Redefining Patient Care from Hospital to Home December 11, 2012, 2:00 - 3:30 pm ET

Welcome to Philips Healthcare’s “Reimbursement Simplified” WebinarSeries

Tracey MoorheadPresident and Chief Executive OfficerCare Continuum Alliance

Ron Greeno, MDChief Medical OfficerCogent HMG

David BakerChief Executive OfficerBanner Home Care

Laurel Sweeney (moderator)Senior DirectorGlobal Health Economics & ReimbursementPhilips Healthcare

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The voice of wellness, prevention and chronic care management

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The Continuum of Care

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Essential Elements of Population Health Management

Address health needs at all points along the continuum of health and well being through:

• participation• engagement• targeted interventions

Maintain and/or improve the physical and psychosocial well being of individuals through cost-effective and tailored health solutions.

• Central leadership role of the physician• Importance of patient engagement,

education, activation• Capacity expansion of care coordination

through non-physician team members

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Conceptual PHM Framework

Source: Care Continuum Alliance, Outcomes Guidelines Report, Vol. 5, 2010.

PHM Program Elements

Population Identification Health Assessment Risk Stratification

Health Promotion

and Wellness

Health Risk Mgmt

Care Coordination &

AdvocacyCare Mgmt

Program Outcomes and Evaluation

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Quality improvement reporting and feedback (loop)

How do you deliver PHM in any Care Setting?

Assess Stratify

Implement Solutions

Measure & Report

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Healthcare ReformMoving Toward an Accountable Health Care System

Coverage for All

Improve Quality and Support Innovation

Tools to Rebuild and Restructure Health Care

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Turning the Ship

Physician-managed

health rather than health

plan managed

care

• New models of care delivery and coordination

• Payment aligned with goals• New tools for clinical alignment • Better PHM capabilities• Experience in performance

management/ data reporting • Experience in population risk

adjustment/ risk mitigation• Increased awareness of

prevention and wellness value• Educated, empowered patients

Creating need for new skill sets, policy, tools and competencies

Drivers:

• Health care cost crisis

• Health reform

• Improved HIT

• Greater stake-holder align-ment

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Accountable Care Organizations•“Shared Savings Program”•Largest pilot program in ACA•Physician practices/Hospitals

• Promote accountability in care (quality vs. volume)• Require coordination of all services and redesigned care

processes – including home care and community care• Encourage infrastructure investment

•Requires reliance on telehealth, RPM

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Redefining Care through Payment

• Provider organizations (IDS; ACO; Hospitals, etc) receive lump sum payments for all care in a given episode

• Finances telehealth indirectly – providers incented to invest in technologies to reduce costs.

• Concern: no direct reimbursement for telehealth devices/services

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Important Physician Competencies

Characteristics:• Outcomes-

oriented• Enabled by

technology• Patient -

centered• Use of data

and analytics• Performance

transparency• Ability to

partner across organizations

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Bridging Care and Provider Settings

Hospitals Health Coordinators

Physicians Practices

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“Active Care Pathway”

1) Self ID2) MD Referral3) Medical Claims4) Rx Claims5) HRA6) Predictive modeling

1) Self ID2) MD

Referral3) Medical Claims4) Rx Claims5) HRA6) Predictive modeling

1) Patient Self-Care2) MD Engagement3) Care Coordination (Specialists)4) Evidence-Based Guidelines5) Care Transitions

1) Inpatient Utilization Outcomes2) Outpatient Claims Expense3) HEDIS and NQF4) Care Experience Measures

Capture Persons under Active Provider care

Identify persons without access

Outpatient 1:1, Face-to-Face or

Remote Monitoring

Triple Aim Outcomes(Better care,

better health, lower costs)

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Evolving Role of Health Coordinator

Case Management• the collaborative process of

assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes

• Individual, high touch, high intensity

Care Management• Package of physician

supervised interventions assisting patients & their support systems in managing diagnoses &related psychosocial problems.

• Seeks to improve patients’ functional status, enhancing the coordination of care, eliminating the duplication of services, & addressing expensive services

• Populations, high tech & medium intensity

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Redefining Patient Care from Hospital to Home

The Role of Site Based Specialists In the Healthcare System of the Future

Ron Greeno MD, MHM, FCCPChief Medical Officer

Cogent HMG

Chairman, Public PolicySociety of Hospital Medicine

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Cogent HMG

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Quick Facts:

Nation’s leading privately held Hospital Medicine and Critical Care company

Headquartered in Nashville, Tenn.

