Presentation on theme: "Stephen N. Flood New Orange Hills, Inc. Orange, CA."— Presentation transcript:
Stephen N. Flood New Orange Hills, Inc. Orange, CA
1.We have reason to believe that the next 2-5 years will see a complete shift away from government controlled delivery systems. The following MCO systems are here or at our doorstep. Accountable Care Organizations Bundling Dual Eligible Programs Senior Advantage Programs County Run Medi-Cal Organizations 2. The previous ownership of New Orange Hills anticipated this type of change and pushed forward toward systems that would be rewarded by MCO’s.
1. History Opened in 1987 Integrated Health Services – Bought in 1992 Owned Between 1992-2002 Contracted: Kaiser, St Joseph’s, Others Sub-Acute with Piped Oxygen – 1996 Sold to Facility Administrator – 2002 Sold to Current Ownership – Dec. 2006
A. Percentages by Payer Type Managed Care – 50% Medicare – 10% MCAL Subacute – 30% Custodial – 10% B. Programs – Diagnosis/Disease Based TBI/SCI/CVA & Other Neuro Dx Orthopedic Advanced Wound Care Infectious Disease Dx Pulmonary and Cardiac
If we want to move to the next level in the managed care environment we have to start with a different philosophy. The question we must ask is “What will it take (leaders, personnel, experts, resources and practices) to create a managed care relationship that operates on a “Win-Win” basis and adjusts regularly to; ensure progress and maintain equilibrium.
PROVIDERPARTNER Payment: Maximized by Provider and Minimized by Payer Utilization: Minimized by Provider and Maximized by Payer Quality: Minimal Efforts to Coordinate Quality Efforts Utilization/Payment: Optimized through Collaboration Quality: Regular Efforts to Align Care Systems and Keep Each Other Mutually Accountable
Payment Methodology Fixed Payments that Represent the Large Percentage of Patients - Predictable and Based on the Mean: New Orange Hills: 2 Fixed Tiers Complex Medical Coverage – All Levels Tier with Ventilator Add-on Flexible Systems That Adjust for Acuity: PRN Pharmacy: Exclusions or At-Cost Provision by MCO DME: Exclusions, Provision or Shared Purchase Sitters: Provision by MCO for One-on-One Needs Fee for Service Payment for Transfusions
Census: The Issue is Not the Number of Patients but the Type of Patients Higher Acuity, Greater Complexity, and More Flexibility than the Facility down the street – From ER, ICU, Urgent Care, Home MCO and Facility Works Together to Ensure Hospital refers Right Segment of Patients Less Complex Patients are Not Admitted MCO and Facility Continue to Identify Ways to Increase Capacity for Higher Acuity Patients
Effective Utilization – Outcome Based Average Length of Stay Based on Functional Level at Admission and Admitting Dx Safe, not Highest, Functional Level Upon Discharge % Discharged Home based on Admission Criteria Minimal Rehospitalizations – Risk Adjusted Controlled Hospital Utilization: ER, Direct Admit Specialist Utilization on Site - Efficiency HAC’s: PU’s, HAI’s, Incidents
Managed Care Organization Share Formularies & Care Pathways Share Educational Resources Collaborate on Best Practices Provide QA Oversight and Feedback Facility Commit Resources Outside Contract: ROI Provide Transparency and Access: Trust and Influence Become a Champion of MCO Systems in the Facility Develop Best Practices that Resource the MCO Become the Expert in your Health Care Segment: Add Value
Necessary Components Managed Care Organization (MCO) Commitment of Decision Makers – Find the Leader(s) Vision, Financial, and Organizational Backing You Must be Special to Warrant this LT Commitment Physician and Organizational Involvement in Operations Trust is based on Control/Relationship Skilled Nursing Center Willingness to Do What it Takes Capacity: Procure/Develop Resources to Stay a Step Ahead Independent Owners are in a Special Position to Do This Trust that Resources will be at the right place at the right time on a consistent basis. Owners have capacity for responsiveness and longevity. Care happens locally and is facility based.
Contact Information: Steve Flood New Orange Hills firstname.lastname@example.org (714) 997-7090 (office) (714) 612-7984 (cell)