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Home & Community Based Services Peak Conference J. Benjamin Unkle, Jr. – President & CEO Daniel J. Nimon – President, WC at Home LLC Joseph F. Belvedere.

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Presentation on theme: "Home & Community Based Services Peak Conference J. Benjamin Unkle, Jr. – President & CEO Daniel J. Nimon – President, WC at Home LLC Joseph F. Belvedere."— Presentation transcript:

1 Home & Community Based Services Peak Conference J. Benjamin Unkle, Jr. – President & CEO Daniel J. Nimon – President, WC at Home LLC Joseph F. Belvedere – Chief Financial Officer

2 Westminster-Canterbury on Chesapeake Bay: Who Are We? 33 year-old Continuing Care Retirement Community 441 IL; 96 AL; 95 Nursing Beds

3 Why did WCCB decide to start home health, homecare and hospice? Quality of Care: Need to control clinical quality of care and assure positive clinical outcomes for referrals to community (both on and off campus) A new day: ensuring and proving quality. Saw additional revenue growth opportunities and the ability to diversify revenue stream without bricks & mortar Patients already here on campus and WCCB was “giving that money” to outside HHA’s outside/community patients in short stay at NH & saw opportunity to start home health with immediate volume.

4 Why did WCCB decide to start home health, homecare and hospice? WCCB was already licensed to provide private pay homecare services to residents on the campus. $400K annual operating loss from services that were being provided to ILU residents, much of it without charge – Medication Management – Dressing Changes – Follow-up for all hospital and post acute discharges – ADL Care

5 How is that working for you? On-campus services $400K losses converted to $150K positive income in first full year. Residents happier to recover in their independent living apartment from orthopedic surgery. More bed space for outside community patients for rehab. Can offer community patients the chance to be followed by our Home team. Readmission rates LOW: 13% vs. 17% national average.

6 Problems/Potential Lessons? Need good schedulers, training, coders, and marketer for off-campus. This is NOT a business you can start by hiring one administrator, hoping it was a good hire and not watching it continually. Too much can go wrong. Highest barrier to entry is talent and knowledge. Retail brand risk in failure or poor quality. Earning the support of existing residents. WIFM?

7 Big Picture Strategy To provide home health & hospice services to residents of Westminster-Canterbury on Chesapeake Bay (“Inside the Gates”) To provide home health & hospice services to residents of the Greater Hampton Roads area (“Beyond the Gates in Hampton Roads”) To assist Faith-Based Non-Profit Organizations with development and on-going operations of independently owned home health & hospice services (Partnerships – Behind the Scenes Support)

8 How can we touch more people? (Good idea, but hard to start and monitor) 1.Invest in higher caliber talent than we alone can afford & share talent through partnerships. 2.Leverage size for pricing and quality (value) 3.Bring and learn “best-practices” in a fragmented industry. 4.Help other faith-based CCRCs stay strong and in control of their campus/mission.

9 Options for Starting Home & Community Based Services Program AcquisitionConsultantAdvisory Services Certified Medicare Services immediately Here today and gone when the rubber meets the road Both partners motivated for long-term success Double to Triple the start-up expenses Higher cost of start-up / Need to acquire expertise on staff Lowest cost option for start- up Often Agencies are for sale for a reason…Why? No on-going supportOutsourced back-office allows focus on core business / healthcare side Built-in bad habits / cultureBest practices on day oneBest practices on day one and on-going Chance of acquiring risky baggage with old license, including back Medicare issues No day-to-day operational assistance or experience Often forgotten: Continuum of Care management and development expertise

10 What does WC at Home Offer to Potential Partners? Initial Market and Feasibility Analysis Development of a Financial Pro-Forma & Cash Flow Projections based on results of the Market Analysis Assistance with Initial Start-Up (policies, offices, etc) Selection of Administrator Guidance through State Licensure Guidance through CHAP Accreditation Process Guidance in obtaining a Medicare Provider Agreement IT/software selection & implementation On-going web-based access to specialized home health & hospice clinical and financial software

11 Development and mentoring for clinical staff Assistance in developing or strengthening current continuum of care management strategies at CCRC Education of clinical and health information staff regarding OASIS and proper coding to fully capture $$ from Episodes of Care Provide all billing services for Home Health, Homecare and Hospice once operational. Continued monitoring of clinical performance improvement to assure positive clinical outcomes What does WC at Home Offer to Potential Partners?

