1. 2017 Network Management Updates
MA Medical Directors Meeting

2. Genetic Tests

3. Neonatal Care-LOC

4. Oncology Care

5. IV Drugs Management

6. IV Drugs Management HPHC-NOVOLOGIX-CVS PARTNERSHIP

7. IV DRUGS MANAGEMENT PA-CLAIMS EDITS-SITE OF SERVICE

8. IV Drugs MANAGEMENT: CLAIMS EDITS

9. IV DRUGS MANAGEMENT COST EFFICIENT SITE OF SERVICE

10. 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

11. Hospital At Home

12. 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)

13. Example of Electronic Monitoring Sites

14. 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

15. 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

16. 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

17. 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

18. 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)

20. Transplant Centers of Excellence