2017 Network Management Updates MA Medical Directors Meeting

Genetic Tests

Neonatal Care-LOC

Oncology Care

IV Drugs Management

IV Drugs Management HPHC-NOVOLOGIX-CVS PARTNERSHIP

IV DRUGS MANAGEMENT PA-CLAIMS EDITS-SITE OF SERVICE

IV Drugs MANAGEMENT: CLAIMS EDITS

IV DRUGS MANAGEMENT COST EFFICIENT SITE OF SERVICE

CARE DELIVERY MODELS HOSPITAL AT HOME WITH BUNDLE PAYMENTS (15%-16% SAVING PER EPISODE) 5%-10% OF MEMBERS WITH CHRONIC DISEASE ($3,000-$ 6,000 pmpm) Home Visits CMM RPM-Televideo Palliative Care ADVANCED DISEASE MANAGEMENT PROGRAM ED STRATEGY INCLUDING ONCOLOGY CASES

Hospital At Home

Hospital at Home Definition and History Care Model that provides Safe and Effective Hospital-Level Care in the home for certain conditions Imported from Europe and the NHS Dr. John Burton, of Johns Hopkins School of Medicine, Dr. Donna Regenstein and Bruce Leff of The John A Hartford Foundation conceived a new program in the USA (1995) A 17-patient pilot trial showed that Hospital at Home was feasible, safe, and cost effective (1997) Implemented at Presbyterian Health Services, Albuquerque, New Mexico and 5 VA hospitals (2002-present) “Clinically Home” formed to develop and commercialize a telemedicine-based care model (2010) Mount Sinai, New York is currently testing Hospital at Home program that uses 30-day bundled payment model for fee-for-service Medicare (CMS Innovation Center challenge grant)

Example of Electronic Monitoring Sites

Home visits by physicians are available, if medically necessary Hospital at Home HOW IT WORKS A patient requiring admission for one of the target illnesses is identified in the Emergency Department or Ambulatory site. Clinical Staff assesses if the patient is a good candidate for the program using validated criteria. After giving consent, the patient is then transported home, usually by ambulance Once home, the patient receives extended nursing care for the initial portion of their admission, and then at least daily nursing visits according to clinical need. Nurses are available 24 hours a day/7 days a week for any urgent or emergent situation. Home visits by physicians are available, if medically necessary

Targeted Conditions (Hospital at Home) Pneumonia Congestive heart failure Chronic obstructive pulmonary disease (emphysema) Cellulitis Complex Diabetes Volume depletions / dehydration Urinary tract infection / Urosepsis Deep venous thrombosis Certain forms of pulmonary embolism 30 percent of patients 65 year and older are good candidates

Hospital at Home, Safety, Quality Hospital at Home patients are less likely to experience complications such as delirium and less likely to be prescribed sedative medications. Family members experience less stress Illness-specific quality indicators are similar to those treated in the acute hospital settings

Local Pilots Programs Brigham and MGH launched in October 2016 Atrius expected to launch in April 2017 HPHC in discussions with Partners to join the pilot Reimbursement: prospective bundles

Reimbursement Models Center of Excellence “Plus” Bundle Payments (7% cost savings) Joint Replacement NH Outpatient Joint Replacement in MA and NH CABG and PCI in ME Hospital at Home Center of Excellence “Plus” ORGAN TRANSPLANTS (UNITED NETWORK)

Transplant Centers of Excellence