1. Positioning Your Hospital for Pay for Performance Through Interactive Patient Care Technology David W. Wright Chief Outcomes Officer September 23, 2010 Copyright © 2010 GetWellNetwork, Inc. Proprietary and Confidential.

2. 2 A Call to Action 2010: Health Reform brings sweeping changes to healthcare industry 35+ million Americans newly insured Accountable Care Organizations Payment reform driving hospital focus on improved quality to reduce cost per case 2009: National Quality Forum declares Patient & Family Engagement as a National Health Priority to reduce harm and eliminate waste Consumer-driven health care #1 issue in US Wall Street Journal, The Informed Patient, 3/16/10 Business Week, Lessons of a $616,318 Death, 3/15/10 P&T (medical journal), Increasing Patient and Family Engagement in Health Care, 4/10

3. 3 Health Law Affordable Care Act signed into law March 23, 2010 Comprehensive health insurance reforms that are intended to:  Lower health care costs  Guarantee more health care choices  Enhance the quality of health care Key goals of the new law:  Insurance more affordable with tax cuts  New competitive market within health insurance industry  Greater accountability with rules to control costs (e.g. premiums)  Eliminates discrimination due to pre-existing conditions  Reduce deficit by $143 billion over first 10 years and $1.2 trillion in 20 years Cost: $940 billion over 10 years

4. 4 Health Law Impact on Hospitals Several provisions in the law directly impact hospitals Reimbursement Changes New Care Delivery Models Quality Reporting Expanded ‘Never Events’ Pay for Performance

5. 5 Key Provisions In Health Law re: Patient Engagement

6. 6 CMS Value Based Purchasing Plan Value Based Purchasing Value Based Purchasing Care Measures (70% Weight) Care Measures (70% Weight) HCAHPS (30 % Weight) HCAHPS (30 % Weight) + Performance will determine payment adjustments through Value Based Purchasing Plan Due by January 2012 Implementation FY 2013 (Oct 2012)

7. 7 VBP HCAHPS Based on 8 Categories Rating based on national ranking on roll-up scores 1.Nurse Communication 2.Doctor Communication 3.Responsiveness of Staff 4.Pain Control 5.Communication about Medicine 6.Room Cleanliness 7.Quiet at Night 8.Discharge Education

8. 8 VBP HCAHPS Summary Calculation There are 3 performance metrics that are weighted and factored into the HCAHPS Component: 1.Attainment Score 2.Improvement Score 3.Minimum Performance Score Total Attainment/ Improvement Points (max 80) Minimum Performance Points (max 20) Total Points Earned (max 100) += CMS will use the higher score of the two

9. 9 VBP – HCAHPS Components Attainment Score Score range from 0 – 10 Based on the percentile rank Below 50 th percentile = zero points 51 st - 94 th percentile = points vary between 5 and 9 95th percentile or above = max 10 points Improvement Score Score range from 0 - 9 Examples: Improvement from 10 th to 40 th percentile = 3 Points Improvement from 20 th to 60 th percentile = 4 Points Minimum Performance Score Score range from 0 - 20 Provides incentive for all 8 metrics as a whole Based on the lowest percentile of the 8 metrics 0 – 50 th percentile = points vary between 0 – 19 If the lowest ranking is 50 th percentile = 20 points Added to the 80 possible Attainment/Improvement points to make a total of 100

10. 10 Sample HCAHPS Attainment Score Roll-up CategoryHCAHPS RankScore Nurse Communication22 nd 0 Doctor Communication31 st 0 Pain Management31 st 0 Communication about Meds53 rd 1 Cleanliness and Quiet64 th 6 Responsiveness of Staff27 th 0 Discharge Information13 th 0 Overall Rating78 th 0 HCAHPS Attainment Score15 out of 80

