Post on 13-Aug-2019
transcript
11/28/2016
1
How to Establish an Accountable Post-Acute Preferred Provider NetworkMaura McQueeney, MPH, DNP, President, BaystateVNA & Hospice/ Post-Acute Care, Baystate HealthLissy Hu, MD, MBA, Chief Executive Officer, CarePortHealth
L22This presenter has
nothing to disclose
Sunday, December 4
#IHIFORUM
Session Objectives
BackgroundProblem discovery 2013 – Multiple vendor and provider relationships coming and going from the medical center and outlying hospitals
Strategic QuestionHow should we partner for results in BCPI and ACO when we do not OWN post acute facilities? Embed MDs($)? Embed Mid levels($)? Partner for quality results ?
DecisionDevelop clear, post - acute partner scorecard, be transparent with results, select a preferred network based upon quality BEYOND star ratings, define monitoring and sustainable outcomes, create written agreements
MethodsHow we created an accountable preferred post acute network
Results and Takeaways Sharing our success tips
P2
#IHIFORUM
11/28/2016
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Shifting Payment Landscape3
MACRAReadmission
s
IMPACT
Act
Bundled
Payment
s
CJ
R
ACO
Baystate Health
o Largest health system in Western
Massachusetts
o One academic medical center, two
community hospitals, 973 beds
o Owns a health insurance company –
Health New England
o 250 Physician Practices
o Acquiring surrounding community
hospitals to secure competitive
boundaries
o Next Generation ACO
o Early entrant into MSSP TJR bundle
o Strategically not in the long-term care
“space”
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11/28/2016
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DME, Lab Services, Imaging Services
SNF Liaisons
HHA Liaisons
Hospital SNF HHA
Creating a Central Nervous System: SPACC
• Strategic Post-Acute Care Committee (SPACC)
• Complex web of relationships and potential for conflict of interest
• Need to organize relationships around quality in context of BPCI and ACO
Getting Started: SPACC
• SVP for Quality and Population Health
• President, VNA & Hospice
• Physician leader of ACO
• Geriatrician representing post-acute
medicine
• Director of Quality (oversees BPCI
program)
• Director for Post-Acute Integration
• Heart & Vascular service line director
• VP, Strategic Planning
• Director of Case Management
• Ad hoc members: Lab and Imaging,
Medical Director of Health New
England (insurance organization)
• Identified relevant post-acute
stakeholders (ACO, BPCI)
• Hired Director for Post-Acute
Integration
• Instituted monthly meetings for
group to discuss SNF selection
criteria, quality measurement, and
performance improvement
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Assessing Skilled Nursing Facilities
• Assessed 30 facilities with high-
volume of Baystate patients
• Collected facility staffing levels,
process expectations, outcome
reporting expectations through
site visits and interviews
• Major criteria included CMS star
rating (3 and above), 24-hour
nursing care, physician staffing
levels, readmission rates, ability
to take difficult patients, and
willingness to partner
Collaborative Partner Facility ProfileCollaborative Partner Facility Profile
Contact 1 Title
Ownership Type (private, profit, nonprofit, parent company)
What is your ability to manage pts with psychiatric
diagnoses
Individual Facility DemographicsIndividual Facility Demographics
Category Response Yes/No (Yes
= 1; No = 0)Comments/additional Information
License Types (please list all) LTC
Number of Sub Acute Beds Short Stay all private rooms
Number of LTC Beds
Number of LTACH Beds
Number of Specialty Services Beds (vent, rehab)
MDs Contracted-Internist, and days per week on unit LTC (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)
