FLAACOs 2014 Conference - Reducing Fragmentation in Post-Acute Care: A Citra Health Solutions Case...

Reducing Fragmentation in Post-Acute Care: A Citra Health Solutions Case Study

Ken Van Cara

VP New Products & Innovation

MedSolutions

Krista K. Sultan

Program Development Manager

Citra Health Solutions

Today’s Intent

• The Current Environment of Post-Acute Care

• Key Steps to Coordinating Care in the Post-Acute Care Setting

• Exploring the Partnership Further: Aligning Post-Acute Care for Citra Health Solutions

2Confidential: Do Not Distribute

The Current Environment of Post-Acute Care

Acute Symptoms InpatientPost-Op

Longitudinal Experience of Health Care

Cumulative Costs of Patient Health Care Experience


Fragmentation

Acute Symptoms InpatientPost-Op

The lack of coordination between acute and post-acute care facilities creates severe

fragmentation, leading to higher costs, and over-treated, under-treated, and readmitted

patients.

Challenge is to align providers and post-acute care facilities to reduce

waste and patient harm.


Tremendous Waste

“Over half of the residents who

experienced harm went to a hospital for

treatment, with an estimated cost to Medicare of $208

million in August 2011”

Department of Health & Human Services (2014). Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare

Beneficiaries


Patient Harm

“1 in 5 Medicare beneficiaries who had post-acute SNF stays

that were 35 days or less experienced at least one

adverse event during their stays”

“79% of these events either extended the beneficiaries’

stays in the SNF or resulted in emergency department visits

or inpatient readmissions”“59% of these adverse events and temporary

harm were clearly or likely preventable”

Department of Health & Human Services (2014). Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare

Beneficiaries


Readmission Penalties

“In 2013, the CMS began penalizing excess

readmissions by trimming up to 1% from payments for heart attack, heart failure,

and pneumonia.”“Maximum penalties reached 2% in 2014 and will rise to 3% in 2015, when they will also be assessed for COPD

and hip and knee replacements”

SG2 (2013). Performance Guide: Reducing 30-Day Readmission Rates


Readmission Penalties

1/4Of Medicare FFS patients

discharged from a hospital are readmitted

within 30 days.

$227MTotal readmission

penalties for 2014. For 2015, the maximum

penalty increases from 2% to 3%.

< 40%Of hospitals have a process to alert physicians within 48

hours of a patient’s discharge or to inform patients about

test results.

ACO Providers share financial risk for

avoidable readmissions.

SG2 (2013). Performance Guide: Reducing 30-Day Readmission Rates


What will it take?

“True coordination of care – defined as the

organization of services among the hospital,

physicians, post-acute care provider, and

patient to encourage the delivery of the

highest-value services – is required to ensure the best possible outcome

s.”Ackerly & Grabowski (2014). Post-Acute Care Reform – Beyond the ACA


Improving Care Coordination:Keys to Success

Patient/Physician connectivityCreates transparency into the acute and post-acute care settings to improve continuity of careNurse outreach supports primary care follow-up visits

A Solution That Meets Multiple Needs

Improved post-acute experiences for members and their loved ones

Better clinical outcomes and medical cost reductionsPost-acute care site of service management

• Identifying facilities with the services and quality suited to the needs of each member

• Supporting patient decision making and care site selection with evidence based guidelines

Readmission reductions


Individualized Plans of Care

• One Clinical Point of Contact

Coordinates a single, individualized plan of care throughout the entire post-acute treatment – ideally managed by a single point of contact.

Applies clinical decisions based on evidence-based guidelines.

