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Aspire H e a l t h This PowerPoint is proprietary and confidential and not intended for distribution. July 18, 2018
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Confidential and Proprietary
Aspire Health: At-a-Glance Nation’s largest provider of non-hospice, community-based palliative care Currently serving patients in 25 states and 67 cities Practices led by some of the nation’s most well known palliative care physicians Targeted programs for Medicare Advantage, Managed Medicaid and commercial health plans as well as ACOs, IPAs, MSOs and oncology practices Playing a leadership role in developing national community-based palliative care quality metrics Proven positive return on investment across multiple sites and payers © 2018, Aspire Health Confidential and Proprietary 2
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Aspire’s Palliative Care Approach
© 2017, Aspire Health Palliative Care: A Medical Specialty Medicare Hospice Benefit Old Life-Prolonging Care Key Enrollment Question “Would you be surprised if this patient passed away within the next year?” Common Disease Categories Cancer (Stage IV) Advanced Heart Failure (Class III-IV) Advanced COPD (Stage III-IV) Advanced ESRD Advanced Dementia Life-Prolonging Care Medicare Hospice Benefit New Palliative Care Diagnosis 6-12 months Death © 2018, Aspire Health Confidential and Proprietary 3
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Confidential and Proprietary
Aspire’s Philosophy Build a clear understanding of palliative care as a separate service from hospice Set up an independent palliative care physician practice in each market dedicated exclusively to serving non-hospice patients facing an advanced illness Educate physicians and patients on the services this specialized practice offers Utilize Aspire’s data analytics to proactively identify patients who can benefit from palliative care services Develop deep working relationships with PCPs and specialists The primary task of Aspire’s lead physician in each market is building physician-to-physician relationships Develop individualized mechanisms for communicating with large practices based on each practice’s preferences Operate outpatient clinics co-located within large oncology practices (select geographies only) Provide co-management, interdisciplinary palliative care clinical services 24/7 across settings Patients are co-managed by their current physicians and Aspire’s palliative care physician Practice employs an interdisciplinary team that includes physicians, NPs, RNs, SWs and chaplains Practice conducts home visits, operates outpatient clinics, and provides comprehensive telephonic support and monitoring Practice also provides 24/7 access to clinicians, including home visits Utilize robust data collection, tracking and sharing processes All Aspire clinicians use a single data system with protocols designed specifically for patients facing an advanced illness System allows patient’s status and quality metrics to be tracked and reported to other physicians and health plans This system produces a one-page visit summary that is sent back to each patient’s PCP or specialist after each Aspire home visit © 2018, Aspire Health Confidential and Proprietary 4
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Aspire’s Home-Based Palliative Care Model
Customer - Regularly receives data on patient’s status & provides Aspire Health cost and utilization data by patient Customer - Medicare Advantage Plans - Managed Medicaid Plans - Commercial Health Plans - IPAs and MSOs - ACOS Patient Identification - Aspire partners with its customer to identify patients who could benefit from palliative care using a combination of the customer’s data, Aspire’s algorithm and direct referrals Initial Palliative Care Assessment - A palliative care clinician conducts a comprehensive palliative care assessment in the patient’s home that can be used for risk-adjustment Palliative Care Support Team - Home or outpatient clinic palliative care visits from physicians, NPs, RNs, SWs and chaplains as needed - Regular telephonic outreach to the patient and their family - 24/7 access to palliative clinicians, including home visits - Access to Aspire’s patient & family educational materials - Weekly care support team meetings led by a palliative care physician to review complex patients PCPs & Specialists - Consulted on care plan changes & receives alerts on patient’s status changes as desired Aspire Health core service © 2018, Aspire Health Confidential and Proprietary 5
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Confidential and Proprietary
