1

The San Diego Readmissions SummitFebruary 5, 2015

2

Agenda

• Changes to the PAC World

• PAC Market Drivers & Business Needs

• Tools and Solutions

• Resources

3

Changes to the PAC World are Occurring on Many Fronts

4

Medicaid Managed Long Term Care Expansion

“State Demonstration Proposals to Align Financing and/or Administration for Dual Eligible Beneficiaries…”

“Medicare Advantage Enrollment in 2014 Exceeds Projections by 6 Million Beneficiaries”

Building Alliances

LTPAC

Hospitals

MCOACO

Changes are Coming Fast and Furious

5

Payment Model Changes -- The Catalyst

Volume Driven Value Driven

Fee For Services (FFS)

• Heads in Beds (Longer Stay)• Documenting RUGS• Avoiding Take Backs• Surviving Surveys & Audits

Bundled Payment and Shorter Stay

• Cost Control• Care Coordination/Quality Outcomes• Case Mix• Managing Complex Contracts/Possible Cash

Flow Disruption• Avoiding Exclusions

(drugs, procedures, services, etc.)

6

Potential Payer Mix Changes

Graphic courtesy of Avalere

7

PAC Market Drivers

8

Key Drivers - 2015 and Beyond…

CareCoordination

Partnering and Connectivity

ClinicalOutcomes

Financial Outcomes

9

Transition from Fee for Service (FFS) to Bundled

Payments (MCOs, ACOs, etc.)

Consistent care management across the

continuum of careData at the core

• Managed Care growing rapidly – efficiency a necessity

• Contract management

• Move from charge capture to cost capture, allocation & projection

• Managing important metrics (ALOS, re-hospitalization, etc.) Proof of value to garner referrals

• Interoperability with partner systems

• Expanded services (telemedicine, diagnostics, etc.)

• Efficiently move patients across the continuumwith quality outcomes

• Collaboration across settings

• Evidence-based practices/decision support, outcomes

Business Needs & Process Changes

10

PAC Provider Tools

11

Outcomes Reporting

Readmissions (Admissions, Discharges) – High risk diagnosis – Changes in ADLs– Issues upon discharge– Discharge to another LTC facility, or

lower level of care– How many times residents were

admitted to ER while in your care– Planned vs. unplanned discharges

Quality – Established goals vs. actual– Hip fracture or stroke patients

with ADL improvement– Special reports just for dementia:

falls, injuries, pain – Relationships between mobility

and continence– Flu vaccinations– Level or frequency of falls,

injuries, restraints, pain, self harm, wounds, safety, wandering, weight loss, etc.

Cost (LOS)– Payor

– Referral source

– Diagnosis

– Physician

– And more!

Outcomes Reporting

In AHT

Outcomes Reporting

In AHT

12

Physician Engagement & Collaboration

13

For Communication between the Nursing Home and Hospital

Engaging Your Hospitals • Tip sheets for better communication and collaboration with local hospitals Nursing Home Capabilities List • Standardized pre-populated checklist explaining nursing home capabilities for decisions about transfers back to the facility •NH – Hospital Transfer Form • At time of acute care transfer from nursing home to hospital to make key information easily accessible to receiving clinician • Acute Care Transfer Checklist

14

Resources

15

More Information – White Papers

Partnering with MCOs, ACOs and Hospitals as New Payment Models Emerge in Post-Acute Care

www.healthtech.net/resources

16

Thank you!