1. 1 The Impact of the ACA: How Readmissions Penalties Will Affect the Healthcare Executive’s Mission Healthcare Leadership Network of the Delaware Valley May 2, 2014 The Impact of the ACA: How Readmissions Penalties Will Affect the Healthcare Executive’s Mission Healthcare Leadership Network of the Delaware Valley May 2, 2014 Paula A. Bussard Senior Vice President, Policy & Regulatory Services The Hospital & Healthsystem Association of Pennsylvania

2. 2 Preventable Readmissions 1 in every 5 Medicare patients are readmitted within one month of discharge. More than 2,000 hospitals affected by readmission penalties. About $270 million in Medicare funds.  PA FFY 2013 - $12 million—PA ranked 32 nd  PA FFY 2014 - $9 million—PA ranked 31 st Increase in penalty to max of 3%.

3. 3 Readmission rates for 2010, as reported by Pennsylvania Health Care Cost Containment Council (PHC4):  Total readmission rate was 13.5% (2 out of every 15 hospital stays had a readmission within 30 days).  CHF readmission rate was 24.3%.  Septicemia readmission rate was 21.0%.  COPD readmission rate was 20.2%. Preventable Readmissions

4. 4 Pennsylvania Hospital Engagement Network  HAP—one of 26 hospital engagement networks nationwide  60 Pennsylvania hospitals participating in the HEN collaborative project: 15 hospitals participated in one year BOOST project (Better Outcomes for Older adults through Safe Transitions) 45 hospitals in PA-HEN collaborative  Tracking readmission data for all Pennsylvania PA-HEN participating hospitals  PA-HEN has offered: Regional networking sessions (including post-acute providers); webinars; one-on-one coaching calls; and site visits Priorities: Health literacy training Post discharge best practices (appointments/phone calls) Medication reconciliation Patient education

5. 5 5 Reflects a 24% reduction from baseline PA-HEN Readmission Progress

6. 6 Immersion project model Health Literacy Community Cross Continuum Teams – Removal of silos – Collaboration with stakeholders – Regional events including health care and community partners – Encourage education sharing – Encourage patient participation Paradigm shift from ‘doing to patients’ to ‘doing with patients’ 6 Current Priorities

7. 7 Average adult reads 3-5 grade levels below highest grade completed. Therefore, up to ½ of US population may be at risk for: –Medical misunderstandings –Mistakes –Excess hospitalizations –Poor health outcomes 7 Health Literacy

8. 8 Cross Continuum Teams  Primary care  Specialists  Care management  Long-term care  Home health  Hospice  Pharmacy  Personal care  Area Agencies on Aging  Health plans  Durable medical equipment

9. 9 Lessons Learned—Challenges  Patient and family educational needs  EHR—helps, but can be burdensome  Regional differences: Urban—higher indigent population, language and cultural barriers more prevalent Rural—can have limited community services  Behavioral health care needs  Regulatory and payment differences between levels of care  Loss of revenue

10. 10 Effective communication. Information sharing – health record exchange. Management of care: Transition of care. Better outcomes. Engagement of patient and families. Better planning for chronic and end of life care. Use of innovative delivery models, including care in place and effective use of advanced practice professionals. Measurement/performance indicators that are relevant across the continuum of care. Understanding of financial performance and implications. Lessons Learned—Opportunities

11. 11 Leadership Strategies to Sustain Quality Improvement and Prevention of Harm  Connecting quality and cost Align with overall organizational goals and financial incentives  Define clear, measurable aims for improvement Report out to organization and community, if appropriate  Plan, do, study, act Multi-disciplinary team Commit to data collection and reporting  Accountability and transparency Community regularly with administrative and clinical leadership and governing body Show results (good and not-so-good)  Leadership must champion  Hardwire the improvements into every day practice Everyone held to same standard

12. 12 Engaging Patients and Families Health care consumers: Expect care to be high quality. Approach care with a deep sense of uncertainty and vulnerability. Experience with care is very personal and granular. See insurance companies as setting the rules. Want hospitals to see them as people. Want care to be respectful, professional, and quick. Want hospitals to be empathetic and to stand up for them. Source: Findings from HAP Focus Groups – conducted March 2014 PA ranked 40 th in HCHAPS scores

13. 13 Primary Care Physicians Specialty Care Physicians Outpatient Hospital Care and ASCs Inpatient Hospital Acute Care Long Term Acute Hospital Care Inpatient Rehab Hospital Care Skilled Nursing Facility Care Home Health Care Medical Home Acute Care Bundling Acute Care Episode with PAC Bundling Post Acute Care (PAC) Episode Bundling Using Financing to Reshape the Organization and Outcomes of Care Accountable Care Organizations

14. The Hospital & Healthsystem Association of Pennsylvania May 2014 QuestionsQuestions