11. 11 Sample HCAHPS Improvement Score Roll-up CategoryHCAHPS RankScore Nurse Communication12 th – 22 nd 3 Doctor Communication17 th – 31 st 3 Pain Management15 th – 31 st 2 Communication about Meds4 th – 53 rd 5 Cleanliness and Quiet48 th – 64 th 2 Responsiveness of Staff7 th – 27 th 4 Discharge Information11 th – 13 th 1 Overall Rating63 rd – 78 th 2 HCAHPS Improvement Score22

12. 12 Sample HCAHPS Attainment/Improvement Score Roll-up CategoryHCAHPS RankScore Nurse CommunicationImprovement3 Doctor CommunicationImprovement3 Pain ManagementImprovement2 Communication about MedsAttainment1 Cleanliness and QuietAttainment6 Responsiveness of StaffImprovement4 Discharge InformationImprovement1 Overall RatingAttainment8 HCAHPS Improvement Score28 out of 80

13. 13 Sample Minimum Performance Score Roll-up CategoryHCAHPS RankScore Nurse Communication220 Doctor Communication310 Pain Management310 Communication about Meds530 Cleanliness and Quiet640 Responsiveness of Staff270 Discharge Information1311 Overall Rating780 % of Minimum Attainment (50 %)0.26 Allocation of Points (20 Possible)5.2

14. 14 HCAHPs Impact on VBP

15. 15 Process of Care Measures – VBP Impact CMS will establish a benchmark and attainment threshold to score care measures performance reported by hospital  Benchmark = mean value of top-performing 10 % of hospitals  Attainment Threshold = Performance of the median (50 th percentile) hospital in the previous reporting period Hospital would earn 0 to 10 points based on where the score falls relative to the benchmark and attainment threshold –Greater than or equal to benchmark = 10 points –Within attainment range = 1 – 9 points –Equal to or less than attainment threshold = 0 points Hospital can earn 0 – 9 points for improvement over previous period

16. 16 Scoring Example: Care Measures Performance Measure: PN Pneumococcal Vaccination.57 (CURRENT SCORE) _____________________________________________________________.47.87 Attainment Benchmark Threshold Attainment Range Prior Hospital Score Period Score Baseline ________________________________________________________________________________________________________________________________________. 28 __________________________________ 1 2 3 4 5 6 7 8 9 CurrentAttainment Range _______________________________________________________________________________ _____________________________________________ 1 2 3 4 5 6 7 8 9 Improvement Range Care Measures Attainment Score (0 – 9) Prior Period Score:.28 Current Score.57 Attainment Score 3 Improvement Score 5 Performance Score: 5 (Improvement Score) Care Measures Attainment Score (0 – 9) Prior Period Score:.28 Current Score.57 Attainment Score 3 Improvement Score 5 Performance Score: 5 (Improvement Score)

17. 17 Process of Care Measures – VBP Impact Each hospital will also have a “Total Possible Points” for Care Measures Total possible points = total number of measures reported by hospital x 10 points The hospital’s clinical process of care performance score is a percentage calculated as follows: Overall performance score = total earned points/total possible points x 100% There would be no penalty for regression in performance No points awarded for surpassing the previous period’s performance scores if the score is below a level of performance achieved two or more prior periods

18. 18 Process of Care Measures – VBP Impact TOTAL CARE MEASURES PERFORMANCE SCORE Total Points182 Number of Measures Reported 19 Total Possible Points (19 x 10)230 Clinical Performance Score79 % (182/190 =.79) TOTAL CARE MEASURES PERFORMANCE SCORE Total Points182 Number of Measures Reported 19 Total Possible Points (19 x 10)230 Clinical Performance Score79 % (182/190 =.79)

19. 19 Overall VPB Calculation 250 bed hospital $55.5 million/year in inpatient Medicare revenue Potential financial impact of performance: $192,279 - $961,397

20. 20 Interactive Patient Care…a powerful care model & solution to drive performance improvement

