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

2. 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

3. 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

4. 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?

5. 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.

6. 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

7. 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.

8. 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.

9. 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.

10. 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

12. 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

13. 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

14. 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.

15. 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…..

16. Questions??