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Attracting ACOs with Telehealth

MN - 2014
by

Brett Quas

on 27 May 2014

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Transcript of Attracting ACOs with Telehealth

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Attracting ACOs - Utilizing RPM to increase your business
You need to know a
little more about them...
Accountable Care Organization
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
But where did they come from?
Patient Protection and Affordable Care Act - 2010
2006
Elliot Fisher
CMS Payment Advisory Commission Meeting
Pay for improvements
that save
Reliable & progressive metrics
Provider led complete
care continuum
L
K
What do they
Mounting Challenges
Home Care Value
Preparing for success
Over 25 million beneficiaries
2.4 MM Medicare patients
15 MM Non-Medicare patients
Remainder in Non-Medicare ACOs
10,000's Physician network
Provider led structure
"Medical Neighborhood" vs. "Medical Home"
Stronger link to post acute
Continuing growth
Regardless of ACO status, any hospital receiving Medicare reimbursement is subject to re-admission penalties
Healthcare reform - 2012
CHF, