Partnerships & Care Transitions Colleen Swartz, DNP, MBA, RN, NEA-BC Penny Gilbert, MSN, MBA, RN, NE-BC, CPHQ June 22, 2017 3:30 PM

Partnerships & care transitions Objectives Provide an overview of UK HealthCare Discuss the need for post-acute care partnerships Review data Discuss hurdles Identify lessons learned

UK HealthCare

Partnerships & care transitions Who we are: Central and Eastern Kentucky’s only Level 1 trauma center Receive the most severe traumas The only Level IV neonatal intensive care unit in the area Discharge ~105 patients/day Some days discharge greater than 170

Partnerships: Why We Need Them

Partnerships & care transitions Health systems recognize they cannot go it alone and are partnering with post-acute providers to achieve higher quality and lower costs.  American Hospital Association November 2010 Maximizing the Value of Post-acute Care Today, patients often require a diverse array of services to treat major health episodes, manage chronic disease and pursue independent, healthy living.

Partnerships & care transitions “Nationally, 1 out of 5 patients in traditional Medicare who leave the hospital go straight to a skilled-nursing facility…hospitals want more influence over where patients go and what happens while they are there”.1 1. Evans, M. (2015). Hospitals select preferred SNFs to improve post-acute outcomes. Journal of Modern Healthcare. 14-15.

Partnerships & care transitions Eight (8) Skilled Nursing Facility Enterprises Four (4) Home Care Agencies Three (3) Long-Term Acute Care Facilities One (1) Inpatient Acute Rehabilitation organization One (1) Inpatient Substance Use Disorder Facility One (1) Community-based Care Transitions Program (CCTP) State Quality Improvement Organization (QIO)

Data: Driving Decisions

Partnerships & care transitions WHERE TO START? Data Opportunity days Length-of-stay Readmissions Bundle-payments

Partnerships & care transitions Opportunity Days Initial evaluation revealed higher opportunity days for SNFs and IRUs. So partnership developed began with those entities SNF discharges 714 (‘16) compared to 980 (‘17 to date) CMI 2.17 (‘16) compared with 2.229 (‘17)

Partnerships & care transitions Length-of-Stay 1.10 1.03 1.02 Length of stay was also longer for those going to SNFs or IRUs. A process was developed to assist in a more rapid acceptance and transition for these patients. March and April O/E returned to normal at 1.02 and 1.03 respectively Mar Apr Spike in numbers are driven by discharges with long hospitalizations

Partnerships & care transitions Readmissions Readmissions were climbing even for those going home—one theory was patients were going home due to inability to achieve SNF or IRF admission—then bouncing back for a readmission

Partnerships & care transitions October 2017 Bundled Payments Cardiac Patients DC locations home home care Skilled nursing Inpatient rehab unit Substance use disorder rehab unit Partnerships will be key 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 30

Hurdles: Down the Rabbit Hole

Partnerships & care transitions Hurdles develop out of the unexpected or unforeseen. It will be important to work through those from all perspectives, not only the acute care side. Things are very different from a post-acute care perspective.

Partnerships & care transitions HURDLES Expectations v. realities Communication Outcomes Difference of opinions

Lessons Learned

Partnerships & care transitions Lessons Learned Important your partners know what you need from them and why Be ready to make compromises Use the data to drive expectations Use data to drive executive support Stay focused on overall strategy You really can climb out

Partnerships & care transitions Summary University of Kentucky HealthCare® central & eastern KY only Level I trauma facility Often discharge and admit ~105 patients per day Post-acute care partnerships are no longer a luxury but a necessity Decisions/expectations should be data driven Everyone must share & communicate Partnership hurdles will come and go Focus on your overall strategy Move on when necessary

Partnerships & Care Transitions Colleen Swartz, DNP, MBA, RN, NEA-BC chswar2@uky.edu Penny Gilbert, MSN, MBA, RN, NE-BC, CPHQ penny.gilbert@uky.edu June 22, 2017 3:30 PM

Partnerships & care transitions Questions