How to Establish an Accountable Post-Acute Preferred ...

1 How to Establish an Accountable Post-Acute Preferred provider network November 14, 2016 How to Establish an Accountable Post-Acute Preferred provider network Maura McQueeney, MPH, DNP President, Baystate VNA & Hospice/ Post-Acute Care, Baystate Health Lissy Hu, MD, MBA Chief Executive Officer, CarePort Health 2 Shifting Payment Landscape 3 MACRA Readmissions IMPACT Act Bundled Payments CJR ACO Background Problem discovery 2013 Multiple vendor and provider relationships coming and going from the medical center and outlying hospitals Strategic Question How 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 ?

2 Decision Develop 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 Methods How we created an Accountable Preferred post acute network Results and Takeaways Sharing our success tips 4 Overview Baystate Health Largest health system in Western Massachusetts One academic medical center, two community hospitals, 973 beds Owns a health insurance company Health New England 250 Physician Practices Acquiring surrounding community hospitals to secure competitive boundaries Next Generation ACO Early entrant into MSSP TJR bundle Strategically not in the long-term care space 5 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 DME, Lab Services, Imaging Services SNF Liaisons HHA Liaisons Hospital SNF HHA Creating a Central Nervous System.

3 SPACC Strategic Post-Acute Care Committee (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 Getting Started Collaborative Partner Facility ProfileCollaborative Partner Facility ProfileFacility NameFacility AddressCity State ZipPhoneContact 1 nameContact 1 TitleContact 1 e-mailWeb SiteOwnership Type (private, profit, nonprofit, parent company)

4 What is your ability to manage pts with psychiatric diagnosesIndividual Facility DemographicsIndividual Facility DemographicsCategoryResponseYes/No (Yes = 1; No = 0)Comments/additional InformationLicense Types (please list all)LTCN umber of Sub acute BedsShort Stayall private roomsNumber of LTC BedsNumber 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 PCPMDs 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 PCPMDs 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)?

5 ?124/hr day RN (Y/N)?1 Staff: 50% RNNursing Model: Primary Nursing Model (Y/N)?1 Nursing Model: Consistent Alignment (Y/N)?1 RN Specialty Certification: Rehabilitation (Y/N)? 1RN, Cardiac SpecialistRN 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 NPPalliative and Hospice Care (Y/N)?1 Palliative MD at to support; Hospice w/ AffiliatePharmacy Name Formulary available (Y/N)?1 Contracted Payers and Plans (list) Medicare (Y/N)?1 Medicare Advantage (Y/N)?

6 1 Medicaid (Y/N)?1 Medicaid Pending (Y/N)?1 CCA (Y/N)?1 HNE (Y/N)?1 Fallon (Y/N)?1BC/BS (Y/N)?1 AARP (Y/N)?0 Others (% Agency on Short Stay Unit?)No agencySub$Total23nonprofitPsych serivce in 2-3 x/weekProcess Expectations: Pre-Admission to DischargeProcess Expectations: Pre-Admission to DischargeDRAFT 7 (9/24/13)/ 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 Assessing Skilled Nursing Facilities CategoryResponseYes/No (Yes = 1.)

7 No = 0)Comments/additional InformationPreadmission 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 meetingsINTERACT** Tool Used or Alternative Tools (Enter # points in Y/N column)5 INTERACT IIIE lectronic Medical Record (Y/N)?0 Complete by 2014 Member of Data Exchange (Y/N)0 Direct Admits from Home, MD Office, 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)?

8 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 SolutionsList 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 MeetingIDT Rounds: Social Worker involved (Y/N)?

9 1 IDT Rounds: Done 48 hours after admit (Y/N)?072 hr meetingSub$Total29 Reporting Expectations: OutcomesReporting Expectations: OutcomesCategoryResponseYes/No (Yes = 1; No = 0)Comments/Additional InformationCMS 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: ListD/C Dx, dispostion and HC provider , PCP, LOS, Referral info: adm, lost, declinedALOS Sub acute (Enter 1 if 15 days)0 Ortho: 19; Cardiac: 1830 Day Re-hospitalization Rates Subacute- average of last 3 months (Enter 1 if 20%; 2 if 15%; 3 if 10%)39%Mortality Rate Sub acute TBD Patient Satisfaction benchmarked with national database (Y/N)?

10 1If 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$Total10 For Internal Use OnlyFor Internal Use OnlyCategoryResponseYes/ NoComments/Additional InformationSTAAR Attendance1 Baystate MD Affiliation/Presence1 Cardiac: Top 70% referral 20120 Citizenship (difficult patient placement)0 Affiliation (ACO, PHO, other)0 Total62**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.