INDUSTRYNURSING HOME

NOVEMBER 2014

RHODE ISLAND

MEDICAID RATES

FALL SHORTof cost to provide care

REIMBURSEMENT CHANGES

CARE INITIATIVEINTEGRATED2 PHASE ROLLOUT

Started Nov. 2013Enroll eligible individualsinto managed care

Medicaid and long-term services andsupport (LTSS) onlyMembers had a choice of a casemanagement or a health plan

PHASE I

Expected April 2015Impact

28,000 dual eligible79% live in the community21 live in nursing homes

GoalAlign financing and care with Medicareand Medicaid or "dual eligibles"

PHASE II

How?All Medicare and Medicaid benefits willbe provided through a health plan

Negotiating intricacies of health plan contractsUnderstanding and documenting how risk scores support the requested rate

MANAGED CARE

Dwindling resources due to economic challengesShorter time frame before converting to another pay source

PRIVATEProspective payment systemBundled paymentsAccountable care organizations

MEDICARE

12

3$

OTHER PAYORS

OF THE INDUSTRY INTO THE NEXT YEAR

EXPECTED TRENDS

STAFFING

EXPECTED TRENDS

Issue - increasing numberof high acuity resident

10,000 Americans turn 65everydayLife expectancy grows by 2.5years each decade

ResponseRecruit staffImplement on-site training

AGING IN PLACE AND THECONTINUUM OF CARE

EXPECTED TRENDS

Issue - 90% of elders 65+prefer to stay in theircurrent residenceResponse

Consider expanding services tohome health and hospiceConsider how increasedworkload will be handled

PERSON CENTERED CARE

EXPECTED TRENDS

Issue

ResponseHumanize the healthcare experience

Customer satisfaction

TECHNOLOGY, HIRING & RETENTION

EXPECTED TRENDS

Issue

ResponseObtain better hires and preventturnover by implementingbehavior assessments

Need committed employees toprovide high level or focusedcare

ACUTE CARE FOCUS

EXPECTED TRENDS

More short term staysRequire intensive medicalcare for patientsRequire a greater variety ofcomplex care services

OCCUPANCY CHALLENGES

EXPECTED TRENDS

REGULATORY ENVIRONMENT

EXPECTED TRENDS

AuditsClaims reviewComplianceHospital re-admissionsHIPAA and breachesQuality measuresSocial mediamonitoring

CONSOLIDATION & AFFILIATION STRATEGIES

EXPECTED TRENDS

CONSOLIDATION & AFFILIATIONSTRATEGIES

EXPECTED TRENDS

Operate more efficientlyDecrease cost structureEnhance financialpositionImprove the value of thecare delivered

ENVIRONMENTAL

EXPECTED TRENDS

Update strategic planConduct market researchDesign & diversify fordiffering levels of careConsider the culture

WellnessCohousingSmall house / green houseCommunity partnering

SERVICES PROVIDED

EXPECTED TRENDS

By Pamela L. Sawin, LGC+D Principal; Design By Jessica Santamaria

AN LGC+D HEALTHCAREPRESENTATION

http://www.lgcd.com/industries/healthcare/