Hospital partners with over 130 hospitals and over 1,100 physicians

Solutions Include:

Full Outsource hospitalist and critical care programs designed and managed from the ground up.

Consulting Services to provide a roadmap for high performing hospitalist and critical care programs.

“The Accountable Care Organization is a

patient care model, not a financial model.”

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Macro Trends

• Consolidation• New forms of intergration• Emphasis on Quality and Outcomes• Increased Transparency• Shifting risk

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Macro Trends

Everyone in Healthcare is going to be in the Same Business,

the Population Health Business

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The Current Challenge

To prepare for the future environment of increased integration and population

health while growing and prospering in the current environment of FFS payment

and financial uncertainty.

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What Does It All Mean For Us

• This environment means increased risk, but also increased opportunity for hospitals and providers

• Hospitals will need reliable physician partners to manage this risk

• The winners will be the hospitals that are able to create innovative and enduring partnerships with physicians

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Those relationships will take many forms

• Successful relationships will share several features:– Team based– Supported by systems of care– Data driven– Enduring governance– Design will be “organization centric”

not “practice centric”– Shared goals, incentives, and risks

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• Intensive Care Medicine

• Emergency Medicine

• Hospital Medicine

The Home Team In Acute Care Hospitals

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Hospital Medical Staff of the Future

• Inpatient Physicians (ED docs, Hospitalists, Critical Care physicians) “live” in the Hospital and have primary accountability for the majority of patients

• Supporting services provided by Path, Radiology, Anesthesia

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Medical Staff of the Future

• Specialists will be specialists and be as efficient as possible

• Administration, Nursing, Pharmacy, Case Managers will work with “inpatient physicians” in a system designed to improve quality, satisfaction, safety and cost efficiency

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Macro Trends

Everyone in Healthcare is going to be in the Same Business,

the Population Health Business

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Impact

Impact of these factors on:

• Our Growth Strategies• Our Business Models• Our Provider Models• Our Deliverables

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Expansion of Scope of Services

• Acute Care Hospital• ICU• Specialty hospitals• Specialty hospitalists• Post DC Clinic • Pre op Clinic• LTACH• Acute Rehab• SNF

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Scope of Services

• NH• Hospital at home• Palliative care• Hospice

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What Additional Capabilities Will We Need• Data aggregation • Data analysis• Data sharing• Predictive modeling• Mobility• Integrated decision support• Care coordination and long term planning• Communication optimization• Quality and compliance alerts

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What is the Index?

The Greeno-Hawley Hospital Medicine Index is the first objective tool

designed to measure the capabilities of a hospital’s Hospital Medicine

Program.

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Benefits: hmindex.net

The Index will highlight areas for improvement in your Hospital Medicine program’s capabilities. A well-designed,

high-functioning Hospital Medicine Program can have significant impact on

improving:

• Hospital and or system-wide strategic patient outcome initiatives

• Clinical quality and safety• Cost efficiency

• Patient satisfaction• Avoidable readmissions

hmindex.net

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Banner HealthNetwork

Banner HealthMaking a difference in people’s

lives through excellent patient care.

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Banner Health:National Leader in Health Care

• Top 5 Health System - Clinical Quality• TOP 5 HEALTH SYSTEM – CLINICAL QUALITY

Thomson Reuters – 2012• Top 10 Integrated Health Network• TOP 10 INTEGRATED HEALTH NETWORK SDI – 2010,

2011, 2012• Health Care’s Most Wired• HEALTH CARE’S MOST WIRED Hospitals & Health

Networks Magazine• US News/World Report• US NEWS & WORLD REPORT Best Hospitals

(six in top 14 in Arizona)Banner Good Samaritan Medical Center ranked #1 in AZ

• Top Leadership Team in Health Care• TOP LEADERSHIP TEAM IN HEALTH CARE

Awarded in 2011 by HealthLeaders Media

Selected as a Pioneer ACO 39

Banner HealthOne of the nation’s largest nonprofit health care organizations.

• 23 hospitals, and an array of other services, including family clinics, home care & hospice, home medical equipment, long-term care, surgery centers, etc.

