Raising the bar in Home Health

EvergreenHealth’s journey to become a high acuity HH provider

Brent Korte, Director of Home HealthEvergreenHealthKirkland, WA

EvergreenHealth Home Health:Largest single location HH provider in the Pacific Northwest265 Clinicians129,000 visits in 2015Hospital based in Kirkland, WAHorizontal leadership structure

5 Managers each overseeing 50+ employees Model that mandates clinician inclusion and referent leadership

Our model to raise acuity and to innovate…Identify opportunity/issue

All ideas are considered from all staffClinicians and support staff solve the problem

Present problem=>Interest gauged=>SIG forms=>Innovation project begins

Why give it to the clinicians to solve? Utility: They will be doing the work Expertise: If we hire the right people, our clinicians are a pool of experts Engagement: The more they are able to lead, the higher engagement Think tank: 265 minds are better than 1

Culture of Innovation Innovation: Tech vs. Healthcare

Technology innovates to:• Change the world, to disrupt, to make $$$

Healthcare innovates to survive because..• we were told to…in 20,202 pages/11.5M words through the

regulations of the ACA Tech hears: “Do the unthinkable, break the mold and change the

world” Healthcare hears: “Do better, less $$, more ”, “oh and partner with

everyone”, and by the way “you need to compete with your new partners”.

Tech: Change is literally in the air…..Good food and flying packages Healthcare: EvergreenHealth’s plans

Shortlist of Current Innovation ProjectsPsychiatric Nursing/Occupational therapy program

Trying to get ahead of behavioral/mental health issues

COPD and CHF pathways involving telehealth and community partnerships

Value Based Purchasing Model Restructured all processes to achieve success with outcomes

HH for Same Day Joint Replacement….

Same Day Total Knee ReplacementsOutpatient TKA happening for years..but at very low rates.

As of March 2014, only 1.6% of all TKA surgeries** Few non-HMO Home Health providers have programs

Why did we decide to pursue this program? To innovate is to compete:

• Top Surgeons in Seattle metro area are performing outpatient TKA more often• Top Surgeons in Seattle metro area refer to EH…for now

How did we identify the opportunity for OTKR?Answer: The need identified us.

Surgeon #1-Top ortho MD in US, but “what is bundling?”

Visit to local 90 bed SNF, same question.

And then. Call on drive back from Surgeon #2-Help me design our OTJR Program Quotes

What is our model for OTKR?Expectations:

Prehab visit PT waiting at patient’s home daily or BID visits for next three days

Reality: Prehab visitPT waiting at patient’s home Daily or BID visits for next three days

What is our model for OTKRHow we reacted to these asks:

“We’ll figure it out” Orthopedic Special Interest Group engaged the next day

• Study best practices• Audits of Total Joints over past year• Deep dive into quality metrics affecting surgeons

Ortho “Strike Team” formed Ongoing planning with go live set for October for TKR, August for

partials and anterior hipsCultural shift to: The answer is yes, what’s the question?

Who are we competing with?Skilled Nursing Facilities

How can HH compete with Skilled Nursing? MDs care about LOS, pain/swelling/infection control, HCAHPS,

readmissions We think we can get most patients to 110-120 knee flexion within 2

weeks We are cheaper

Why does this matter to SNFs?

We are now competing for many of the same patients and Home Health’s value proposition is strong

Home Health nationwide is being asked to do provide care for highly acute patients-and the top HH providers are raising the bar

HH is provided at a lower cost

Why does this matter to Home Health?Long term care is already providing care to highly acute patients and

does it very well

Up to three hours of combine rehab daily and more equipment

MD referral trends are slow to change

Home Health may be less costly, but can’t provide the same level of care

What have we learned clinically?

Lasting change occurs at the clinician level

Hire Top Clinicians, keep them engaged and support them with education $1000 per clinician/$265K for optional CE

Communicate the ‘Why’

Leaders step back, clinicians drive the change

What have we learned financially?ROI on education investment is significant

VBP example

ROI by building upon our reputation as the top provider “We can take whatever you throw at us”

HH is seeking to become leader not just of Post Acute but within the entire continuum

Relationship between higher acuity and risk based models..Raise the bar with higher acuity, showcase quality outcomes and your organization can be…

Top referral source

Sought after partner with top end providers

Sought after partner in ACOs, CINs and other risk based contracts Quality mechanism is already in place, great outcomes follow

Questions…