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5/2/2017
1
Randi Roy, Chief Strategy Officer
Shaun Ruskin, VP, Business Development and Post Acute Services
1
Bundles of Joy: VillageCare as a
Model 3 BPCI Episode Initiator -
Journey toward Full Risk
LeadingAgeNYAnnual MeetingMay 24, 2017
The Future of Value-based Care 2
5/2/2017
2
VillageCare, with 40 years of service to New York, served approximately 25,000 individuals in 2016
3
Post-Acute Nursing Facility
(1,600 patients
discharged home annually)
Health Home, Housing and other
community programs (13,000 +members)
ManagedCare Plans (8,000+ members)
4
VillageCare offers three discrete service lines
Post‐Acute
Care
Community Supports
Managed care
Village Center for Rehab & Nursing
Rango – Technology for Treatment Adherence
Managed Long Term Care PlanVillageCare Health Home
5/2/2017
3
Overview of Post-Acute Facility: VCRN5
New modern facility; built 2010
1,600+ admissions per year
Rehab offered 7 days per week
Full medical staff including onsite NPs 16hrs per day
Advanced Care Unit, clustering highest acuity patients
Nursing to patient ratio is 1:13
Ability to admit 7 days per week
Only BPCI Model 3 post‐acute facility in NYC
16.9%
24.7%
21.2%
18.8%
24.9%
17.0%
21.1%
23.7%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
VCRN
MARY MANNING WALSH
AMSTERDAM
THE RIVERSIDE
THE NEW JEWISH HOME
ISABELLA
GOUVERNEUR
UPPER EAST SIDE
Lowest Rehospitalization Rate of Peer Facilities – 30 days
Source: Rehospitalization rate from CMS Nursing Home Compare
7.6% : 30‐day In‐house Rehospitalization Rate (Equip)
CMS 5 Star facility2010‐2017
History of decision to pursue BPCI 6
Hedging our bets
• Healthcare shift toward Value Based Payment
arrangements
Learning how to Manage Risk
“Skin in the game”, referral source appreciation
Marketing benefits
Experience with NYU’s Model 2 bundle
• Pioneers in NYC, 2013
• Partnering to manage utilization and re‐
hospitalization protocols with Major Joint
Replacement and Cardiac Valve
5/2/2017
4
Implementation 7
Selecting our partner with CMS
• Remedy Partners, Awardee Convener
Choosing our bundles with Remedy Partners
• Historical Data
Hiring a Post Acute RN
• Managing patients throughout the entire episode,
Day 1 through Day 90
Monitoring
• Reporting mechanism to ensure success
Care Redesign: Transitional Care8
• Created a Transitional Care Program
• Hired an RN with population health training
• Created protocols and workflows
• Upon admission
• During stay
• Upon discharge
• Utilized an IT platform
• Began post‐discharge calling program: Focused on
5 keys areas
• Assessing performance and refining processes
• Congestive Heart Failure example
5/2/2017
5
Post-Discharge Transitional Care 9
• PCP and Specialist appointments scheduled within 5‐7 days?• Questions: Transportation? Someone to attend with you?
• Medication management?• Questions: Do you have the ability to purchase and obtain the medication?
• Caregiver support/ home care arrived? • Questions: Is there a recognition of caregiver strain?
• Has the DME arrived? • Questions: Do you know how to use it?
• CHF example
• Barriers to self‐care?• Questions: Can the individual buy food, pay bills, take care of themselves?