1 Community PCP
MDs Contracted-Geriatrician, and days per week on unit
LTC (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
MDs Contracted-Specialty MD, and days per week on unit
LTC (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
MDs Contracted-Internist, and days per week on unit Sub
Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)1 Community PCP
MDs Contracted-Geriatrician, and days per week on unit
Sub Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
MDs Contracted-Specialty MD, and days per week on unit
Sub Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
Midlevel (RN/PA) Practitioner Contracted and days per
week on unit LTC (Enter 1 if once/week; 2 if 3-5 days; 3 if daily)1
Midlevel (RN/PA) Practitioner Contracted and days per
week on unit Sub Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)?? 1
24/hr day RN (Y/N)? 1 Staff: 50% RN
Nursing Model: Primary Nursing Model (Y/N)? 1
Nursing Model: Consistent Alignment (Y/N)? 1
RN Specialty Certification: Rehabilitation (Y/N)? 1 RN, Cardiac Specialist
RN Specialty Certification: Geriatrician (Y/N)? 0
Full time, licensed (RN, SW, OT, PT) Case Manager or
Navigator (Y/N)?1
Dietician available (Y/N)? 1
Special diet available: low sodium, ADA etc. (Y/N)? 1
Special diet available: TPN (Y/N)? 1
Certified Wound Care Nurse available (Y/N)? 1 Hospital CWOC NP
Palliative and Hospice Care (Y/N)? 1Palliative MD at to support;
Hospice w/ Affiliate
Pharmacy Name Formulary available (Y/N)? 1
Contracted Payers and Plans (list)
Medicare (Y/N)? 1
Medicare Advantage (Y/N)? 1
Medicaid (Y/N)? 1
Medicaid Pending (Y/N)? 1
CCA (Y/N)? 1
HNE (Y/N)? 1
Fallon (Y/N)? 1
BC/BS (Y/N)? 1
AARP (Y/N)? 0
Others (% Agency on Short Stay Unit?) No agency
Sub$Total 23
nonprofit
Psych serivce in 2-3 x/week
Process Expectations: Pre-Admission to DischargeProcess Expectations: Pre-Admission to Discharge
DRAFT 7 (9/24/13)/
Category Response Yes/No (Yes
= 1; No = 0)Comments/additional Information
Preadmission Process: Liaison on site at BH (Y/N)? 1
Preadmission Process: Response Time for Decision (Enter
1 if ≤ 60 mins; 2 if ≤ 30 mins)2
Warm Hand-Off: Documented RN-to-RN Communication on
Admit (Y/N)?0
Warm Hand-Off: Documented RN-to-RN Communication
upon Discharge (Y/N)?1
Home Care Liasion at center for weekly
meetings
INTERACT** Tool Used or Alternative Tools (Enter # points
in Y/N column)5 INTERACT III
Electronic Medical Record (Y/N)? 0 Complete by 2014
Member of Data Exchange (Y/N) 0
Direct Admits from Home, MD Of fice, and other Community
Sites: 24/7 Clinical RN Supervisor (Y/N)?1
Direct Admits from Home, MD Office, and other Community
Sites: Med List (Y/N)?1
Direct Admits from Home, MD Office, and other Community
Sites: Payor Confirmation (Y/N)?1
List 24/7 Ancillary Contracted Services (lab, imaging,
pharmacy services) (Enter 1-3)3 Mobilex, O2 Solutions
List 24/7 Ancillary Contracted Services (lab, imaging,
pharmacy services) with 2 hour turnaround for reports
(Enter 1-3)
3
Rehab Services provided: frequency (Enter 1 for once per
week, up to 7 = daily)7 Contract w/
Rehab Services provided: coverage by all payors (Y/N)? 1
Physician or Mid-level Rounds: Describe (Enter 1 for once
per week, up to 7 = daily)1
IDT Rounds: MD involved (Y/N)? 0
IDT Rounds: Patients & Families involved (Y/N)? 0
IDT Rounds: RN involved (Y/N)? 1 MCR Meeting
IDT Rounds: Social Worker involved (Y/N)? 1
IDT Rounds: Done ≤ 48 hours after admit (Y/N)? 0 72 hr meeting
Sub$Total 29
Reporting Expectations: OutcomesReporting Expectations: Outcomes
Category Response Yes/No (Yes
= 1; No = 0)Comments/Additional Information
CMS Star rating (most recent) (Enter rating in Y/N) 3 AHCA:/ :/ /App/in;/JCAHO/
