Post Acute Care in the Changing Health Care Landscape 2016 Dual Chapter Autumn Institute Healthcare Financial Management Association  October 27, 2016

The Landscape is Changing The Affordable Care Act Medicaid Expansion Balancing Incentive Program Center for Medicare and Medicaid Innovation-CMMI Medicare ACOs Medicare Value-based Purchasing Medicare Bundled Payment Program Medicare Advantage growth

The Changing Landscape: Ohio Medicaid Expansion Dual Eligible Projects Behavioral Health Carve-In Federal Health Insurance Exchange SIM Grants and Episodes of Care Population-based health care Medicare Advantage

Challenges for Providers in New Care and Payment Models Assessing the current service delivery model and how it fits with the value-based systems of ACOs, Bundled Payments, PCMH, etc. What outcomes are being achieved? Where are the areas for improvement? What is the core business and what can be done through partnerships?

The Triple Aim In Ohio, We spend more on health care than residents in all but 17 states. We pay a lot and get very little for it.

How Health Care will be Delivered Regional Approach Fewer hospital systems Affiliations and partnerships Midwest Health Collaborative (Aultman, Cleveland Clinic, ProMedica, OhioHealth, Premier, TriHealth) Health Innovations (University Hospital, Summa, Mt. Carmel. Kettering, Mercy Health) Risk Sharing becomes important Producing data and outcomes is imperative

What does this mean for Health Care Providers? Payment reforms will challenge service delivery reform. Reducing readmissions and length of stay – imperative! Reduced hospital and nursing stays, more home care P4P, Bundled payments, capitation  PCMH “If I keep doing what I’m doing…I’ll be fine” This mindset will not work and you may find yourself out of business.

Payors will Change Too… Quality verses Efficiency Paying for outcomes Providers must take advantage of opportunities to engage with payors to determine what those outcomes are and how they will be paid. Don’t assume payors know your business, be ready and willing to educate them how you deliver services and the outcomes you are trying to achieve.

It’s All About Data Collecting and analyzing data will be imperative for providers. Presenting that data in a meaningful format for your partners whether they be hospitals or payors shows your value to them. Readmissions and Length of Stay – the low hanging fruit.

Post Acute Care Data 30 day unplanned readmissions Observation stays ER Visits Return to Community Pressure Ulcers UTIs Falls with Major Injury Flu and Pneumonia vaccines Staffing hours

Big Budget Items to Watch MCO Issue SIM Episodes last phase roll-out Expanding to 50+ episodes, including behavioral health, for reporting (Wave 3) Wave 3 implementation will follow a similar pathway to Wave 2 episodes Wave 2 episodes moving into performance evaluation/reporting Episode-based payment models ICD10 coding alignment, including behavioral health codes

Big Budget Items to Watch Continued… Patient Centered Medical Home Goal of reaching 80% of Ohio’s population Requirements for enhanced payment (Jan. 2018) CPC Statewide, begin early entry in 2017 CPC+, CMS selected Intend to award to 7 current CPCi regions with an extension to 13 new regions CMS selected practices will be eligible for CPC+ Medicare payments starting Jan. 1, 2017 More healthcare items with social determinants of health included

Achieving Success Know your costs – not your charges!! Know your quality – collect data and analyze it. Identifying those services you do best and find partners for other services – you don’t have to own it all. Know who your partners are and the value they bring to you.

Looking Ahead We need to continue challenging ourselves to assess the way we are providing services so we can improve overall health and collect data that is meaningful to our patients and payors. Identify our partners who can help us achieve desired outcomes and develop those relationships. Data, data, data…..

Questions??