AdvancingPopula/onHealthandConsumerism

44,954

SeniorEnrollees 27

4,345

CommercialEnrollees

66,070

CommercialACOMembers

ProgramsforChronicDiseasesImplementa/onofevidencebasedguidelinesTier2:ModerateSeverity

20%

Walkingwell;needperiodicscreeningtestsPreven/veCareReminderProgramAnnualwellnessexamandtargetedoutreachTier1:LowSeverity

60%

ChronicDiseaseswithtwohospitalizaKons;Needsco-ordinaKonofcareReduceavoidablehospitalizaKonTier3:HighSeverity

15%

5%

Tier4:Complex

Popula/onHealthRiskStra/fica/on:KeepPa/entsHealthy,Happy&atHome

260,000paKentsFTEworkingattopoftheirlicense

ProgramsforChronicDiseasesReachinggoalsasperevidence-basedguidelinesforchronicdiseaseDiabetes,Asthma,CHF,COPD,Obesity,HTN

DiseaseManagerlevel2&3,Pharmacist

MulKpleChronicCondiKonsNeedco-ordinaKonofcareReducingavoidableHospitalizaKon

CaseManagerRN,ChronicCareRN

NursePracKKoners/MDSocialWorker,CaseManager

COMPLEXCareatHome

NURSENavigator

Walkingwell;needperiodicscreeningtestsPreven/veCareReminderProgram

CareCoordinatorDiabe/cEducatorHealthCoachPharmacyTech

93131 118

147187

232

204

247

301337

311

413

359

505

346

294 298 323

395

292

319

306

376

467534

735

543

645

772

884 891

705

550

754

0

100

200

300

400

500

600

700

800

900

1000Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-1

3Au

g-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Jul-1

4Au

g-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

#ofReferrals

NurseNavigator:One#/e-referraldoesitallVolumeByMonth

Challenge:MovingfromIndividualtoTeamBased

FeeforService ValueBasedAccountableCare

20minutevisit22pa/entsadayUnknownHealthRisksEpisodicCare

PanelManagementHealthRiskAssessmentQualityCarePreven/veCareTotalCostofCarePa/entExperience

CareatHomeProgram

•  Averageageis83•  Currentenrollment:135•  MixofMA,NextGenACOandDuals•  Doctorsreferpa/entsdeemedatrisk– Diagnoses–mul/plechronicandseverecondi/ons– U/liza/ondata–  Func/onallimitsthatinhibitappointmentsatclinics

•  Frequencyofvisitsvaries

Thesearecomplexpa/ents….

•  Highcost:basedonu/liza/ondatasuppliedbyplanbasedclaims

•  Highrisk:basedonpredictedfutureu/liza/on•  Highsocialneeds

CAHStaffing

•  Teambasedcare–  1RNCasemanager-coordinatescareandhandlescallsandguidespa/ents.

–  4NPs–makingvisits:usuallyone/meper6weeks.NPdoes5visitsaday.Firstvisitis60-90minutes,andthesubsequentonesabout40mins.

–  1SocialWorker–whenneeded;assistswithbehavioralissues;supportgroups

– MAs•  Eachpa/entretainstheirPrimaryCarePhysician

HowdoyouscaleandsustainCAH?

1.  Createbusinesscase

2.  CalculateROI

3.  Sharewithleadership

Businesscase:Defini/on

Jus/fyinganorganiza/on’sexpenditurebasedontheposi/veeconomicconsequencestothatorganiza/on.

ABUSINESSCASETYPICALLYBEGINSWITHTHEEXISTENCEOFAFINANCIALBURDENIFNO

INVESTMENTISMADE

$

ExamplesofECONOMICBURDENSRELATEDTOHEALTHCONDITIONS▪  ThecosttoMedicareofahospitalreadmissionwithin

30’sdaysofdischargeisabout$18,000.

▪  Morethan25%ofMedicareexpendituresareprovidedinthelastyearoflife.

▪  Costperhospitalstayforthoseadultsthatdieinthehospitalisover$112,000.

▪  TheannualMedicarespendingforanindividualwiththreeormoreco-morbidi/esandwithdemen/aisabout$50,000.

