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Boca Raton, FL | Orlando, FL | Potomac, MD | Boston, MA | Guaynabo, Puerto Rico Bloomington, MN | Iselin, NJ | Montvale, NJ | Magnolia, TX | Austin, TX.

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Presentation on theme: "Boca Raton, FL | Orlando, FL | Potomac, MD | Boston, MA | Guaynabo, Puerto Rico Bloomington, MN | Iselin, NJ | Montvale, NJ | Magnolia, TX | Austin, TX."— Presentation transcript:

1 Boca Raton, FL | Orlando, FL | Potomac, MD | Boston, MA | Guaynabo, Puerto Rico Bloomington, MN | Iselin, NJ | Montvale, NJ | Magnolia, TX | Austin, TX Herbert J. Sims & Co., Inc. 106 East Sixth Street, Suite 900, Austin, Texas 78701 Member FINRA/SIPC March 5, 2014 Operations: Analyzing Multiple Paths to Strengthening Operations

2 Innovative uses of Technology in Senior Living Presented by: Jill Sorenson, Sr. VP/Sr. Director of Operations Management

3 EMR Dashboard (LCS Insight) Touchtown – Resident Tablets Telehealth Its Never 2 Late Robots in Senior Living Community

4 Many communities have seen a significant increase in RUG rates as a result of more accurate ADL tracking Carillon in Lubbock, TX saw an increase of over $60/day Average census 22 Medicare residents = $469,920 increased revenues For all LCS communities who have implemented EMR, we are seeing an AVERAGE payback in EMR software, hardware and training costs of less than 1 year EMR

5 Dashboard – LCS Insight




9 Being used for: –Daily check-in –Dining Room reservations –Work Orders Next on the list: –Activity sign-up –Guest Room reservations Resident Tablets



12 Telemedicine project with El Camino Hospital and The Forum at Rancho San Antonio, Cupertino, CA –To provide follow up medical assessments from the residents home –Follow up on skin conditions (rashes, wounds) are the most indicated at this time Telemedicine VGo Robot

13 –Follow up on minor medical issues, such as blood pressure checks, that gives a visual of the patient and, in turn, provides the health practitioner a more complete picture of the residents status in general –Allows the community health staff, RN, LVN or CNA, to be present during the visit, to be an advocate for the resident as well as collect accurate information for further orders from the physician and ensure these orders are followed and understood by the resident Telemedicine VGo Robot

14 El Camino Hospital

15 Gives our residents access to a variety of technological, memory-stimulating activities such as –email access –Skype –TV game shows –instructional videos –pictures of different places in the world –Music

16 Residents can use the touchscreen, laptop, or get assistance from team members We also encourage family members to get involved so they can have quality visits with their loved ones


18 The Forum at Rancho San Antonio is piloting a project as a beta test site with a local company Using GPS technology, the robot: –Delivers packages to resident units from the front desk –Delivers drinking water or extra blankets to residents in SNF after call light triage Robots for other uses in Senior Living

19 Robot use in Senior Living

20 Technology in senior living, like all other industries, is constantly evolving and will continue to impact the way we do business We are seeing new ways to innovatively use technology to improve quality of life for residents and increase operating efficiencies In summary

21 THANK YOU! For additional information, feel free to contact me: Jill Sorenson Life Care Services Questions

22 LeadingAge Maryland Jill Schumann March 5, 2014

23 Portfolio criteria Better healthcare Better health Reduced costs Process Solicit ideas for new models Select the most promising models Test and evaluate models Spread successful models Share info at

24 Sampling of initiatives ACO Bundled payments Comprehensive Primary Care Initiatives Financial Alignment Initiative FQHC Advanced Primary Practice Demonstration Graduate Nurse Education Demonstration Health Care Innovation Awards Independence at Home Demonstration Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Innovation Advisors Program Medicaid Emergency Psychiatric Demonstration Medicaid Incentives for the Prevention of Chronic Diseases Partnership for Patients State Demonstrations to Integrate Care for Dual Eligibles Strong Start for Mothers and Newborns

25 John Holahan, PhD, Director of the Health Policy Research Center at the Urban Institute said, Price is what you pay. Benefit is what you get. Value is the relationship between the two. ACOs are part of a wider trend to coordinated and integrated care, population health, value-based focus, provider responsibilities for dollars, quality and outcomes

