Plenary Session 8 - Health Dimensions Group

Plenary Session 8
Peter
P
t A
A. Longo
L
Cantex Senior Communities
©2010 Health Dimensions Group
1
Caring with Pride
Cantex Post Acute – A Seamless Network
HCBS
Transitional Care
Chronic Care
Comprehensive in-house
rehabilitation
Trach/IV/Wounds
Pharmacy
Hospice
Extensive amenities
Rehabilitation
Home Health
Evidenced-Based
Practices
Diagnostics (contract)
Chronic Disease
Management
Complex Care
Private Rooms
Ancillary Services
Caring with Pride
Cantex’s Value Proposition
Excellent outcomes, at a low cost, with systemsystemwide coverage
coverage, resulting in:
Lower re-hospitalization rates
Better LOS management for hospital partners
Seamless transitions
Caring with Pride
Why Partner …
Survival in an ACO/bundling environment
Solidify referral flows
St d di care paths
Standardize
th
Strengthen care transitions management
Participate in E.H.R. development
Caring with Pride
Value--Based Partnership Strategies . . .
Value
Expand post
post-acute
acute service offerings
Build system-wide coverage in key markets
St
Strengthen
th
competencies
t
i to
t handle
h dl higher
hi h acuity
it patients
ti t
Build physician relationships and presence
Gather, trend, benchmark key quality metrics
Manage and track detailed costs
Caring with Pride
Choosing Your Partners . . .
Not all hospitals/health systems were created equally!
Understand acute reimbursement, consult MedPAR data
C
Consider
id re-hospitalization
h
it li ti
rates,
t
D/C traffic,
t ffi LOS mgmtt
Geographic overlap
Existing post-acute services, relationships
Community reputation, cultural affinity
Caring with Pride
Using Data to T
Tell Your Story . . .
Traditional Metrics:
State and Federal quality scores
A
Annual
l survey quality
lit
Patient and physician satisfaction
Quality indicators
Caring with Pride
Cantex QRS and CMS 55--Star Rating
g Comparisons
p
Quality Rating Scores
CMS 5-Star Ratings
90
81
77
4
36
3.6
79
3
2.6
70
TX Average
2
59
60
60
50
1
0
2008
2009
CANTEX
2010
2010
TEXAS
Source: Texas Department of Aging and Disability Services
Source: Center for Medicare and Medicaid Services
Caring with Pride
Average
g Health and Life Safetyy Code Tags
g
15
13
11
11
10
6
5.1
4.1
5
0
CANTEX
2008
2009
TEXAS
2010
So rce Te
Source:
Texas
as Department of Aging and Disabilit
Disability Ser
Services
ices
Caring with Pride
Customer Satisfaction 2009
Likely to Recommend Facility to Others
Overall Satisfaction
90%
92%
90%
90%
88%
86%
85%
86%
85%
84%
84%
82%
88%
88%
84%
84%
82%
80%
80%
80%
80%
78%
76%
78%
74%
76%
Family
Resident
Family
Resident
CANTEX
So rce M
Source:
My Inner
Innerview
ie S
Survey
r e
TEXAS PEERS
Caring with Pride
CANTEX Quality Indicators Exceed State Benchmarks
19.1
20
15.2
15.3
15
12.4
10
10.1
7.1
5.9
4.9
5
2.3
1.9
03
0.3
2.1
07
0.7
1.3
0
Falls
Significant Weight
Loss
Decline Late
Loss ADL’s
Restraints
Low Risk
Pressure Ulcer
Chronic
Pain
Post-Acute Pain
CANTEX Averages*
TEXAS Averages
Source: SimpleLTC,
p
, 2010
*Percent of population in the Cantex facility that has an MDS assessment
Caring with Pride
Using Data to T
Tell Your Story . . .
Metrics Targeted to ACO/Bundled Environment:
Re-hospitalization rates
D/C to
t h
home
Cost control, e.g. drug utilization
Rehab/pharmacy/diagnostic support
Functional outcome measures
Caring with Pride
Functional Outcome Measures
10
8.5
8.3
7.3
8
66
6.6
6.7
67
65
6.5
6.3
5.8
6
7.3
5.3
5.8
4.7
3.4
3.7
4
3.0
2
2.0
0
Community
ADLs
Functional
Mobility During
ADLs
LB Dressing
Toileting
UB Dressing
Community
Mobility
Level Surfaces
Stairs
Baseline
Discharge
Caring with Pride
Quality/Value
y
Advantage
g with our OutcomeOutcome-Based
Rehabilitation Team
Patient--Centric Programs
Patient
Led by a Physiatrist
Neurological Recovery
Advanced Specialized Equipment
Biodex Balance System
Electro-modalities from Accelerated Care Plus for Pain
Management and Neuro-Muscular Re-education
Cardiopulmonary Rehabilitation
Light Gait Partial Weight Bearing Device
Light-Gait
Aggressive Orthopedic Rehab
MIST Therapy Ultrasound Wound Healing System
Lymphedema Management
Anodyne Monochromatic Infrared System
Comprehensive Wound Care
Electromodalities
the Treatment
Disorders
El t
d liti ffor th
T
t
t off Swallow
S ll
Di
d
Pain Management
Omni Cycle for Strength and Endurance Training
Prosthetic/Orthotic Training
Balance Recovery
Bladder Control
Caring with Pride
Groom Up InIn-Patient Setting . . .
Hospitality veneer
Private patient rooms
Di ti t spaces for
Distinct
f distinct
di ti t populations
l ti
Physician/extender spaces
Strong technology infra-structure
Caring with Pride
P
Prairie
ii E
Estates - F
Frisco
i
The Belmont - Allen
The Carlyle - Southlake
San Remo - Richardson
Caring with Pride
Private Rooms
Caring with Pride
Restaurant Quality Dining
Caring with Pride
Q&A . . .
