1 The San Diego Readmissions Summit February 5, 2015

2 Agenda Changes to the PAC World PAC Market Drivers & Business Needs Tools and Solutions Resources

3 Changes to the PAC World are Occurring on Many Fronts

4 Medicaid Managed Long Term Care Expansion “State Demonstration Proposals to Align Financing and/or Administration for Dual Eligible Beneficiaries…” “Medicare Advantage Enrollment in 2014 Exceeds Projections by 6 Million Beneficiaries” Building Alliances Changes are Coming Fast and Furious

5 Payment Model Changes -- The Catalyst Volume DrivenValue Driven Fee For Services (FFS) Heads in Beds (Longer Stay) Documenting RUGS Avoiding Take Backs Surviving Surveys & Audits Bundled Payment and Shorter Stay Cost Control Care Coordination/Quality Outcomes Case Mix Managing Complex Contracts/Possible Cash Flow Disruption Avoiding Exclusions (drugs, procedures, services, etc.)

6 Potential Payer Mix Changes Graphic courtesy of Avalere

7 PAC Market Drivers

8 Key Drivers and Beyond… Care Coordination Partnering and Connectivity Clinical Outcomes Financial Outcomes

9 Transition from Fee for Service (FFS) to Bundled Payments (MCOs, ACOs, etc.) Consistent care management across the continuum of care Data at the core Managed Care growing rapidly – efficiency a necessity Contract management Move from charge capture to cost capture, allocation & projection Managed Care growing rapidly – efficiency a necessity Contract management Move from charge capture to cost capture, allocation & projection Managing important metrics (ALOS, re- hospitalization, etc.) Proof of value to garner referrals Interoperability with partner systems Expanded services (telemedicine, diagnostics, etc.) Managing important metrics (ALOS, re- hospitalization, etc.) Proof of value to garner referrals Interoperability with partner systems Expanded services (telemedicine, diagnostics, etc.) Efficiently move patients across the continuum with quality outcomes Collaboration across settings Evidence-based practices/decision support, outcomes Efficiently move patients across the continuum with quality outcomes Collaboration across settings Evidence-based practices/decision support, outcomes Business Needs & Process Changes

10 PAC Provider Tools

11 Outcomes Reporting Readmissions (Admissions, Discharges) –High risk diagnosis –Changes in ADLs –Issues upon discharge –Discharge to another LTC facility, or lower level of care –How many times residents were admitted to ER while in your care –Planned vs. unplanned discharges Quality –Established goals vs. actual –Hip fracture or stroke patients with ADL improvement –Special reports just for dementia: falls, injuries, pain –Relationships between mobility and continence –Flu vaccinations –Level or frequency of falls, injuries, restraints, pain, self harm, wounds, safety, wandering, weight loss, etc. Cost (LOS) –Payor –Referral source –Diagnosis –Physician –And more! Outcomes Reporting In AHT Outcomes Reporting In AHT

12 Physician Engagement & Collaboration

13 For Communication between the Nursing Home and Hospital Engaging Your Hospitals Tip sheets for better communication and collaboration with local hospitals Nursing Home Capabilities List Standardized pre-populated checklist explaining nursing home capabilities for decisions about transfers back to the facility NH – Hospital Transfer Form At time of acute care transfer from nursing home to hospital to make key information easily accessible to receiving clinician Acute Care Transfer Checklist

14 Resources

15 More Information – White Papers Partnering with MCOs, ACOs and Hospitals as New Payment Models Emerge in Post-Acute Care

16 Thank you!