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9/9/2016 It’s All About Value: Creating an ACO – Friendly Marketing Approach NAHC – 2016 Arnie Cisneros PT - HHSM ● ● ● ● ● ● ● ● 30+ year Post-Acute Provider (Hosp, SNF, HH) 30+ year Home Health rehab clinician Leaders Post-Acute Clinical Management Pioneer ACO (x3) – Post – Acute Strategist Model 2 BPCI Award – DMC – DRG 469/470 JUMP = Joint Utilization Management Program UR for Home Health – Value-Based Care SURCH – VNAA 2016 Innovative Model Award 1 9/9/2016 Preparing for ACOs: Home Health enters the Value Era Home Health enters the Value Era ● CMS Initiatives based on “Volume to Value” shift ● Multiple ACA – Based reforms connect w value ID ● ACOs represent the working model of the ACA ● ACOs rewire the payment and care delivery model ● ACOs tie Provider payments to quality metrics ● Focus on quality metrics (outcomes) reduces cost ● Focus on Outcomes creates Volume to Value shift ● Many ACA care models use value as payment factor 2 9/9/2016 Home Health enters the Value Era ● CJR – Episodic Bundling for Total Joint Replacements ● Value Based Purchasing – P4P – 9 + 9 addn states ● Pre Claim Review – addresses improper payments ● Improper Payments rose to > 50% in 2015 – 5 states ● Pre-Claim Review assures value via quality care ● HH Legacy concerns inhibit Care Plan value quotient ● ACO value expectations extend to All Part A Providers ● ACO structure limits accessibility for HH Providers Addressing the Home Health Value Proposition (Are We Ready? – Sort of) 3 9/9/2016 Addressing the Home Health Value Proposition ● Silo behaviors limit Home Health intrinsic value ● HH Value concerns compared to CMS Part A Providers ● HH Care Production specifics – address in value terms ● Care Delivery for outcomes - Vet current programs ● Admission accuracy suffers at OASIS SOC (coverage) ● Front – line clinical management fails value approach ● HH Legacy – failed to achieve value in terms of volume ● Lack of Utilization Review compromises Part A value Addressing the Home Health Value Proposition ● ACOs look for Home Health to create finite value effect ● Limiting readmissions, Care costs, Care volumes ● Reducing Care Transition issues for efficiency ● Ongoing, real-time communication for coverage ● Assurance of Evidence-Based, Best Practice Care ● IT use for intra-episode communication for value ● Establishing & managing a DC for Outcomes culture ● Creating a standardized level of care quality 4 9/9/2016 Good News for Home Health Providers preparing for the Value Era Good News for Home Health Providers ● Potential Value comparison makes HH ACO choice ● Inexpensive Care redesign allows for value shift ● Comparable cost comparison makes HH PAC choice ● Ability to manage PAC and Chronic population health ● Eliminates risk of inpatient care – infections, re-admit ● Global and functional care programs increase value ● Legacy of community delivery addresses PAC issues ● Patient care is not returning to inpatient culture 5 9/9/2016 Home Health is the Preferred ACO Provider of Choice Good News for Home Health Providers ● Legacy of Flexible Delivery – Pioneers New Models ● Care Delivery over a changing acute care model ● Patient & MD preference increases with education ● Home Health offers ACA value beyond readmits ● Reduction of silo-based inpatient Post – Acute ● SNF LOS reduction decreases $$ + Reinfect/Readmit ● HH ACA Future? – Leaders in Pre/Post-Acute Care ● Care Redesign required for ACA value success 6 9/9/2016 What Home Health Metrics Are Relevant For ACO Success? Home Health Metrics relevant for ACO success ● Publicly Traded Quality Data – Re-admits, Star Rating ● Attention paid to ACO – related clinical outcomes ● Timely SOC, Meds, Improved Ambulation (Falls) ● Respiratory, Wounds, ER Use, Patient Satisfaction ● Clinical Visit Totals – Per discipline – Per Episode ● Supervisory/Clinical Staff Education – Schedule ● Not seeking Providers with Benchmark-level care ● Not Relevant – Recert Rate, High per Episode Cost 7 9/9/2016 What Home Health Areas Should be Targeted For ACO Success? Home Health Areas to Target for ACO Success ● Inadequate SOC Response times – 24 hours? ● Concerns regarding SOC OASIS accuracy & integrity ● Incomplete Programming – multi-discipline PPS model ● 60 – Day Certification Period Mentality (Post-Acute) ● Efficiency/Productivity/Lack of In – Episode Control ● Lack of Safety-Based Frequency