DPH (Date of last survey, status and deficiencies) 2013 DPH Score :
Flag on Admission to BMP: To PCP (Y/N)? 1
Flag on Admission to BMP: By Diagnosis (Y/N)? 1
Population reports available: List
D/C Dx, dispostion and HC provider ,
PCP, LOS, Referral info: adm, lost,
declined
ALOS – Sub Acute (Enter 1 if ≤ 15 days) 0 Ortho: 19; Cardiac: 18
30 Day Re-hospitalization Rates Subacute- average of last
3 months (Enter 1 if ≤ 20%; 2 if ≤ 15%; 3 if ≤ 10%)3 9%
Mortality Rate – Sub Acute TBD
Patient Satisfaction benchmarked with national database
(Y/N)? 1
If Yes, please record database Vendor and Quartile rank for
Overall Satisfaction MyInnerview: 98%
If No, please record how Patient Satisfaction is measured
AND last 6 months trend for Overall Satisfaction
Will you be able to schedule a Baystate Health Post Acute
Team site visit within the 4 weeks (Y/N)? 1
Sub$Total 10
For Internal Use OnlyFor Internal Use Only
Category Response Yes/ No Comments/Additional Information
STAAR Attendance 1
Baystate MD Affiliation/Presence 1 Cardiac:
Top 70% referral 2012 0
Citizenship (difficult patient placement) 0
Affiliation (ACO, PHO, other) 0
Total 62
**INTERACT- Interventions to Reduce Acute Care Transfers) is a quality improvement program designed to improve the early identification,
assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities. The goal o f INTERACT
is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous
complications of hospitalization, and billions of dollars in unnecessary health care expenditures.
Collaborative Partner Facility ProfileCollaborative Partner Facility Profile
Facility Name
Facility Address
City State Zip
Phone
Contact 1 name
Contact 1 Title
Contact 1 e-mail
Web Site
Ownership Type (private, profit, nonprofit, parent company)
What is your ability to manage pts with psychiatric
diagnoses
Individual Facility DemographicsIndividual Facility Demographics
Category Response Yes/No (Yes
= 1; No = 0)Comments/additional Information
License Types (please list all) LTC
Number of Sub Acute Beds Short Stay all private rooms
Number of LTC Beds
Number of LTACH Beds
Number of Specialty Services Beds (vent, rehab)
MDs Contracted-Internist, and days per week on unit LTC (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)
1 Community PCP
MDs Contracted-Geriatrician, and days per week on unit
LTC (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
MDs Contracted-Specialty MD, and days per week on unit
LTC (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
MDs Contracted-Internist, and days per week on unit Sub
Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)1 Community PCP
MDs Contracted-Geriatrician, and days per week on unit
Sub Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
MDs Contracted-Specialty MD, and days per week on unit
Sub Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)0
Midlevel (RN/PA) Practitioner Contracted and days per
week on unit LTC (Enter 1 if once/week; 2 if 3-5 days; 3 if daily)1
Midlevel (RN/PA) Practitioner Contracted and days per
week on unit Sub Acute (Enter 1 if once per week; 2 if 3-5 days; 3 if daily)?? 1
24/hr day RN (Y/N)? 1 Staff: 50% RN
Nursing Model: Primary Nursing Model (Y/N)? 1
Nursing Model: Consistent Alignment (Y/N)? 1
RN Specialty Certification: Rehabilitation (Y/N)? 1 RN, Cardiac Specialist
RN Specialty Certification: Geriatrician (Y/N)? 0
Full time, licensed (RN, SW, OT, PT) Case Manager or
Navigator (Y/N)?1
Dietician available (Y/N)? 1
Special diet available: low sodium, ADA etc. (Y/N)? 1
Special diet available: TPN (Y/N)? 1
Certified Wound Care Nurse available (Y/N)? 1 Hospital CWOC NP
Palliative and Hospice Care (Y/N)? 1Palliative MD at to support;
Hospice w/ Affiliate
Pharmacy Name Formulary available (Y/N)? 1