• Appropriate Site Selection Support

Builds on individual risk assessment with an understanding each patient’s clinical, environmental, and psycho-social resources and needs:

• Caregiver

• Transportation

• Home Environment

• Health Literacy and Cognitive

Ability

• Activities of Daily Living13Confidential: Do Not Distribute

Individualized Plans of Care

• Length of Stay Management at Every Site

Work directly with patients and post-

acute care clinicians to review patient

progress and ensure appropriate

utilization of facilities

• Readmission Reduction

Reconnect individual with primary care

physician

Provide Transition Coaching /

Medication Reconciliation

Deliver Patient Engagement Materials


Robust Transition Support

Transition to the Appropriate Site of

Care

Assessment and engagement with

members on acute admission

Continuous monitoring of

patient progression along

the care continuum

Transition coaching based on member’s

needs and readmission risk level

Transition Home as Soon as Appropriate

Transition Coaching to Reduce Poor

Outcomes & Readmissions


Technology-Enablement

One of the keys to Citra Healthcare's success was their use of MedSolutions' post-acute care management system,

which: Tracks members over time

across sites of care

Ensures appropriate utilization of facilities

Performs medication reconciliation

Accesses evidence-based guidelines

Develops and delivers care plans and member education materials


Exploring the Partnership Further:

Citra Health Solutions & MedSolutions

Krista K. Sultan RN, BSN, MSProgram Development ManagerCitra Health Solutions

Partnership

Citra Health Solutions partnered with MedSolutions due to a lack of care coordination for their Medicare ACO patients.

Medicare Shared Savings

ACO

Lack of Post-Acute Care

Coordination

Financial and Quality

ConcernsCommunication Gap

Little Visibility Into Hospital

PCP Only


Post-Acute Care Process

MedSolutions was hired to create a coordinated approach that included all five elements of Citra

Health Solutions as part of the solution

We partnered to create and launch a collaborative approach that brought the hospital,

Citra, and hospitalist stakeholders together, without making any large-scale changes to the

processes already in place

Using the MedSolutions approach, which incorporates the keys to care coordination

success, Citra Health Solutions has realized a 43% reduction in utilization of Skilled

Nursing Facilities (SNFs) and a 25% reduction in Inpatient Rehab Facilities (IRFs)


Program Results

Discharges To

InitialDischarge

Recommendation

Actual Discharge w/

MedSolutionsRecommendation

% Increase/ decrease

Estimated Saved

(PMPM)Discharges %

Discharges

%

Home 22 32.4% 27 39.7% 23% --Home Health

19 27.9% 21 30.9% 11% $1.08

SNF 16 23.5% 10 14.7% -38% ($18.54)IRF 4 5.9% 3 4.4% -25% ($6.17)Other 7 10.3% 7 10.3% 0% --

Totals 68100.0

%68 100.0% -- ($23.62)Program Effectiveness

20% of patients were discharged to a more appropriate post-acute settingSignificant reduction in SNF and IRF over-utilization and corresponding increase in use of Home Health and Home settings

(Important note: Medicare FFS setting – we could only recommend)


Patient Scenario

The Discharge Planner took MedSolutions’ recommendation and sent patient “A ” home.


Quotes of Success

“In a previously unmanaged patient environment, Citra and MedSolutions partnered to develop a unique solution for managing post-acute spend. Citra’s management of the patient-physician relationship and patient profile coupled with MedSolutions’ expert staff and clinical guidelines resulted in positive behavior change that out-performed traditional methodologies. The success utilizing influential techniques rather than denial truly embodies the transformation of healthcare today.”

Nicole Bradberry - President and COO of Citra Health

Solutions23Confidential: Do Not Distribute

Quotes of Success

“At [St. Vincent’s] Southside, the pilot has been a successful one. The MedSolutions team have been very supportive and responsive to the needs of the CM department and the patients they have serviced. The implementation was very seamless for all, while initially there were a few bumps in the road with communication, there now appears to be a solid/open line of communication established, which I think has been a huge factor to the success we have had this far.

We look forward to continuing the partnership.”LaRhonda Brown – Case

Management, St. Vincent’s Healthcare - Southside

Confidential: Do Not Distribute 24

Reach UsKen Van [email protected]://www.MedSolutions.com

Krista K. Sultan RN, BSN, MSCitra Health [email protected]

Q&A

Date post:	29-Jun-2015
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