26 Formal provider organizations that take responsibility for care of a defined group, with care evaluated on quality metrics Pioneer Model, Advanced Payment, Medicare Shared Savings Program Patient centered care, coordination of care, performance incentives based on benchmarks December 2013- 360 ACOs caring for 5.3million beneficiaries

27 Legal entity Responsible for Parts A and B of Medicare ACOs -providers jointly accountable for the health of patients -financial incentives to cooperate and save money; trying to reduce fragmentation Still Fee for Service, but eligible for shared savings & in some cases risk of loss (MSR & MLR benchmarks established) Shared savings individualized based on size of population & other variables, but generally between 2 – 3.9% Use EHR, care coordination, prevention, patient engagement & outcomes focus to reduce costs and improve care

28 Evaluated on 33 quality measures Providers choose at-risk or no-risk Must serve at least 5,000 Medicare fee-for- service patients, & participate for three years Must have governing body representing ACO providers, suppliers & beneficiaries & which can hire/ fire executive Primary care physicians are required to belong exclusively to one ACO, but other provider types can belong to multiple ACOs

29 Evidence-based medicine, EHR, patient engagement, quality measures, cost, care coordination are required components Providers who are participating in another shared savings program or demonstration under fee-for-service Medicare are not eligible to participate in shares savings ACO With a patients permission, ACOs may request beneficiary claims information from CMS

30 ACO professionals in group practice arrangements Networks of individual practices of ACO professionals Partnerships or joint ventures between hospitals and ACO professionals Hospitals employing ACO professionals Other Medicare providers and suppliers Critical access hospitals, FQHCs, rural health clinics can independently participate in Shared Savings Program

31 Fee for service Medicare patients who see ACO providers maintain all Medicare rights, including right to choose any doctors and providers that accept Medicare. Patient can decline to have data shared within the ACO Key difference from HMO – ACO patients are not required to stay in the network; trying to avoid the consumer backlash of the 1990s

32 Leavitt – new paradigm Measured outcomes of AC – experience of care; population health; reduce cost of health care Process-level care management – oversee provision of clinical care; infrastructure to coordinate care across continuum; use IT to manage population health Aligned financial structures – bear financial risk for measured health of population; align financial & professional incentives for high quality health outcomes Leavitt

33 ACOs cover people in all 50 states In majority of states penetration is 1% - 10% Oregon is at 25% - Medicaid Coordinated Care Organizations More than half of ACOs are physician-led serving fewer than 10,000 beneficiaries Growth in number of ACOs & covered lives slowed in 2013, likely because: Tapped out market for trailblazers No proven model to follow Payer delays Leavitt

34 Pioneer model – early mixed results; of 32, 9 opted out in July 2013 NAACOS survey – need average of $4m of start-up capital; biggest problem areas – CMS data, IT and data analysis issues, quality reporting Early results MSSP ACOs -5.8% lower costs Still early to evaluate – working on systems, alignment, IT General consensus that ACOs or similar arrangements are viable

35 Medicare ACOs about 52% of ACOs (8/13) Commercial ACOs – insurers, health systems, provider groups not serving Medicare; set own quality metrics Potential conflicting intersection – high deductible plans and commercial ACOs Medicaid ACOs – Oregon is the leader; four other states are developing Medicaid ACOs; others are in the pipeline

36 ACO /Provider partnership to provide services to entire population ACO /Provider partnership to address specific concerns or cost drivers (such as ER utilization, drug adherence, readmissions) ACO /Provider partnership to treat specific members (such as home health monitoring for people with diabetes) Non-ACO relationships with health systems or others- readmissions; chronic disease mgt; population health

37 Healthy behaviors, primary & secondary prevention Wellness programs, chronic disease management, evidence-based programs, monitoring & assistive technology, consumer incentives Right treatment at the right time in the right setting Effective evidence-based clinical interventions in the least restrictive/ expensive/ disruptive setting; reduced hospitalizations & readmissions Healthcare delivery capacity – acuity; specialized care Care coordination Care management, reduced redundancy, good transitions, EMR, behavioral health, medical home Data tracking and analysis; IT and analysis investments Cost effectiveness and cost containment Reduced FFS, benchmark costs, provider financial risk assumption, aligned incentives, connect cost-quality-outcomes

