1. Maintaining patient health after a hospital stay…

2. …so we all sleep more peacefully.

3. (Your Hospital Name) A Committed Participant in the RARE Campaign

4. RARE Campaign Works across the continuum of care to reduce avoidable hospital readmissions in Minnesota Seeking commitment from all hospitals in Minnesota Engaging other care providers in our community who work with patients post-discharge, as avoidable readmissions are the result of a fragmented health care system

5. Statewide Triple Aim Goals Population health –Prevent 4,000 avoidable readmissions within 30 days of discharge OR, in other words, –Reduce overall readmissions rate by 20% from 2009 base by 12/31/12 Care experience –Help patients and their families spend 16,000 more nights in their own beds instead of in the hospital –Improve by 5% on HCAHPS survey questions on discharge Affordability of care –Save an estimated $30 million for commercially insured patients; additional savings for Medicare patients

6. Broad Community Support Campaign Operating Partners Role –Manage operations, provide the majority of staffing and resources to support participating hospitals Institute for Clinical Systems Improvement (ICSI) Minnesota Hospital Association (MHA) Stratis Health

7. Broad Community Support Supporting Partners Role –Provide significant resources and support to develop and implement specific aspects of the campaign Minnesota Medical Association MN Community Measurement Community Partners Role –Endorse and actively support the campaign A growing list of providers, state health agencies, health plans, home health agencies, nursing homes, patient advocacy groups and other community organizations

8. The Right Thing to Do Likely had a loved one who returned to the hospital soon after discharge Causes anxiety, unrest and burden on patients and their families Patients prefer to maintain their health and sleep peacefully in their own beds

9. Our Hospitals Need to Improve Nearly 1 in 5 Medicare patients discharged from hospitals in Minnesota is readmitted within 30 days Many of these readmissions are avoidable 18 states had lower readmissions rates than Minnesotawe can do better!

10. A Care Delivery System Approach Many hospital readmissions are the result of a fragmented health care system Addressing this fragmentation across the care continuum will reduce avoidable readmissions and improve care delivery overall

11. Potential Financial Penalties Hospitals with higher than expected risk- adjusted 30-day readmission performance can incur penalties up to 1% of their total inpatient Medicare payments beginning in fiscal year 2013 (i.e., starting Oct. 1, 2012). The penalty increases each year after that. CMS will evaluate prior years readmissions data, effectively starting the clock ticking on Oct. 1, 2011

12. Potential Financial Gains Affordable Care Act creates readmissions reduction program to help hospitals smooth transitions for patients, and reward hospitals successful in reducing avoidable readmissions CMS is developing regulations that will be issued this year

13. Timing Is Right Key focus of CMS and its projects –Quality Improvement Organizations Statement of Work –Care Transition Project (seeks to improve the patients continuum of care after discharge from the hospital and reduce avoidable hospital readmissions) –Partnerships for Patients program –Community Based Care Transitions program. The campaign can make Minnesota the national leader supporting the federal initiatives

14. Helps Make Health Care Affordable Estimated average cost of a readmission ranges from $8,000 to $13,000 Opportunity to save tens of millions of dollars, helping more people to afford health care (National Priorities Partnership Compact Action Brief, Preventing Hospital Readmissions: A $25 Billion Opportunity.)

15. We Know It Can Be Done Other hospitals have already significantly reduced avoidable readmissions in the past year, one by 30% Hospitals with similar successes will share their best practices as part of the campaign

16. RARE Goals Committed to reduce our overall readmissions by 20% from our 2009 base Equates to (Insert your hospitals specific PPR reduction goalXX) fewer readmissions by Dec. 31, 2012 This means reducing readmissions by X per month through the end of next year

17. What Weve Committed To –Meet our specific readmission reduction goals –Conduct an organizational assessment of our readmissions –Commit to improving performance in key areas identified through the organizational assessment –Share our organizational assessment results and readmissions data with the RARE Operating Partners –Agree to publicly disclose participation in the campaign to show our support for RARE

18. Five Focus Areas to Choose From Comprehensive Discharge Planning Medication Management Patient and Family Engagement Transition Care Support Transition Communications

19. Support Campaign Operating Partners support –RARE Resource Consultant provided to partner with throughout the campaign –Will assist us in identifying the areas to focus on that have the greatest opportunity for reducing readmissions

20. Support for Our Hospital Best practice toolkits Face-to-face sessions Webinars Conference calls Peer coaching Data reporting Innovator approach

21. Support for Our Hospital Technical assistance on developing an action plan to reduce avoidable readmissions Recognized experts in the five focus areas Opportunities to network and collaborate with other hospital teams

22. Progress Will be Measured MHA will provide our Potentially Preventable Readmissions (PPR) data quarterly We will collect data on a variety of process measures as we do improvement work Our 30-day all cause readmission rates for select clinical conditions will be publicly reported on MN HealthScores for hospitals and provider groups in 2012 (currently under development)

23. Campaign Rollout Our initiative starts now Our hospital RARE team has been formed to lead this effort –List team lead, physician champion, other team players. –Targeted hospital engagement July/August 2011 Improvement and monitoring work continues through Dec. 31, 2012

24. Need Everyones Support Our active participation in RARE and achieving our goals is: Right for our hospital Right for our community Right for our state Most importantly, right for our patients and loved ones

25. Thank you for helping everyone sleep more peacefully.

26. For More Information (Add your key internal RARE Campaign contacts information here) www.RAREreadmissions.org kathy.cummings@icsi.org tdaniels@mnhospitals.org kweng@stratishealth.orgkweng@stratishealth.org