The Wharton MBA Health Care Management Program A National Initiative to Identify and Address the many “NO BRAINERS” in Long Term Care Presented by: John Whitman, MBA, NHA The Wharton MBA Health Care Management Program Executive Director The TRECS Institute October 1,, 2018

What is a NO BRAINER? A current practice within long term care, potentially driven by historical practice patterns, reimbursement, regulations or whatever, that have two undeniable outcomes: 1) The practice is not in the patient’s/resident’s best interest 2) The practice results in wasted and unnecessary spending for our health care system

CMS Aware of the Need to Change When made aware of specific “No Brainers” CMS was very supportive of the need to make changes CMS outlined a very specific path to change the current reimbursement regulations creating the “No Brainer” discussed however… To change the reimbursement regulations following CMS requirements would require almost 4 full years!

Major Goals of the “NO BRAINER” Initiative Raise the level of awareness concerning the built in “quality depressors” and “wasted spending” that is unavoidable given the current systems restraints. Bring proven quality improvement and cost savings opportunities to large insurance companies, ACOs, managed care companies and other 3rd party payers who can make changes without CMS approval. Encourage (shame) CMS into developing an expedited process for correcting problems that clearly fall into the “NO BRAINER” category

Process to Advance the “No Brainer” Initiative Introduce the “NO BRAINER” concept to the many nation associations actively involved in long term care Have these associations distribute the details to their members and encourage active participation Review suggested “NO BRAINERS” as submitted to confirm appropriateness and prevent duplications Submit to a clinical review committee to confirm the quality improvement potential of the idea Submit to a financial review committee to create a rough estimate of the dollars that could be saved annually

Host a One Day Invitation Only Summit at The Leonard Davis Institute to Discuss Policy Implications of Findings Identify and invite up to 50 health care professionals representing a wide array of expertise including: CMS (Reimbursement and regulations) Providers – large and small nursing home providers National Long Term Care Associations American Health Care Association LeadingAge Other Professional Associations (NADONA, Medical Director’s Association) Insurance companies, managed care companies, ACOs, etc. Ancillary service providers (Rehab, pharmacy, medical equipment, etc.)

One Day Invitation Only Summit at The Leonard Davis Institute Provide attendees with a detailed overview of the key “No Brainers” identified and their quality and annual cost implications Host an open discussion with all attendees, lead by a facilitator, to discuss opportunities to remove the current barrios leading to the “No Brainers” identified, and Discuss opportunities to make insurance companies, managed care companies, ACOs and other risk bearing entities adopt changes necessary to eliminate the “No Brainers” discovered

Present Findings to CMS Present the individual and cumulative findings to CMS with the goal of CMS… Implementing an expedited process to eliminate key “No Brainers” which would result in improved care and a reduction in unnecessary spending

Present Findings to Major Third Party Payers Present the individual and cumulative findings to major third party payers across America with the goal of… Encouraging third party payers to eliminate the barriers causing the identified “No Brainers” which would result in improved care and a reduction in unnecessary spending

Seek Out Grant Opportunities to fund a “deep dive” into several of the more costly “No Brainers” Identified Major data review and analysis to provide a more detailed and more accurate estimate of the potential savings available to the system. Present to CMS to further support the request for an expediting the process and appropriate policy changes Consider expanding the “NO BRAINER” idea to other parts of health care system, such as hospitals, home health care, hospice, etc.

Additional Information Anyone can submit a potential “No Brainer” specific to long term care if it meets these two criteria: 1) The practice is not in the patient’s/resident’s best interest 2) The practice results in wasted and unnecessary spending for our health care system Please submit your “No Brainer” idea using the “No Brainer” Submission Form found at: www. For additional information about this initiative, please contact: John Whitman, MBA, NHA Executive Director The TRECS Institute johnwhitman@theTRECSinstitute.org 484-557-6980