1. Post-Acute Care Healthcare Beyond The Hospital Claire M. Zangerle, RN, MSN, MBA President and Chief Executive Officer

2. Elements of the Post-Acute Care Continuum Bridges hospital stay to SNF or home; 20-30 day LOS Lower-cost option for rehab; less acute patients Lowest cost, preferred option; greater opportunity for innovation Focused physical therapy; inpatient or outpatient

3. Shifting from Disease-Specific to Population Health…across the continuum… Optimal Health Outcome Variables Social, environmental, cultural and physical determinants of health Treating specific diagnoses with consideration to the particular human populations

4. The Impact of Healthcare Reform on Home Healthcare Medicare Cuts Total cuts for home health are estimated at $39.7 billion over ten years Yet, homecare accounts for less than 4 percent of all Medicare spending

5. Real Cost of Home Care Average shortfall per visit to Home Care Patients

6. Ohio Medicaid – The Facts Ohio’s largest health and long-term care program 2.2 million Ohioans are covered Accounts for 47% of all nursing home payments Ohio’s fastest growing and largest governmental program; even more so with healthcare reform

7. The Medicaid Imbalance Since 1965, federal law requires Medicaid pay for institutional care in nursing homes Home/community-based care and hospice are optional services for Medicaid coverage The result = Ohio ranks 44 th among the 50 states in percentage of Medicaid long term care spending for home/community-based care

8. Opportunities & Challenges for Homecare Hospital Readmission Reduction Program Since October 2012, hospital DRG payments have been reduced for excess hospital readmission rates on the following diagnoses: –Chronic heart failure –Pneumonia –Acute Myocardial Infarction Beginning in 2015, the following diagnoses will be reviewed, in addition to the originials: –Total Knees and Hips –COPD Post-Acute Care is an essential component to reducing hospital readmission rates

9. May include groups of healthcare providers, i.e., physician groups, hospitals, nurse practitioners, physician assistants This is an outgrowth of physician practice demo projects deemed ineffective for cost savings Will have a minimum of 5,000 beneficiaries assigned to it by CMS from patients receiving services from primary care physicians in the ACO Opportunities & Challenges for Homecare Accountable Care Organizations (ACOs)

10. The Looming Crisis Today, over 400,000 Ohioans receive home healthcare By 2030, more than 500,000 Ohioans will need long term care By 2030, Ohioans aged 80 and older will more than double in the NE Ohio region Ohio will need at least 13,000 more home health aides to meet this growing need

11. Employment of registered nurses is expected to grow by 22 percent from 2008 to 2018 RN employment will not grow at the same rate in every industry –Home health care services is projected to grow by 33% –Nursing care facilities and hospitals (public and private) the projection is only 25 and 17% respectively Post-Acute Care Employment Statistics

12. Build The Population Health Infrastructure Ensure workforce is flexible –Retrain staff; build population health competencies The IOM Nursing Report suggested, in key messages, that nurses should… –Practice to the full extent of their education and training –Achieve higher levels of education and training through an improved education system that promotes seamless academic progression –Be full partners, with physicians and other health professionals, in redesigning health care in the United States

13. Build The Population Health Infrastructure Connect information technology across post-acute care sites –Build a comprehensive record of patient information –Share patient information across providers with disparate EMRs –Share information with the patient, outside the visit (MyChart type of technology)

14. Build The Population Health Infrastructure Develop a preferred partner network –Providers don’t need to own every part of the post-acute care network; it is cost prohibitive –Organizations must select partners based on compatible culture, collectively- managed performance and cost/quality data

15. Post-Acute Care Healthcare Beyond The Hospital Claire M. Zangerle, RN, MSN, MBA President and Chief Executive Officer