Innovative Service Models and Medicare Reimbursement
Speakers
Adam Brooks, MPT BAYADA Home Health Care
Meredith Mills, MHA, PCHA Country Meadows
John Hopkin, DO CCS Healthcare
Sarah Walmsley, PT BAYADA Senior Living Solutions
BAYADA Home Health Care • 10 service lines • 330 offices in 23 States; 6 countries • Over 25,000 Home Health Care professionals • 900,000+ clients/year
Drivers for Change in Medicare •
US healthcare system is the most costly in the world (17% of GDP)
•
Aging US population
•
Medicare funds are not unlimited
Health Care Triple Aim 2007
Affordable Care Act 2010
The Affordable Care Act shifts payments from…
VOLUME • • • •
Payments made for Volume of Services No uniform quality measures Demand for services/ tests/ procedures increasing Fragmented communication between providers
to…
VALUE • Payments made for thoughtful utilization of services/ tests/ procedures • Analysis of financial and clinical data to determine quality • Creates accountability and collaboration between providers
Meredith Mills, MHA Sr. VP & COO
Residents
Locations in PA and MD with IL/AL/MC
Family owned and operated
Becoming the Solution Discharge Patterns Q4 2018 Metric
Provider 1 (SNF)
Provider 2 (SNF)
Provider 3 (SNF)
Provider 4 (SNF)
Provider 5 (SNF)
AVERAGE
Proposed Alternative
Receiver CCN
396134
395560
395347
395437
395846
Receiver Name
PENN STATE HERSHEY TRANSITIONAL CARE
MASONIC VILLAGE AT ELIZABETHTO WN
FREY VILLAGE
LEBANON VALLEY BRETHREN HOME
GARDENS AT CAMPBELLTOWN
AVERAGE OF TOP 5 SNF PROVIDERS
COUNTRY MEADOWS
Vol. Received from Hospital
90
79
56
37
37
60
30-day Readm. Rate
25.6%
N/A 12.7%
12.7%
17.1%
37.8%
21.2%
9.9% (non-risk adj.)
Identify Provider’s Pain Points
90-day Readm. Rate
40.0%
21.5%
25.5%
ALOS (days)
12.2
14.7
23.4
Spend per case ($)
$4,696.15
$6,414.11
$385.63
$436.45
Daily cost ($)
51.4%
34.6%
15.2
19.6
17.0
$10,018.50
$5,221.88
$7,094.69
$6,689.07
$5,525.00
$428.60
$343.18
$362.57
$393.47
$325.00
17
Becoming the Solution
Assess ability to meet provider’s needs
Becoming the Solution
Assess ability to meet provider’s needs
Becoming the Solution
Progressions Program
Pinpoint Highest Value Solution Source: Advisory.com
Solution
Results Patients Referred since 2017
Conversion rate to permanent status
Opportunities to support MA Plans
Progressions Program
Hospitality is what we do. Care has to be an important piece of that hospitality, because it is the right thing to do, and it is allowing our residents what they want— to stay in their home.
CCS Healthcare Physician founded medical group serving Senior Living Operating since 2016 Currently serving 16 communities in PA and NJ Mission: Leverage CMS Value Based Initiatives to: • • • •
Increase access to care Improve Care Coordination Decrease hospital utilization Decrease overall cost of care
Tectonic Shift The Healthcare of tomorrow will move away from
Hospital
Home
CMS Quality Strategy Goals
The Opportunity ALs/ILs well poised to BENEFIT from value based models:
• The demographics of the population served • The residents are in a controllable, condensed uniform environment • Less Federal regulation than skilled setting
Systems can be built to support the residents in an effort to:
• Increase overall access to care • Improve care coordination • Decrease hospital utilization
Resulting in:
• More care in place • Increased patient satisfaction • Increased overall Length of Stay
The CCS Healthcare Integrated Model 24/7 Telehealth Coverage
On Site Primary Care
xx Integrated Behavioral Health
Remote Care Coordination
Results of Integrated Care Initial Analysis Video visits analyzed from January 2017 to June 2017 within 2 Senior Living communities • 107 Visits performed during that time period • 7 % transfer rate of that subset
March 2019 Performance 28 Video Visits performed across 12 Communities • Out of this subset only 4 patients were sent to the Emergency Department
On the Horizon • Beginning in the Summer of 2019, CCS Healthcare will be work with a prominent academic institution to analyze the overall economic impact of our model
Strategic Partnerships Preferred partners are critical Reorganization may be necessary
Medical Team Therapy
Hospice
Home Health
Senior Living Community
Pharmacy
BAYADA Senior Living Solutions LAUNCHED IN 2012
Health Services Provided:
Home Health, Outpatient Rehab, Wellness, Fitness and Hospice
Residents currently under BAYADA Senior Living Care
Communities across the US
States where BAYADA offers the full suite of services
Conventional Network SNF
HOSPITAL
Innovative Network
ASSISTED LIVING
HOSPITAL
Rehab / Respite Model
Hospital has agreed to rent 2 rooms in AL
ASSISTED LIVING
Win.
Win.
Win. Provider of choice agency supports nursing and therapy needs
HOSPITAL
Home Health / Rehab Agency
From Theory to Reality
Identify Pain Points
Quantify Costs
Partner Collaboration
Build the Solution
Engage Stakeholder s
Contract
Financial Savings SNF
ASSISTED LIVING HOSPITAL
1,270 / Day
$365 / Day
ALF LOS: 75 days; $95,000 in Hospital
$200 - $250 / Day $78,750 savings
Lessons Learned Identify the Decision Makers
Present a Developed Solution to Customize
Work with Established Partners
Prepare the Legal Team
Patience and Persistence wins
“Part of me thinks that innovation, real innovation in healthcare delivery, needs to happen from the bottom to the top” ―Malcolm Gladwell