delivery model ● Lack of Acuity–Based Programs w/o Utilization Review ● Concerns - recerts, frequent flyers, compliance, MV 8 9/9/2016 Home Health Care Production Targets For ACO Success Home Health Areas to Target for ACO Success ● Intake Management – Referral Integrity (F2F) (POC) ● OASIS Accuracy – Individualized Clinical Profile ● OASIS UR Real-Time Control – Global POC ● Proportional Care Plan Production – Clinical Deficits ● Total Management of Nursing and Rehab Volumes ● Universal Safety – Based Frequencies – Adapt to care ● 100% Provider – Managed Programming – Part A UR ● Frequency & Duration Control – responsive to acuity 9 9/9/2016 Home Health Areas to Target for ACO Success ● IT Management – Documentation for Coverage ● Discharge for Outcomes Management of all Programs ● Change “Clinician – Centered” Home Health Culture ● Address MV, Non – Compliant Programs, Eval Only ● Assess areas where you can create ACO processes ● Support Care Transition Efficiency – Liaisons, etc. ● Telehealth for SNF Volume Reduction – PAC control ● Break Culture of Traditional HH PPS Episode Clinical Management of Home Health for Value-Based Care (Utilization Review) 10 9/9/2016 Utilization Review in Home Health The development and delivery of Home Health services created from a Utilization Review, PPS - compliant perspective. Patient centered, case managed care; modified in an ongoing manner for patient response to treatment. UR-Managed HH produces levels of clinical and fiscal outcomes not regularly seen in homecare as it supports ACA episodic program care model. How Utilization Review for Home Health Creates Value 11 9/9/2016 Address Home Health Clinical Targets ● Pain – employ OASIS manual clarification (M1242) ● Respiratory – OASIS guidance manual (M1400) ● Dressing – OASIS guidance manual (M1810/1820) ● Bathing – employ OASIS guidance manual (M1830) ● Medications - OASIS guidance manual (M2020/2040) ● Transfers - employ OASIS guidance manual (M1850) ● Ambulation - employ OASIS guidance manual (M1860) ● Post – Acute SOC Clinical Orders – 30 days Home Health Provider redesigns care in terms of Utilization Review for Value 12 9/9/2016 HOME HEALTHCARE HOSPICE AND COMMUNITY SERVICES (HCS of Keene, New Hampshire) (Cathy Sorenson, CEO) HCS of New Hampshire – UR Care Redesign ● Non – Profit Organization – Keene, NH ● Census – 200 (approximate) Home Health ● Installed UR program 7/15 – UR Kickoff 8/3 ● Addressed UR elements prior to UR Kickoff ● Present to Administrative/Management UR – process ● Present to Clinical Staff – Mandatory all front-line staff ● Establishment of UR SOC Collaboration Call Line ● UR Kickoff – first 30 day phase crucial for redesign 13 9/9/2016 HCS of New Hampshire – UR Care Redesign ● Inadequate SOC Response times – 24 hours? ● Concerns regarding SOC OASIS accuracy & integrity ● Incomplete Programming – multi-discipline PPS model ● 60 – Day Certification Period Mentality (Post-Acute) ● Efficiency/Productivity/Lack of In – Episode Control ● Lack of Safety-Based Frequency delivery model ● Lack of Acuity–Based Programs w/o Utilization Review ● Concerns - recerts, frequent flyers, compliance, MV HCS PRE / POST – UR STATISTICS HH CMI Rating ----------- 0.9 / >1.25 HH CMI Rating ----- $2600 / >$3600 HH Star Ratings - 3 Stars / 5 Stars 14 9/9/2016 Checklist for Marketing Value-Based Care for ACO Clinical Programming Checklist for Marketing Value – Based Care ● Home Care Compare Star Ratings – 4 of 5 or better ● Home Care Compare Clinical Outcomes ● Special focus on Meds, Falls, Re – admissions ● SOC Care Transition Management – timeliness ● Communication Fluency – with direct care staff support ● IT support – clinical reports on inter–connecting EMR ● Ability to decrease inpatient PAC costs and risks ● Willingness to go “AT RISK” for PAC programs 15 9/9/2016 Checklist for Marketing Value – Based Care ● Global Staff Productivity and Scheduling Control ● Post-Acute Care Programming (30 Day POC) ● Value – Based Clinical Protocols (Eliminate Volume ID) ● Front – Line Clinical Staff Control ● Transparent Utilization and Care Path Management ● Identification & Reduction of HH Legacy Silo Behaviors ● Internalization of APM models and savings/value ID ● Belief in the reduction of in-efficient care practices CAN YOU MANAGE MANAGE TO IMPROVE YOUR CARE? 16 9/9/2016 LINK Home Health Strategic Management 1- 877- 449 - HHSM www.homehealthstrategicmanagement.com 17