Thebiggertheburden,thebiggertheopportunity

TheStepstocrea/ngthebusinesscase

1.Measureandadduptheexpectedbenefitsintermsofcostsavingsplusanyrevenueenhancementstogetgrossbenefits2.Es/matethetotalcostsoftheprogram3.Subtractthesecostsfromthegrossbenefitstogetnetbenefits4.Omenthenetbenefitsareexpressedasapercentageoftheprogramcosts-andcalled“returnoninvestment”orROI,forshort5.TheROIiscomparedtoa“hurdle”rate-aminimumpercentagethatanyinvestmentmustgeneratetobeconsideredaprac/ve

CAH:Step11.Measureandadduptheexpectedbenefitsintermsofcostsavingsplusanyrevenueenhancementstogetgrossbenefits•  Costsavings:

§  Reduc/oninadmissions,readmissions,ED§  Team-basedcare,usingnon-licensedstaff

•  Revenueenhancements:§  ACOreimbursement

CAH:Step22.Es/matethetotalcostsoftheprogramToconsider•  Staffing•  IT•  Transporta/on•  Othersocialservice•  ……..

CAH:Step33.Subtractthesecostsfromthegrossbenefitstogetnetbenefits•  SummarizeusingROICalculatorTool

•  Example

CAH:Step4

4.Omenthenetbenefitsareexpressedasapercentageoftheprogramcosts-andcalled“returnoninvestment”orROI,forshort

CAH:Step55.TheROIiscomparedtoa“hurdle”rate-aminimumpercentagethatanyinvestmentmustgeneratetobeconsideredaprac/ve

DecreasingCHFAdmissionsDecreasing30daysReadmissions

32.75

29.63

32.33

28.72

24.16

20.00

22.00

24.00

26.00

28.00

30.00

32.00

34.00

36.00

38.00

40.00

CY2011 CY2012 CY2013 CY2014 CY2015

HFAdmissionsper1,000MembersperYearSeniorHMOPopulaKon

CHFAdmissionCostSavingsovera2yrs.periodCY2013per1,000membersperyear: 32.33 CY2015per1,000membersperyear: 24.16 Reduc/oninadmissionsper1,000: 8.17

MeanCostofSeniorHospitaliza/on(MEPS): $18,554

Es/matedCostSavings $2,615,923

ARU:DecreasingAcuteAdmissionsper1,000Members

22

CY 2013 per 1,000 members per year: 222.00CY 2014 per 1,000 members per year: 204.00

Reduction in admissions per 1,000: 18.00Mean Cost of Senior Hospitalization (MEPS): $18,554

Estimated Cost Savings for 2014: $5,116,117

AcuteAdmissionCostSavingsin2014

243236

229225

207

197196

202 202 199194

165

180

195

210

225

240

255

HospitalAdmissionsper1,000RateforSRSSeniorHMO

FiscalYears

YeartoDate

Goal

Goal:203

Transi/onsofCare85%consolida/onSeniorHMOpa/entsatnineSNFfacili/es

17.2013.10

0.00

5.00

10.00

15.00

20.00

AverageLengthofStayDays

Before 2015

#DaysStayReduced24%

10%0%

10%

20%

30%

30dayreadmission

Before 2015

DirectReadmissionsfromSNFtoAcuteCare(30days)

10%0%10%20%30%

ReadmissiontoHospital30daysPostSNFdischarge

Before 2015

PostSNFDischargeReadmissionRate

BaselinedatasourcefromLeansixsigmastudyperiodOct2011toDec2012

MedicareACOprogram(assuming30,000a?ributedmembers)2daysLOS=$2M2%Readmitrate=$0.5M

CareatHomeProgramOutcomeAnalysisInpaCentAdmissionsandERvisitsper1,000perYear

(33monthsanalysis12/2013to09/2016,uniquepaCentssee1371)

1244

980

542

702

Inpa/entHospitalAdmissionsper1,000perYear ERVisitsper1,000perYear

Pre-Engagement Post-Engagement

56%Improvement 28%Improvement

ROICalculatorTool

•  Linktotool– hpp://www.thescanfounda/on.org/business-case-person-centered-care

•  Discussion– Howhavegroupslookedatsuppor/ngbudgetforcareteams?

– Howhaveshowneffec/venessofprogram?– Whatoutcomescalculated?