2016

Case StudyVCU Health SNF Network Implementation

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© HDG 2016 May 12, 2016

Background

• VCU Health is one of Virginia’s key regional referral centers and serves as the region’s only Level 1 trauma center for adults and children; the Medical Center represents the flagship of VCU Health, spanning from central Virginia into northern North Carolina

• VCU Health serves the community and region as both a leading academic medical center and community safety-net hospital

• Like many academic medical centers and health systems across the country, VCU Health is embracing the challenges of delivery reform stemming from the Affordable Care Act, including the need to:

– Implement population health management initiatives

– Focus on overall patient experience and overall societal health

– Participate in consolidating markets and not be marginalized

– Continue to support teaching and research missions

54Source: Manatt/Assoc. of American Medical Colleges, November 2013

© HDG 2016 May 12, 2016

Background (continued)

VCU Health engaged the ongoing assistance of Health Dimensions Group (HDG) to make recommendations regarding development of a skilled nursing facility preferred network and centralized care coordination model; HDG’s work focused in four key areas:

1. Review VCU Health skilled nursing facility (SNF) needs, and guide preferred partnership development

2. Review VCU Health’s current and planned care coordination initiatives, future needs, and readiness for advancing integration of care

3. Research and assess integrated medical care management models

4. Identify gaps and opportunities through internal feedback

This presentation details findings of our work and specific recommendations and advisement for VCU Health

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© HDG 2016 May 12, 2016

Goals of Engagement

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Establish a skilled nursing facility network

VCU Health care redesign to support accountability and partnership between VCU Health and the skilled nursing facility network

Develop coordination of care model across the VCU Health care continuum



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© HDG 2016 May 12, 2016

Through partnership and collaboration, VCU Health seeks to improve the care continuum for patients discharged from the VCU Health Medical Center to skilled nursing and long-term care providers. The improvement will be achieved through a

seamless and integrated patient experience and will meet the objectives of providing safe, timely, efficient, effective,

equitable, and patient- and family-centered care. This new structure will enhance the strong work being performed both at VCU Health and at nursing homes across the community, and

will better enable the network to meet the objectives of enhancing population health and driving down the cost of care.

Through partnership and collaboration, VCU Health seeks to improve the care continuum for patients discharged from the VCU Health Medical Center to skilled nursing and long-term care providers. The improvement will be achieved through a

seamless and integrated patient experience and will meet the objectives of providing safe, timely, efficient, effective,

equitable, and patient- and family-centered care. This new structure will enhance the strong work being performed both at VCU Health and at nursing homes across the community, and

will better enable the network to meet the objectives of enhancing population health and driving down the cost of care.

Overarching Goals of the Network

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© HDG 2016 May 12, 2016

Member Selection: Decision-Making Framework

• Historical referral and transactional relationships

• Provider capacity

• Geographic distribution

• Performance and resources via data-oriented questionnaires and in-person analyses

– Clinical outcomes could include star rating, length of stay, readmission rates, utilization of emergency department, etc.

• Willingness to accept all payor sources

• Willingness to collaboratively work toward outcome improvements

• Patient satisfaction

• Clinically advanced diagnosis acceptance58

© HDG 2016 May 12, 2016

Skilled Nursing Facility NetworkOperational Structure Components

Through this engagement, the following have been established collaboratively between HDG and VCU Health to promote best practice design and optimal return on investment (ROI) of the network:

• Provider agreement, including uniform indigent contracting component

• Ongoing provider oversight structure

• Network member requirements

• VCU Health obligations and commitment to members

• Joint operating committee structure establishment

• Data collection

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© HDG 2016 May 12, 2016

Beyond ImplementationDiscussion regarding ongoing oversight and enhancement of the network, including early wins, lessons learned, and partnership benefits thus far

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Discussion and Questions

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© HDG 2016 May 12, 2016

Consider WHCA/WiCAL Options

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May 12, 2016

© HDG 2016 May 12, 2016

Continue to be a high-value member-based trade association committed to advocating

and advancing the interests of the long-term care provider community, assisted living facilities and the residents they serve.

Develop a criteria-based, market-responsive network of skilled nursing facilities from

member organizations to meet the demands of value-based care delivery

Establish a management services capability that offers scaled, market-responsive

services that enable members to be attractive to and successful in preferred network

arrangements

Alternatives

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