Partnership for Home Care10
VNSNY
• Partnering with a Certified Home Care Agency
to deliver high quality of care
• Continuity of care from hospital, to SNF, to
Home
• Post Acute Pathways to reduce avoidable
rehospitalizations;
• Weekly and Monthly communication to
discuss individual patient issues, lessons
learned, and best practices
• Innovative ideas to deliver high quality of care
at a lower cost; sharing of claims data
• Review of Key Performance Metric on
quarterly basis
5/2/2017
6
Marketing and Relationships11
Only Model 3 SNF in all of NYC that elected to participate
in the BPCI initiative
• Upside – “Get out of jail free” card
• Downside – Referral sources wanting to manage their
own bundles
Demonstrates that we have “skin in the game”, and can
be penalized ‐ just like our hospital partners
Marketing differs contingent on the hospital’s bundle
voluntary or mandatory participation
• Model 2 hospitals
• Comprehensive Care for Joint Replacement (CJR)
Program Performance – Major Joint12
$18,000
$18,500
$19,000
$19,500
$20,000
$20,500
$21,000
$21,500
$22,000
Average Episode Cost
Epis
ode
Cos
t
MLJ Bundle Performance
First 3 Qs Last 4 Qs
Reductions in LOS (3 days) and readmissions (12 to 10) from first three quarters to last four quarters – 195 total episodes
5/2/2017
7
Congestive Heart Failure (CHF)13
Skilled Nursing Facility68%
Home Health9%
Outpatient2%
Post-Anchor Inpatient
10%
Post-Anchor Part B11%
CHF
Congestive Heart Failure• Important to referral
partners• Opportunity for
patient education and palliative care
• Implemented Care Redesign during SNF stay
• Targeting for Admission diversion
Program Performance - CHF14
$20,544
$37,508
$-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
Average Episode Cost
Congestive Heart failure
w/o Readmit with Readmit
5/2/2017
8
Overall Program Performance vs. all Remedy Model 3 programs
15*NPRA as % Program Size (Net of CMS 3%)
Other APMs16
• Targeting 80% of revenue in VBP
by 2020
• Case rates with United and
Emblem
• Allows for pre‐authorization
to take patients directly
• Another contract pending
• Looking at ACOs
• Participating in risk arrangements
with hospital partners
5/2/2017
9
Ongoing Management17
Working with Remedy Partners
• Receiving, analyzing, and understanding our data
• Dropping bundles that are not viable
Using data for Marketing Efforts
• Marketing for specific diagnosis
• Driving volume to successful bundles
Monitoring and Reporting
• Reporting Mechanism to ensure this program
makes sense, and aligns with organization’s strategy
Plans for the Future18
Population health initiative
• Organization‐wide effort to share best practices
across service lines
• Continue to quantify our value as partner
Disease specific team and pathways – Improve patient
quality of life; reduce readmissions
• Implemented nurse‐led team, family champion
contract, joint education materials with hospital
and home care agency
Full Post‐Acute risk with home care partner VNS
VBP across the organization
Advanced BPCI ‐ 2018
5/2/2017
10
©2014 The Advisory Board Company • advisory.com 29490B
19
Visibility Requires Quality Impact on a Large Scale
Healthcare Cost and Utilization Project, “Statistical Brief #172: Conditions with the Largest Number of Adult Hospital Readmissions by Payer,” Agency for Healthcare Research and Quality, 2014, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf; Florida Office of Program Policy Analysis and Government Accountability, “Profile of Florida’s Medicaid Home and Community-Based Services Waivers,” 2012, http://elderaffairs.state.fl.us/doea/Evaluation/Profile%20of%20Florida's%20Medicaid%20Home%20and%20Community-Based%20Services%20Waiver%20OPPAGA%2012-03.pdf; Vaidya A, “8 Statistics on the Average Cost Per ED Visit,” Becker’s Hospital CFO, May 31, 2013, http://www.beckershospitalreview.com/finance/8-statistics-on-the-average-cost-per-ed-visit.html; Post-Acute Care Collaborative interviews and analysis.
1) Per month.
How Can We Reach $1 Million Impact?
Cost Savings Opportunity
Single Occurrence Cost Assumption
Needed to Reach $1 Million
Hospital Readmissions
$13,333 75
One-Day Reduction in SNF Length of Stay
$480 2,083
Readmissions avoided
ED Diversion $1,062 942 ED visits prevented
Days eliminated
One last thought…..20