Transforming Perspectives Effective use of Care Management services in a Value Based World

Disclosure All presenters and planners of today’s activity do not have any financial relationships with any commercial interest related to the content of this activity This activity has not received commercial support

Objectives To understand the definition of Longitudinal Care Management To understand the key strategies and goals of Care Management To understand the importance of Care Management involvement with the transformation to Value Based Contracts

Michelle’s Story “You treat a disease: You win, you lose. You treat a person, I guarantee you win, no matter the outcome.” -Patch Adams Pictured: Michelle Jonassen, BSN, RN Care Manager

What is Care Management? Care management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes (The Case Management Society of America, 2016: http://www.cmsa.org/)

Longitudinal Care Management Supportive care of a patient and family over a period of time Encompasses a holistic, dynamic, and integrated plan of care Includes treatment goals and plans reflecting the patients values and preferences

Care Management Responsibilities Engaging patients in their health Patient education related to disease management and prevention Self-management support through close follow-up as needed Comprehensive care planning Medication reconciliation Transitions of care Coordinating referrals and tests Connecting patients to community resources Advance care planning

Goals of Care Management Help patients achieve self-management of chronic diseases Improve coordination of care Provide cost effective, non-duplicative services Improve quality outcomes Improve access to care Increase patient satisfaction

Goals of Care Management Cont. This Care Management work supports, but does not replace, the work and relationship of the care team

Trinity Health: People Centered 2020 The goals of People-Centered 2020 : attain high-quality, longer lives free of preventable disease, disability, injury and premature death. To achieve health equity, eliminate disparities and improve the health of all groups. To create social and physical environments that promote good health for all. To promote quality of life, healthy development and healthy behaviors across all life stages.

Population Health As defined by the CDC, Population Health is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It is an approach to health that aims to improve the health of an entire human population. Care Management is an essential component of successful population health management

The Population Health Journey Highly Care Managed Future State ------------------------------------------------------------------ Fact: by the year 2050, nearly 20% of the population will be 65 and older, Medicare expenditures will continue to grow as the population ages, which is why population health is so important. With the gradual shift from fee for service to the value based care models, care management is aligned perfectly to care for the rising risk populations that directly affect the cost of healthcare. The transition from fee for service to value based reimbursement won’t happen overnight, it will take time. And is definitely a financial challenge for healthcare systems. --------------------------------------------------- Traditional Model No or Little Care Management Fee-for-service Full-Risk / Value Based Contracts

Value Based Care Performance-based payment or reimbursement Payment tied to health outcomes and metrics A tool for aligning incentives among: Health systems, suppliers, manufacturers, employers, payers A shared performance or risk-sharing model Value based care is tied to patient health outcomes, efficiency, and quality. The goals of the stakeholders are improved patient outcomes, experience, quality of care, enhanced population health, and operational efficiencies. We share the benefits or the penalties if the goals are not achieved.

Value Based Care

Value Based Contracts Priority Health Commercial & Medicare Advantage plans Blue Cross Blue Shield of Michigan Select Commercial & Medicare Advantage plans State Innovation Model (SIM) - Managed Medicaid Plans Trinity Health ACO (TH-ACO) - Medicare Bundled Payment for Care Improvement (BPCI) - Medicare These are the current value based contracts Care Management participates with. PH and BCBSM pay fee for service with incentive dollars tied to care management work. SIM pays a per member per month for care management services with an additional incentive for meeting quality metrics. The Trinity Health ACO is our Next Generation model accountable care organization (ACO) that serves as population health management for our Medicare community. Payment is based on keeping healthcare costs down and meeting quality benchmarks. BPCI is our bundled payment care improvement program – the payment model provides a single bundled payment to providers based on the patient’s episode of care during a hospital stay, and follow up care, for a period of time.

Who Needs Care Management? Those at risk for developing complications from poorly controlled chronic disease Those with a new diagnosis or medication(s) and need education Those at risk for readmission or exacerbation Those with high and/or inappropriate service utilization Those with multiple co-morbidities Those with identified Social Determinants of Health needs

Pictured: Jill Maciejewski, RN Care Manager and her Family Jill’s Story Pictured: Jill Maciejewski, RN Care Manager and her Family

Benefits of Care Management The shift from fee-for-service to Value Based Care has increased the need for Care Management in the primary care setting Care Management follows the guide of the Triple Aim in caring for our at risk patient population What are the Benefits of Care Management? Better Health, Better Care, Lower Costs.

Better Health Improving the health of populations overall Improving quality metrics Closing gaps in care Addressing Social Determinants of Health Utilizing clinical-community linkages Care Management helps to improve patients health by:

Better Care Improving patient experience Improving relationships and trust between patient and care team Patients feel better as their health improves Patients are able to set and meet health goals Patients have direct access to their Care Manager for timely care Care Management helps to provide better patient care, by:

Lower Costs Reducing hospital admissions Reducing hospital readmissions Reducing ED utilization Reducing length of stay in Hospital and Skilled Nursing Facilities Avoiding duplicative testing and services Providing prompt care and treatment to reduce risk of complications Care Management helps to lower healthcare costs by:

Trinity’s Mission and Core Values Patient Population Health Value Based Contracts Care Management Trinity’s Mission and Core Values

“He who has Health has Hope; and he who has Hope, has Everything.” -Unknown