Contracted Payers and Plans (list)
Medicare (Y/N)? 1
Medicare Advantage (Y/N)? 1
Medicaid (Y/N)? 1
Medicaid Pending (Y/N)? 1
CCA (Y/N)? 1
HNE (Y/N)? 1
Fallon (Y/N)? 1
BC/BS (Y/N)? 1
AARP (Y/N)? 0
Others (% Agency on Short Stay Unit?) No agency
Sub$Total 23
nonprofit
Psych serivce in 2-3 x/week
Process Expectations: Pre-Admission to DischargeProcess Expectations: Pre-Admission to Discharge
DRAFT 7 (9/24/13)/
Process Expectations
11/28/2016
5
Category Response Yes/No (Yes
= 1; No = 0)Comments/additional Information
Preadmission Process: Liaison on site at BH (Y/N)? 1
Preadmission Process: Response Time for Decision (Enter
1 if ≤ 60 mins; 2 if ≤ 30 mins)2
Warm Hand-Off: Documented RN-to-RN Communication on
Admit (Y/N)?0
Warm Hand-Off: Documented RN-to-RN Communication
upon Discharge (Y/N)?1
Home Care Liasion at center for weekly
meetings
INTERACT** Tool Used or Alternative Tools (Enter # points
in Y/N column)5 INTERACT III
Electronic Medical Record (Y/N)? 0 Complete by 2014
Member of Data Exchange (Y/N) 0
Direct Admits from Home, MD Of fice, and other Community
Sites: 24/7 Clinical RN Supervisor (Y/N)?1
Direct Admits from Home, MD Office, and other Community
Sites: Med List (Y/N)?1
Direct Admits from Home, MD Office, and other Community
Sites: Payor Confirmation (Y/N)?1
List 24/7 Ancillary Contracted Services (lab, imaging,
pharmacy services) (Enter 1-3)3 Mobilex, O2 Solutions
List 24/7 Ancillary Contracted Services (lab, imaging,
pharmacy services) with 2 hour turnaround for reports
(Enter 1-3)
3
Rehab Services provided: frequency (Enter 1 for once per
week, up to 7 = daily)7 Contract w/
Rehab Services provided: coverage by all payors (Y/N)? 1
Physician or Mid-level Rounds: Describe (Enter 1 for once
per week, up to 7 = daily)1
IDT Rounds: MD involved (Y/N)? 0
IDT Rounds: Patients & Families involved (Y/N)? 0
IDT Rounds: RN involved (Y/N)? 1 MCR Meeting
IDT Rounds: Social Worker involved (Y/N)? 1
IDT Rounds: Done ≤ 48 hours after admit (Y/N)? 0 72 hr meeting
Sub$Total 29
Reporting Expectations: OutcomesReporting Expectations: Outcomes
Category Response Yes/No (Yes
= 1; No = 0)Comments/Additional Information
CMS Star rating (most recent) (Enter rating in Y/N) 3 AHCA:/ :/ /App/in;/JCAHO/
DPH (Date of last survey, status and deficiencies) 2013 DPH Score :
Flag on Admission to BMP: To PCP (Y/N)? 1
Flag on Admission to BMP: By Diagnosis (Y/N)? 1
Population reports available: List
D/C Dx, dispostion and HC provider ,
PCP, LOS, Referral info: adm, lost,
declined
ALOS – Sub Acute (Enter 1 if ≤ 15 days) 0 Ortho: 19; Cardiac: 18
30 Day Re-hospitalization Rates Subacute- average of last
3 months (Enter 1 if ≤ 20%; 2 if ≤ 15%; 3 if ≤ 10%)3 9%
Mortality Rate – Sub Acute TBD
Patient Satisfaction benchmarked with national database
(Y/N)? 1
If Yes, please record database Vendor and Quartile rank for
Overall Satisfaction MyInnerview: 98%
If No, please record how Patient Satisfaction is measured
AND last 6 months trend for Overall Satisfaction
Will you be able to schedule a Baystate Health Post Acute
Team site visit within the 4 weeks (Y/N)? 1
Sub$Total 10
For Internal Use OnlyFor Internal Use Only
Category Response Yes/ No Comments/Additional Information
STAAR Attendance 1
Baystate MD Affiliation/Presence 1 Cardiac:
Top 70% referral 2012 0
Citizenship (difficult patient placement) 0
Affiliation (ACO, PHO, other) 0
Total 62
**INTERACT- Interventions to Reduce Acute Care Transfers) is a quality improvement program designed to improve the early identification,
assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities. The goal o f INTERACT
is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous
complications of hospitalization, and billions of dollars in unnecessary health care expenditures.