• Located in seven states…major footprint in metro Phoenix• High performing specialty hospitals

– Cardon Children’s Medical Center (Pediatrics)– Banner Heart Hospital (Cardiology)– Banner MD Anderson Cancer Center (Oncology)

• Robust research enterprise– Banner Alzheimer’s Institute– Banner Sun Health Research Institute– Banner MD Anderson Cancer Center– Clinical research in cardiology, Parkinson’s, Neurology, cancer

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BHC Entry Into Telehealth

• Banner Home Care partnered with Banner Heart Hospital and Tri-City Cardiology to provide home telehealth services to CHF patients in August, 2006.– Part of successful approval process as a Colloquium– Also part of IHI 5 million lives campaign– Target was Medicare patients with primary diagnosis of CHF from Banner

Heart– Initial goal: reduce 30 day readmission of primary/secondary CHF patients

by 50% by December 2008.• Results of this initial phase (19 months).

– Patients served: 122– Readmission results: Total readmissions with primary/secondary CHF –

5%

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BHC Growth Strategies

• Geographic Expansion• Specialty Services• Recruitment of Clinicians• Payer Mix

– Banner Capitated Market

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BHC Payor Mix

2007 2008 2009 2010 2011 20120%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

MedicareMedicaidInsuranceCapitated

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Telehealth by Disease Category

2007 2008 2009 2010 2011 20120%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Other Chronic Condi-tions (CAD, HTN, COPD, etc)CABGCHF

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BHC Telehealth – Patients Served

Number of Patients0

200

400

600

800

1000

1200

200720082009201020112012 Annualized

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Clinical / Operational Model

Goals• Decreased visit utilization

with increased patient monitoring

• Decreased acute care hospitalization

• Balanced costs and outcomes

Achievements• Visits/episode

All patients : 10 visits/episode

Capitated: 8.1 visits/episode• Re-hospitalization rate

All patients : 9%Capitated: 5%

• Exceed financial/clinical targets

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H@H Phase I • Banner Health IRB-approved study- patient consent was required• Location - BGMC• Started September 2011, ends September 2012

– Recruitment ends Sept 14, 2012– 30d HH care ends Oct 14, 2012

• Admitted patients with one of 4 primary diagnoses: HF, COPD, CAP, Cellulitis

• Evaluate feasibility, safety, effectiveness, and satisfaction- of a program that attempts to discharge these inpatients earlier, into a 30d tele-monitored/ Home Health environment

• Metrics- adverse outcomes/ complications, LOS/ 30d re-admission rate, patient/ physician satisfaction surveys, lessons learned

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Readmission Rates (preliminary data analysis)

Diagnosis (n = 139)

Readmit Day(rate)

Comments

HF* (n = 33)

(12%)301

258

cardioversion

COPD (n = 14)

(14%)60 stroke driving home

CAP*(n = 39)

(2.5%)30

Cellulitis(n = 53)

(0%)

* National readmission rates (2010) for CHF 25% and CAP 18%

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Post Hospital Discharge Pt Satisfaction Survey

% Favorable Response (n=107)49

Post 30d Program Discharge PatientSatisfaction Survey

% Favorable Response (n=72)50

Hospitalist Satisfaction Survey

% Favorable Response51

Home Tele-monitoring to avoid HF admissions

•Pilot- Banner Home Care PI Project (sites= BTMC, BBWMC, BBMC) –Tele-health components

•Weight, VS, signs/ symptoms, education, daily pt call from TH Center

–In home, medication reconciliation•Results- BHC TH has decreased HF re-admissions rates to below 5% (BHH)

•Spread ‘service’ to those who don’t ‘qualify’ for HH services–Cost

•HH Nurse visit $125, 30 d TH monitoring $90, total $215/ patient.

–Benefit-

•Hospital re-admission cost $7000 to $12000.

•Spread this program to patients w other hi re-admission chronic disease states–Identify patients in ED–Define H@H Phase II

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H@H Phases

Urgent Care/Doctor’s Office

Phase III

Emergency Department-

Phase II

HospitalStudy- Phase I

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Obstacles

• Logistics: equipment delivery, inventory control

• Technology: data transfer/extraction• Culture: health promotion, patient-centered

goals

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Into the Future

• Define future needs• Business requirements for technology• Partnering with device firms

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We would like to hear your views on today’s webinar. Go to http://www.surveymonkey.com/s/JVYFZB5

For more information on reimbursement, please visit the Philips Healthcare Reimbursement Website at

www.philips.com/reimbursement

Questions?