12 STEP 1: Initial Market and Feasibility Analysis Current Medicare SNF usage Current Home Health competition in market Home Health and Hospice referrals from hospitals Home Health usage in market Provider reputation in market Provider ability to strengthen management of continuum for referral development You can use this whether you hire us or not

13 STEP 2: Financial Pro-Forma & Cash Flow Projection Utilize Market Analysis to develop a 5 year pro-forma operating budget – Referral assumptions to create volume/revenue – Expenses based on your data and our formulas – Cash Flow Analysis: initial investment and cash generation over 5 years Presentation to your Leadership Team: a candid assessment of win/win potential

14 Step 3: Initial Start-Up Assistance Provide operational & clinical assistance and expertise for: – Recruitment of Administrator and Health Information Coordinator – Required start-up staff – Assist CCRC and/or Administrator with initial office selection and set-up of IT & software – Policy and procedure development

15 STEP 4: Licensure, Accreditation and Medicare Provider Agreement Assistance in obtaining state licensure CHAP (Deemed Status) Accreditation readiness CHAP Survey assistance and guidance Guidance with Fiscal Intermediary Assistance with CMS initial home health application and guidance through the process Obtaining Medicare Provider Agreement and billing numbers

16 Step 5: Information Technology and On-Going Software Support Recommend initial and on-going hardware needs Provide discounted volume based pricing for software & licenses Coordination and installation/configuration of software Train staff on use of software Assign WC at Home staff as primary liaison for any software “Help” issues that may be encountered

17 Step 6: Continuum of Care Management Strategies Identify current Continuum of Care systems Develop and/or assist CCRC Team in enhancing a strong continuum of care management strategy – Identify Medicare SNF, assisted living and independent living referrals – Develop and/or provide education to Continuum of Care Committee RE: home health eligibility requirements – Assist CCRC with Part B Out Patient issues – Negotiate pricing with current rehab services provider and/or assist with selection of home health rehab service

18 Step 7: Billing & Coding Services Quality Assurance Audits to assure Medicare compliance Provide training for all staff on completion of OASIS documentation Review of OASIS coding to assure proper reimbursement levels for each Episode of Care Serve as conduit for submission of all billing to third parties (Medicare, commercial insurances)

19 Step 8: On-Going Advisory Services Routine on-site consultative meetings with Home Health staff – Administrator coaching – Clinical and Operations Support Monthly Advisory Conference Calls – Clinical Care Review – Operations Review – Financial Review External review and quarterly reporting on quality measures, clinical indicators and financial results to CCRC executive leadership

20 Timeline Summary WC at Home recommends an initial Home Health start-up followed by Hospice – Months 1 to 3 - Recruit and train Administrator, develop policies/procedures, begin enhancement of management continuum strategies – Months 4 to 6 – Prepare and receive state licensure, deploy software and train – Months 6 to 9 – Prepare for CHAP accreditation – Months 10 to 12 – Obtain accreditation and Medicare Provider Agreement

21 How’s that working for you and for your partners? Recent Partner Case Study: Partner Experience An Agency owned by two faith-based CCRCs Purchased from a “Mom & Pop” provider in 2007 History of unstable on- site leadership – Focus problem for CCRC’s Not capturing internal referrals

22 Recent Partner - Services Retained to analyze whether agency should even continue in home health Medicare program Based on feasibility study, WC at Home was contracted to provide: – Assistance with development of a strong continuum management program on each campus – clinical expertise and billing services – IT infrastructure and software – Interim leadership

23 How’s that working for your partner? Tripled the episodes/cases. Positive margins for its owners. Clients are happy.

24 Offers over 100 years of combined healthcare experience with our senior leadership team WESTMINSTER-CANTERBURY AT HOME, LLC

25 Leadership Dan Nimon Serves as President of WC at Home, LLC. Dan has 27 years of health care operations experience and excels in reimbursement and continuum management. He has been involved in the start-up and operations of 3 separate home health organizations in Waterville, Maine, Lynchburg, VA, and Virginia Beach, VA.

26 Joe Belvedere CFO. Joe has 10 + years of multi – site home health financial management in addition to 25 + years of corporate financial management experience. Joe was responsible for 7 owned home health & hospice offices and 4 affiliated organizations with operating revenues in excess of $40 million annually. Leadership

27 Sally Huston, RN, MSN Sally serves as Sr. Director of Clinical Services and Operations. Sally is an RN with 30+ years of healthcare management experience, having most recently served as Corp. V/P of Clinical Services for the past 10 years with the same organization as Joe Belvedere. Sally has also been a consultant for CHAP and is very experienced with home health & hospice standards. Leadership

28 Heather Elsner Heather serves as Director of Health Information and Reimbursement. Heather has 10 + years experience with home health coding and billing, having served as the Corporate QA Coordinator for Senior Independence in Ohio prior to joining the staff of WC at Home. Heather is a Certified Healthcare Billing Coder. Leadership

29 The Future??? Who believes the cost/price affordability squeeze will go away? Who believes we will not have to demonstrate provable quality outcomes? Who believes that procedure-based health care payments are coming back? Who worries about keeping overall margins healthy to stay in control of our missions and values?

30 So, what are we going to do about it? Hunker down and ignore it all? Trust our high service levels and the niceness of our staff will justify higher and higher fees? Look for BOTH new revenues and economies? Remember, every year we make new lifetime promises to a new set of older adults. They are depending on us to stay in control and deliver what they bought!

31 Westminster-Canterbury at Home, LLC Questions?


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