Creating A SNF At Home

ModelMonthly Think Tank

August 20, 2020

January 24-27, 2021JW Marriott Marco Island, FL

Home Care Reinvented in the COVID Era

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David Ellis

Founder & President

Lincoln Healthcare Leadership

Michelle Dodd

Home Care Analyst

Home Care 100Intelligence Group

Bill Dombi

President National Associationfor Home Care &

HospiceWashington, DC

Mary Kofstad

Division President Signature Healthcare

at Home

Wilsonville, OR

Linda Murphy

Founder & COO Concierge Home Care

Jacksonville, FL

Summer Napier

President Healing Hands

Healthcare

Wichita Falls, TX

SNF At Home Panelists

August 20, 2020

Blueprint for SNF At Home Model

SNF At Home:A $20 billion opportunity

for Home Health

24 Phone Calls

30-45 Minutes Each

July & August 2020

Conducted by David Ellis & Michelle Dodd

Primarily Home Health CEOs

Research

Preference for Home Prior to PandemicSeniors strongly prefer to age in place and be cared for in the home

Source: AARP 2018 Home & Community Preferences Survey

20%Do Not Wantto Move IntoA Facility80%

Prefer to Age In Place

At Home

Increased Preference for Home Since Pandemic

Public policy messaging reinforces need to stay home

Widespread news of COVID deaths in SNFs

Source: NY Times 7/23/20

58%Of Deaths in

All Other Settings42%Of Deaths in SNF/ SL

SNF Diversion Is Underway

Home Health

SNF Bound Home Health BoundConsumers

Post AcuteSetting

“SNF At

Home”“Natural

HH”

SNF

~20% ~10%

$20B

SNF AtHome Clinical Model

Skilled Nursing & Therapy

PersonalCare

RPM + Telehealth

Physician/NPP

DME

Ancillary Services

Case Management

1

23

4

5

6

1 Saves Money

Why SNF At Home Is Here to Stay

2 Lowers Hospital Re-Admissions

3 Achieves Higher Patient Satisfaction

For Payers

For Consumers

SNF At Home Estimated Episode Pricing

Medicare Traditional

$15K–$18K

$8K–$10K $6K–

$8K$3K

$1.5K–$2K

MA &Medicare

Risk

SNF AtHome Cost

SNFCost

MA

Medicare

Home Health Cost

SNF At Home – Estimated Payment Breakout

Component

Payer Source

Medicare A Medicare B Consumer Total

Home Health $3,000 - - $3,000

Personal Care - - $1,500 $1,500

Physician/NPP - $1,275 $225 $1,500

DME - $850 $150 $1,000

Total $3,000 $2,125 $1,875 $7,000

1 Alternative Payment Plans

SNF At Home – Range of Payer Sources

Start Here Prove Outcomes (100+ Patients)

Then Go Here

2 ACOs

3 Medicare Plus Private Pay orVALTC Insurance Medicaid

4 MA Plans

5 Medicare – Potential New Carve-Out for SNF At Home

Hope for This!

1 How do they scale this?

Selling MA Plans

2 How do you prevent overutilization – or the “woodwork effect” –of SNF at Home? Meaning: Diverting $10K SNF patients into $7K S@H sounds great.

o But what if some of your $2K Home Health patients updraft to $7K S@H patients? Convince me that won’t happen.

Huge Opportunity! But - you need to solve two challenges for them:

SNF At Home Acuity Starts Very High

Low

Day 1 Day 21

Acuity Level

Day #

High

Match intensity of services with acuity of patient. Very high, starting day one.

Mastering case management and interdisciplinary care.

Coordinating services.

Communicating withpatient and family.

Striking a tight clinical partnership with a personal care organization.

SNF At Home – Top Challenges

1 2 3

4 5

The Consumer Experience Today: Cobbling It Together

Hospital

Experience:

Uncertainty at Discharge

Coordinate on Your Own

Pay on Your Own

Home Health

Personal Care

Home

The Consumer Experience Today: SNF At Home “Light”

Experience: Ease at Discharge

Coordinated Care

Easy Billing

HospitalSNF at Home

“Light”Home Health + Personal Care

Home

The Consumer Experience Today: SNF At Home “Full Blown”

Hospital HomeSNF at Home “Full Blown”

Home Health + Personal Care + RPM + Phys. Services + DME, etc.

Experience: Ease at Discharge

Coordinated Care

Easy Billing

Opportunities:1. New revenue stream2. Your entré into longitudinal care management3. Your entré into healthcare risk4. Tighter partnering with hospital5. Tighter partnering with MA Plans6. Personal care – more volume, your entré into healthcare

Threats:1. Your competition will do this – beat them to it2. New entrants will do this3. SNFs & SL may also do this

Why Do SNF at Home?

Consequences of SNF At Home

Growing convergence of Home Health and Personal Care

Hospital at Home Programs – will add SNF At Home

Easiest to do for those with:o Multiple service lineso Risk agreementso Hospital JV partnerships

SNF At Home Will Solidify Shift to HomeCare

Care In

Facilities

Care At

Home

SNFat

Home

Bill Dombi President

National Association for Home Care & Hospice

Medicare Choose Home OptionAn Alternative to Post-Hospital SNF Use

by Medicare Beneficiaries

Patients at Medicare SNF level of care can be cared for at home provided there are services and supports beyond Home Health benefit

Some patients would prefer home care over SNF provided care is sufficient

Informal caregivers would be willing to provide personal care support to a degree to keep patient at home

Medicare will save money with this option

Premises

Home Health Benefit

Must need intermittent skilled nursing care or physical therapy or speech language pathology

Must be “confined to his home”

No prior hospitalization required

30-day episodic payment; case mix adjusted

No cost sharing

Average spending: <$2000 for 30 days

Skilled Nursing Facility Benefit

Must need daily skilled nursing or therapy services

“as a practical matter," care must be provided on an inpatient basis at a SNF

3-day prior hospital stay

Per diem payment; case mix adjusted

Day 1-20 no cost sharing; day 21-100 per diem cost sharing

Average spending: >$17,000 for 30 days

Comparison of HH and SNF Medicare Benefits

Services ComparisonHome Health

Part-time or intermittent skilled nursing care

Physical therapy

Speech-language pathology

Occupational therapy

Medical supplies

Part-time or intermittent home health aide

services

Medical Social Services

Skilled Nursing Facility Skilled nursing care

Physical therapy

Speech-language pathology

Occupational therapy

Medical supplies

Limited drugs

Personal care services

Medical Social Service

Bed and Board

• Expanded home health aide services

• Extended skilled care (meeting “daily” SNF requirement)

• Meal/nutritional supports

• Physician/NPP access and integration

• Telehealth

• Non-emergent transportation

SNF At Home Services & Supports: Beyond Home Health

Capitated or Episodic Reimbursemento Add-on to HH payment or Comprehensive paymento Case-mix adjusted or flat rateo Achieves aggregate savings to Medicare

o risk sharing component?o hospitalization risk in analysis?

Capped service support levelso Informal caregiver support/requirement

Hospital discharge evaluation on eligibility and capabilityo Patient option or diversion process

No cost sharing to incentivize use

Design Structure Options

Bill Dombi

President National Associationfor Home Care &

HospiceWashington, DC

Mary Kofstad

Division President Signature Healthcare

at Home

Wilsonville, OR

Linda Murphy

Founder & COO Concierge Home Care

Jacksonville, FL

Summer Napier

President Healing Hands

Healthcare

Wichita Falls, TX

SNF At Home Panelists

August 20, 2020