Please type your questions into the video player window.The moderator will pose questions to the panelists.

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Speaker BiosTracey MoorheadPresident and Chief Executive OfficerCare Continuum Alliance

Tracey Moorhead is President and Chief Executive Officer of the Care Continuum Alliance. The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. Based in Washington, D.C., the Care Continuum Alliance represents corporate and individual members in promoting the role of population health improvement to raise the quality of care, improve health outcomes and reduce preventable health care costs for people with chronic conditions and those at risk for developing chronic conditions.

Ms. Moorhead is recognized as a leading health care advocate with considerable experience in public policy and coalition management. She effectively directs policy formulation and strategic advocacy efforts, as well as represents the population health management community before the media, allied organizations and constituents, and all levels of government.

Ms. Moorhead previously served as Executive Director of the Alliance to Improve Medicare (AIM), a bipartisan coalition advocating comprehensive Medicare improvements. AIM supported enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. As AIM's Executive Director, Ms. Moorhead coordinated and moderated educational and policy briefings for congressional staff; directed AIM's policy research, development and communications efforts; and developed grassroots programs in conjunction with AIM member organizations.

In addition to her role with AIM, Ms. Moorhead served as Vice President, Government Relations, for the Healthcare Leadership Council (HLC).

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Speaker BiosRon Greeno, MD, FCCP, MHMChief Medical OfficerCogent HMG

Ron Greeno is a founder of Cogent HMG and serves as its Chief Medical Officer. He is also Senior Consultant for The Cogent Group, Cogent HMG’s consulting division. Dr. Greeno is the creator of the Greeno-Hawley Hospital Medicine Index, the industry standard for evaluation of Hospital Medicine programs.

Dr. Greeno is the creator of the hospitalist program management model used by Cogent and originally developed and managed Cogent’s national network of hospitalist physicians that has grown to over 1100 physicians. He is considered a pioneer in Hospital Medicine, which has become the fastest growing field in the history of American medicine. He is a founding member of the Society of Hospital Medicine and has served on the Society’s Leadership Committee since its inception. Dr. Greeno graduated from the University of Nebraska, College of Medicine in 1979. After completing a medical residency in Internal Medicine at the University of Iowa Hospitals and Clinics, Dr. Greeno completed fellowships in Critical Care and Pulmonary Medicine at the Memorial Sloan-Kettering Cancer Center and was a Research Fellow at the Laboratory of Immunology and Cellular Physiology at Rockefeller University in New York.

Dr. Greeno formerly served as Medical Director of the Intensive Care Unit and Director of Respiratory Medicine at Good Samaritan Hospital in Los Angeles, California. He has received board certification in Internal Medicine, Pulmonary Medicine and Critical Care Medicine.

Dr. Greeno is a nationally recognized expert on hospitalist programs and their clinical and administrative management and speaks and writes regularly on the subject. He has authored over thirty articles and book chapters on Hospital Medicine programs for national publications. In addition, he has presented at the national meetings of, among others, the Institute for Healthcare Improvement, Society of Hospital Medicine, and American College of Healthcare Executives. He is on the Editorial Board for both Today’s Hospitalist and Hospitalist Leadership Advisor. He is a recipient of the SHM Award for Outstanding Service in Hospital Medicine given to only one hospitalist physician a year. In addition SHM has awarded him a Master in Hospital Medicine, one of only seven individuals to ever receive this distinction. Three times Modern Healthcare has named Dr. Greeno to its list of “50 Most Powerful Physician Executives in Healthcare,” the first hospitalist ever to make this prestigious list.

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Speaker BiosDavid BakerChief Executive OfficerBanner Home Care

David Baker was named the CEO of Banner Home Care and Hospice in June of 2003.

Prior to coming to Banner Health, Baker served as the regional executive director at St. John Home Care and Genesys Home Care in Detroit, Mich. He also held a position as the manager of consulting for Ernst & Young in Chicago, Ill. Prior to that, he served as the corporate director of Home Care Services, OSF Saint Francis, Inc., (a subsidiary corporation of a multi-state hospital system). Baker's experience also includes being a founder of St. Mary's Medical Center Home Care Division in Tennessee.

He received his undergraduate degree from Lincoln Memorial University, and his masters of social work from the University of Tennessee.

He is married to Kay and they have two daughters.

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