Caring with Pride
Plenary Session 8
Caroll A
C
A. IIrvine
i
Madlyn and Leonard Abramson Center for Jewish Life
©2010 Health Dimensions Group
21
Post Acute and Long Term Care Providers’
Strategies
g
for Partnerships
p and
Accountable Care Organizations Readiness
Carol A. Irvine
P
President
id t and
d CEO
Abramson Center for Jewish Life
2007: Traditional Long-Term Facility Based
Organization
Abramson Residence
(297 LTC Nursing Home beds)
Counseling for
Caregivers
Mildred Shor Inn
(48 market rate units)
Social Adult Day Services
2011: Development of Senior Care Continuum
Abramson Hospice
Abramson
C
Care
Ad
Advisors
i
(Info & Referral/Geriatric
Care Management)
Abramson
Residence
(297 LTC Nursing
Home beds)
Web-based
Navigation
Counseling for
Caregivers
Birnhak
Transitional Care
(27 beds)
Primary Care/
House Calls
Mildred Shor Inn
(48 market rate
units)
Abramson Home
Care
Medical
Adult Day
Services
Remote Health
Monitoring
Social
Adult Day Services
Outpatient
Services
Renal Dialysis
Rehab Services
Abramson Center’s Vision
Transition to Full continuum of senior
service
i to serve the
h b
broader
d Phil
Philadelphia
d l hi
market
Position as the premier high quality
p
provider
Expertise in frail elderly with multiple comorbities focus on cognitive impairments
morbities,
and chronic diseases
Readiness for ACO Partnerships
Philadelphia market will be served by
multiple
l i l ACO
ACOs, Ab
Abramson will
ill not be
b
exclusive
Medical Home concept: primary care,
prevention,, management
p
g
of chronic
diseases
Quality provider,
provider not the least expensive
Nimble delivery of services to meet client
outcomes
Preparation for the Future
Planning Horizon of 2015, 2020 and 2025
Focus on 4 megatrends:
Demographics/Relevance
Workforce
Technology
Funding/Financing
Business Applications
Demographics
“Care at Home” for persons with Alzheimer's
and related diseases
Workforce
Development of Primary Care
Non-Traditional Recruitment Efforts

On-Going
Training & education
d
off staff
ff
Business Applications
Technology
Electronic Health Records
Home Monitoring
S i l M
Social
Media
di
Financing
Expansion of HCBS
g
Care Transitions management
Evidence-based Care Programs to standardize Care
Population Health Manager
Plenary Session 8
JJeffery
ff
Lemon
L
Spectrum Health Continuing Care
30
Jeffery S. Lemon, FACHE
Vice President, Post Acute Care
Spectrum Health Hospital Group
President
Spectrum Health Continuing Care
31
Spectrum Health
Spectrum Health- Highlights
•
2,000 acute care beds
•
Hospice and Palliative Care
•
65,000 discharges annually
•
Special Care Hospital (LTACH)
•
Q t
Quaternary
Medical
M di l Center
C t
•
Visiting Nurse Association
•
Level One Trauma Center
•
Infusion Pharmacy Services
•
Heart Transplantation Center
•
Rehab and Nursing Centers
•
Cardiology, Cancer,
Orthopaedics Centers of
E
Excellence
ll
•
Neuro-Rehabilitation Services
•
Home Medical Equipment
•
Inpatient Rehabilitation Unit
(July 2011)
•
Top Ten Integrated Delivery
System- 2010
The News you Need to Know
First, the g
good news.
Hospitals have (re)discovered post acute care.
Awareness and Recognition
“Policymakers and health
care providers increasingly
recognize that coordination
between acute care
hospitals and post-acute
providers is essential to
improving the overall
quality of care and
reducing health spending.”
Rich Umbdenstock
President and CEO
35
American
Hospital Association
The News you Need to Know
Now the bad news.
Hospitals have (re)discovered post acute care.
“It’s only long term care. How hard can it be?”
Anonymous Hospital CFO
Reading Tea Leaves
•
Moving from venue-based
venue based discharge to care management via an
integrated continuum (time, space, and profession)
•
Enhanced clinical integration in support of emerging models of care
delivery will require significant investments in time, energy, talent,
and money
•
Avoidable rehospitalizations along with migration from fee-for-service
to bundled payment will require risk-based arrangements and new
partnerships
•
“Post Acute Medicine” emerging as a distinct medical specialty with
physician authorship of clinical pathways required
•
Medicare as a profit-center
Six Strategies for Post Acute Care
•
Bend the Cost Curve
•
Understand and Capitalize on Strengths
•
Better Use Technology
•
Focus on Patients AND Process
•
Connect Quality to Value
•
Build New Relationships
40
What Hospitals Want- For Now
•
Quality Dashboards
• ER visits and rehospitalizations
• Planned
• Unplanned
• Avoidable
• Unavoidable
• By Diagnosis with Reason Code
• Trended over time
•
M&M review on every event deemed “avoidable”
41
What Hospitals Need- For Now
•
•
Criteria to assess post acute providers and future partners
•
Clinical Outcomes
•
Geographic Coverage
•
Clinical Depth
•
Financial Strength
•
Intellectual Capital
•
Continuum Capable
All parties must acquire the organizational aptitude needed
to partner around a diverse portfolio of “non-traditional” of
businesses
43
Have a Plan
“Everybody has a plan until they get punched in the mouth.”
Mike Tyson
45