Aspire’s Palliative Care Support Team Palliative Care Physician: Aspire Health’s palliative care physician leads Aspire’s physician outreach and education efforts, sees patients in outpatient clinics, oversees the nurse practitioners, participates in the weekly interdisciplinary team meetings, and coordinates care with the patient’s other physicians; the latter includes talking with both PCPs and specialists about any changes Aspire’s care support team may recommend to the PCP’s or specialist’s treatment plan; physicians are on call 24/7 Palliative Care Nurse Practitioner: Aspire Health’s palliative care nurse practitioners conduct home visits, develop the patient’s home-based palliative care plan, prescribe medications, talk with patient and families as needed, and participate in the weekly interdisciplinary team meetings; NPs are on call 24/7 Social Worker: Aspire Health’s social workers provide both in-person and telephonic counseling services to patients, including behavioral health support; social workers also help connect patients with home health, DME, long-term support services, and other non-clinical resources as needed as well as facilitate hospice transitions Registered Nurse: Aspire Health’s registered nurses provide both in-person and telephonic clinical support to patients as needed; this includes triaging incoming clinical issues during regular business hours as well as placing outgoing clinical calls to patients to check in on their clinical status and follow up on any outstanding clinical issues Patient Care Coordinator: Aspire Health’s patient care coordinators provide support to Aspire’s clinical team as well as coordinate non-clinical logistics for Aspire’s patients and families Chaplain: Aspire Health’s chaplains (and broader network of spiritual leaders) provide counseling services to patients on an as needed basis © 2018, Aspire Health Confidential and Proprietary 6
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Aspire’s Data Collection & Sharing Aspire has built its own proprietary EMR that contains palliative care specific assessments and workflows The EMR has an e-prescribe capability that includes allowing for the prescription of controlled substances This EMR allows Aspire to track palliative care specific outcomes data such as changes in symptom scores and advanced care planning This EMR also generates one-page patient summary reports that are automatically sent to a patient’s primary physician (see sample at right) Aspire’s EMR can also produce customized reports for health plans as well as build API or HL-7 interfaces to facilitate data sharing with health plans as desired © 2018, Aspire Health Confidential and Proprietary 7
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Confidential and Proprietary
Aspire’s Geographic Coverage Area In Operation Targeting 2018 Opening Grand Rapids New York City Detroit Cleveland Chicago Gary Philadelphia Dayton Sacramento Pittsburgh Indianapolis Baltimore Cincinnati Kansas City Charleston St. Louis Richmond Louisville Bristol Winston-Salem Riverside Los Angeles Knoxville Raleigh-Durham Nashville Charlotte Phoenix Memphis Chattanooga Olive Branch Columbia Atlanta Birmingham Dallas El Paso Mobile Austin Pensacola Daytona San Antonio Houston New Orleans Tampa Fort Lauderdale Rio Grande Valley © 2018, Aspire Health Confidential and Proprietary 8
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Confidential and Proprietary
Aspire’s Health Plan Partners © 2018, Aspire Health Confidential and Proprietary 9
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Costs vs. Revenue Last Year-of-Life
Costs vs. Revenue in Last Year-of-Life for Targeted End-of-Life Population Without Aspire © 2018, Aspire Health Confidential and Proprietary 10
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Last Year-of-Life Costs by Category
Distribution of Last Year-of-Life Total Costs for Targeted End-of-Life Population Without Aspire © 2018, Aspire Health Confidential and Proprietary 11
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Aspire Outcomes Data: Primary Diagnosis
Primary Diagnosis of Patients Enrolled in Aspire Program (Medicare Advantage Plan) © 2018, Aspire Health Confidential and Proprietary 12
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Advance Care Planning: Aspire Program vs. National Benchmark
Aspire Outcomes Data: Advance Care Planning Advance Care Planning: Aspire Program vs. National Benchmark © 2018, Aspire Health Confidential and Proprietary 13
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Aspire Outcomes Data: Patient Satisfaction
Patient satisfaction with most recent visit 4.9 Who completed the survey? Patient satisfaction with Aspire overall 4.8 Very Dissatisfied Dissatisfied Neither Satisfied or Dissatisfied Satisfied Very Satisfied How likely would you be to recommend Aspire to a family member or friend 4.9 Very Unlikely Unlikely Neither Likely or Unlikely Likely Very Likely © 2018, Aspire Health Confidential and Proprietary 14
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Admissions Per Thousand: Aspire Program vs. Non-Aspire Program
Aspire Outcomes Data: Hospitalizations Admissions Per Thousand: Aspire Program vs. Non-Aspire Program -67% -58% © 2018, Aspire Health Confidential and Proprietary 15
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Aspire Outcomes Data: Hospice Transitions
Percent of Aspire Patients Who Passed Away in Hospice Hospice Median Length of Stay: Non-Aspire vs. Aspire Referrals © 2018, Aspire Health Confidential and Proprietary 16
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How To Describe Aspire to Your Patients
“Extra layer of support” Experts in treating symptoms like pain, shortness of breath, and nausea Helping avoid unneeded visits to the hospital and ER Making sure patients have all their medications Home visits from a nurse practitioner Coordination with the patient’s PCP 24/7 access to a doctor or nurse practitioner © 2018, Aspire Health Confidential and Proprietary
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How To Refer to Aspire AIS program ?
Create a process for patient referral that works, and introduce to patient. 1 2 Call (877) 3 Fax (888) © 2018, Aspire Health Confidential and Proprietary
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