21. 21 Realizing Measurable Outcomes Improve patient satisfaction Surpass service benchmarks Leverage real-time feedback for service recovery Improve staff satisfaction Improve care measures performance Meet National Patient Safety Goals Automate compliance Reduce risk of “Never Events” Reduce readmissions Differentiate and capture market share Reduce Average Length of Stay Generate new revenue opportunities Achieve workflow efficiencies SERVICE EXCELLENCESAFETY AND QUALITY FINANCIAL

22. 22 Priority Focus for Hospitals Pay for Performance ProgramMost Common Trouble Spots Meaningful UsePatient Specific Education HACs/Never Events Falls Pressure Ulcers Hand Hygiene Care Measures HF Discharge Instruction Pneumonia/Influenza Vaccine Pneumonia Antibiotic HCAHPS Medication Teaching Staff Responsiveness Communication/Information Room Cleanliness Pain Control Bundled PaymentsHeart Failure Readmissions

23. 23 Patient Education Education Pathway Patient is prompted to complete education Document to EMR Caregiver orders education (or in standard order set) Complete HL7 Result Nursing Follow UpNew Education Order ? ? Education

24. 24 AMTELCO Nurse Notification AMTELCO Nurse Notification Medication Administration Bar Code Medication Administration Bar Code Pain Management Pain Management Pathway Pain Assessment (prompt over TV) Automated EMR Documentation Automated Nursing Notification

25. 25 Medication Teaching Pathway Pharmacy Medication Order Medication Teaching Pathway Patient is prompted to view medications ordered by their doctor Automated EMR Documentation

26. 26 Falls Pathway

27. 27 Case Example Applications: Pain Management Pathway Environment of Care/Service Recovery Pathway Fall Prevention Pathway Hot Spot FocusBaseline2010 YTDImpact Never Event: Fall Reduction 4.5/10003.1/100031 % Improvement HCAHPS Top Box Score: Room Cleanliness Pain Control 68.6 % 62.4 % 76.1 % 72.5 % 10.9 % Improvement 12.9 % Improvement

28. 28 Case Example Applications: Environment of Care Question of the Day Service Recovery Pathway Pneumonia Vaccine Pathway Influenza Vaccine Pathway Hot Spot FocusBaseline2010 YTDImpact Core Measures: PN Vaccine Influenza Vaccine 70% 65% 83% 82% 26.1% Improvement 18.6% Improvement HCAHPS National Rank: Room Cleanliness 36 th Percentile52 nd Percentile44.4% Improvement

29. 29 Case Example Applications: Medication Teaching Interface & Pathway Pneumonia Antibiotic Pathway Hot Spot FocusBaseline2010 YTDImpact Core Measures: PN Antibiotic 46 %91 %97.6 % Improvement HCAHPS Top Box Score: Medication Teaching 88.1%94.2 %6.9 % Improvement

30. 30 Interactive Patient Care Technology Capability to engage patients using workflow technology Ability to exchange data with relevant HIT systems Relevant resources for both care team and patient Demonstrated workflow efficiencies with tools and automation Platform that allows for patient-specific information exchange and continuing patient engagement across continuum Applications and Pathways designed with a focus on performance improvement Data and experience supports that IPC is a core strategy for performance improvement

31. 31 Considerations It is not too soon to begin preparing and addressing those performance issues that will directly impact P4P outcomes  Many of the P4P provisions will be based on 1 year-old data Necessitates viewpoint that patient engagement is a core strategy to performance improvement  Requires adoption of Interactive Patient Care (IPC) as a different way of delivering patient care across continuum Impact of IPC heightened with interfaces with HIT systems  Supports compliance with Meaningful Use  Enables improved workflow efficiencies  Integral to improved coordination along the continuum of care Important that hospitals identify priority areas of focus for patient engagement  Selecting those hot spots that will most impact P4P calculation to start

32. QUESTIONS?

33. Thank you! David W. Wright Chief Outcomes Officer (202) 250-9991 dwright@getwellnetwork.com