38 General: Staffing – turnover, agency use, interpreter service, primary care RN/LPN onsite System continuity – offer groups preferred providers to patients at discharge Quality improvement – collaborative QI work, warm hand-offs, outcomes tracking, regular joint meetings

39 Pre-admission Screening/admission – decision in 2 hours, late evening & weekend admissions, direct admits from ER/home/clinician office Medical coverage – assign patient to groups attending physician Care transition – develop a process to receive a warm hand-off

40 During stay Facility environment – meds & DME available on patient arrival; work space & printer/internet for MDs & APCs; wireless internet for patients Care systems – shared protocols/tools; mental health coverage; palliative care; stat radiology & lab in 4 hours; stat prescriptions in 6 hours; therapies available 7 days/wk; assessments done quickly

41 During stay Care Coordination/ Planning – notice to all parties 48 hrs in advance; meeting within 3 days; clearly articulated discharge plan; consistent interdisciplinary meetings Extensive facility case manager responsibilities including discharge planning, coordinating with the Groups care managers One point person for rehab and clinical updates

42 Discharge and post-discharge Medication reconciliation and education Advance directive documentation Communication of discharge paperwork to the Group Standard discharge planning checklist Selection of transfer facility – back to original acute care facility unless contra-indicated

43 Reporting expectations Bed screen outcomes INTERACT or other QI Summary Clinical program specialties Patient satisfaction results Staffing Survey and deficiency/ Joint Commission results QI process measures as established by Group Functional improvement scores

44 Evidence-based clinical pathways used by ACO Data sharing with ACO Drug utilization management Follow patient through multiple levels of care Specialized care transitions programs Health care capacity in housing settings Member health monitoring & risk identification Preventive & routine care in low cost settings Population health for CCRCs

45 Opportunities for ALL settings and levels of care Support, encourage, develop mechanisms to share learning from early adopters Blinded (or not) benchmarking studies Grant funded demonstration projects Library of evidence-based interventions Academic partnerships for applied research Develop mystery shopper, peer review, etc. Promulgate approaches: Interact; Collage; locally developed Tele-health programs Programs for physicians, nurse practitioners, PAs Develop preferred relationships with firms that can assist

46 Hospice of Michigan signed a three-year contract with the Detroit Medical Center ACO to use the hospice provider's product known as @HOMe support, an advanced illness-management service the company developed 10 years ago. As part of the agreement, Hospice of Michigan will provide at-home care services for nearly 200 patients and hopes to add another 200 patients by year's end. The @HOMe resource includes 24/7 telesupport services; home services; emergency room and hospital transition coaches; and outcomes analytics and predictive modeling. (2012)

47 AL beginning to contract with ACOs for rehab Example – providers in NJ developing a rehab unit, hiring sub-acute nurses, investing in EHR, tracking readmissions, partnering with home health and therapy through hospital or other companies Also positioning for other pilots & readmission prevention for the 3 conditions States are liberalizing AL regulations to allow for higher acuity

48 1. Become masters of Medicare system 2. Understand your hospital CEOs world 3. Understand impact on your physicians 4. Align your medical director leadership for the future 5. Know impact on discharge planners (accountability for readmissions?) 6. Your competitors are now your partners 7. Take care of sick people 8. Assess your clinical prowess & make changes 9. Monitor your performance & share results 10. Educate your direct customers Roebuck, Health Dimensions Group

49 Increase skills in population management – wellness, chronic disease management Know your costs sliced by many variables Interoperable electronic health records Measure, measure, measure and analyze Use evidence-based approaches; tune up clinical care; care coordination, transitions Pre-acute as well as post-acute Relationships – health systems, physicians, ACOs… Plan for continuous change

50 Leavitt Partners Center for Accountable Care Intelligence – National Association of ACOs – L & M Policy Research – Beckers Hospital Review (free e-letter) CMS and CMMI websites and

51 Maple Knoll Village and The University of Cincinnati Intraprofessional Innovation Smart House Presented By: Ken Huff of Maple Knoll Communities & Chris Edwards of The University of Cincinnati College of Nursing


53 Maple Knoll Village Continuing Care Retirement Community (CCRC) 143 Independent Living Villas 125 Independent Living Apartments 62 Assisted Living Apartments 156 Nursing Beds