Outcomes Reporting Expectations
Facility Score Card
Scoring Post Acute Providers
• Developed scorecards with point system, reviewed with SNFs
• Chose 14 facilities as preferred providers
• Meet with preferred providers regularly, provide blinded scores
and engage in other quality improvement activities
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Balancing Transparency and Privacy
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Quality of Care (based on 30-Day Readmits & CMS Star Rating)
Baystate Health Post-Acute Care Partner Prioritization Matrix
A B C D E F G H I J K L M N O P Q R S T U V W
Implementation Challenges
Aligning with case managers who had concerns about patient
choice
Communicating preferred providers to patients
Encouraging patients to select post-acute providers based on quality
vs. geography
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Changing the Discharge Discourse
Standardized communication, developed by SPAC committee, case
management leadership and legal:
“The Baystate preferred skilled nursing facility network is a select
group of nursing facilities around the Pioneer Valley that meet
quality and safety standards set for by Medicare and endorsed by
Baystate Health
Engaging Patients in Post-Acute Decision-
Making
Baystate adopted an interactive tool for discharge planners and patients to
choose post-acute care
Preferred providers are highlighted and communicated to patients and
families
Integrates with case management workflow tools and available on a tablet;
search results can be emailed to family members and other decision-
makers
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Post Acute Search Tool Benefits Case Managers,
Patients & Supports Baystate’s PAC Strategy
Compliance with Impact Act and proposed
changes to conditions of discharge planning
Proposed rule “require[s] that hospitals assist patients…in
selecting a PAC provider by using and sharing data that
includes but is not limited to HHA, SNF, IRF, or LTCH data on
quality measures and data on resource use measures.”
With CarePort, Baystate has provided its patients with ' first-of-its kind' technology that helps them decide
where to go for post-acute care—a critical decision, as numerous studies show that post-acute providers
vary on quality and their ability to car e for different types of patients,” said Joel Vengco, VP/CIO,
Baystate Health . “In other words, it ’s not an easy decision for patients and families to make. Until now."
Tracking Baystate Patients Post-Discharge
Integration with regional HIE
(PVIX) and six post-acute
providers
Understanding post-acute
outcomes for all Baystate patients
Skilled nursing facility readmission
rates and length of stay by patient
population
Leakage vs. Keepage
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Sustaining the Network
Quarterly Quality Meetings:
Sharing best practices
“Preferred” Subset for BPCI
Exiting SNF partners
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Outcomes
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19
Outcomes
Outcomes
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Success Factors
Personal Touch
RFPs vs. personal touch because of high turnover of SNF staff
For example tenure of nursing staff, will nursing staff know to call hospital?
TeamIntegration work led by “SNF insider”
Innovation in the communityHealth New England – SNFs can take care of patients with medical needs such as IV antibiotics, TPN to avoid readmission. HNE takes care of cost of IV Abx and TPN
On the Horizon
Deciding to create a Tier 2
Physician Incentive for SNFist from Next Gen ACO
Embedded ACO Physician in the ED
Building care coordination teams
Navigators vs. liaisons
How to make it scalable and cost-effective?
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How Well Do You Know Your Post-Acute Providers?
Break-out session
• Complete a Quick Environmental Scan (Handout)
• What did your assessment tell you?
• Where are your strengths?
• Where do you need help?
BREAK OUT SESSION
How Well Do You Know Your Local Post Acute Providers?
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Next Steps: Road Map
Who are your Executive Sponsors?
Who would possess the attributes of a Post Acute
Integration Leader in your organization?
Where are your internal and external obstacles?
(measurement systems, competing priorities, human resources)
Group Report Out
Q & A