Download It`s All About Value:

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