55 Maple Knoll Village: A cutting edge leader of technology in Senior Care

56 WMKV 89.3 and 89.9FM A leading resource for older adults Broadcast from the halls of Maple Knoll Village and one of the few stations in the country owned by a CCRC A 410 watt station with local broadcast for nostalgia including music, classic radio comedy and drama, Good Morning Local News broadcasting from Channel 12 and information programs. The station is also broadcast worldwide from their website at

57 The University of Cincinnati Intraprofessional Innovation Smart House Maple Knoll Village: Safety and Wireless Connect Wi-fi is a critical part of Maple Knolls mission to offer residents the safest and most comfortable environment In 2008 Maple Knoll installed Healthsense technology throughout its 54 acre campus This advanced technology provides care solutions for all levels of care. In conjunction with Maple Knolls wi-fi it allows for remote monitoring, improves emergency response, and upgrades older nurse call systems, and also provides wellness management solutions such as ActiveTrax, a wireless wellness system that allows nutrition tracking and creates customized workouts.

58 The University of Cincinnati Intraprofessional Innovation Smart House Maple Knoll Village: Meru Uninterrupted Care Network This separate and secure network enhances care and safety of residents and improves staff productivity by enabling our IT department to create separate Wi-Fi channel layers. These channels are: Life Critical: This allows staff to access medical information and resources for patients wherever and whenever they need it, such as in their home. Mission Critical: Supports and strengthens patient location tracking system, IP phone systems and business operations, nurse call systems and electronic medical records. Consumer Critical: Offers residents the option to use electronic devices such as tablets and laptops anywhere on campus and still receive wifi signals.

59 UC was founded in 1819 and offers students a balance of educational excellence and real-world experience. UC is a public research university with an enrollment of more than 42,000 students.

60 UC Collaboration ABOUT THE COLLEGE OF NURSING Founded in 1889 and became the first college to offer a BSN in 1916. Rankings –Best Online Nursing Programs = #37 Best Graduate Nursing Programs = #64 U.S. News & World Report –Online Master of Science in Nursing = #6 –Online Master of Science in Nursing = #10 –Online Nursing Degrees = #18

61 2013 STUDENT ENROLLMENT Total Enrollment: 2,641


63 UC Collaboration COLLEGE VISION Through the creative leveraging of technology, UC College of Nursing will lead the transformation of health care in partnership with the people we serve.

64 UC Collaboration THE COLLABORATION Collaborative model of partnership between a CCRC and academic setting Technological advancements in a patients home setting that is preparing the future workforce

65 UC Collaboration FLO-BOT InTouch Remote Presence Robot Patient assessment Specialist treat from remote locations Quicker intervention Fewer trips to ER Better care at a lower cost

66 UC Collaboration V-GO Lower cost Patient education, monitoring, and remote communication Student workforce telehealth development

67 UC Collaboration HUMAN PATIENT SIMULATORS High fidelity hands-on experience in low-risk environment

68 FALL DETECTION SENSORS Partnered with UC College of Engineering and Applied Science Predict and prevent falls

69 UC Collaboration RESIDENT RESPONSE I consider myself tech savvy and I am excited to see how the new technology brought forth by UC will improve our health care. -Emmett White, Maple Knoll resident (93 years old) Ive seen the automobile and aviation come into being and heck, when I was a kid, we used the neighbors new phone because our house didnt have one yet. To see this, to see robots that assist and care for us, its truly amazing. -Simon Strong, Maple Knoll resident (92 years old) When can I sign up?! -Don Johnson, Maple Knoll resident (77 years old)

70 UC Collaboration WHERE ARE WE GOING?

71 UC Collaboration QUESTIONS?

72 For additional Information: patient-servi/landing.html?blockID=861974&feedID=11110 Engineering.mp4?n=172444271 knoll-village-retirement-community-selects-meru- uninterrupted-care-network-enhance-care-safety-satisfaction- seniors.html

73 Contact Information for the Maple Knoll – UC Intraprofessional Innovation Smart House Dr. Debi Sampsel Chief Officer of Entrepreneurship and Innovation University of Cincinnati College of Nursing 513.558.5305 Kenneth W. Huff Executive Vice President & Chief Financial Officer 11100 Springfield Pike Cincinnati, Ohio 45246 513.782.2550 Chris Edwards, MS Assistant Dean for Information Technology & Communications Director, Center for Academic Technology and Educational Resources University of Cincinnati College of Nursing 513.558.5233

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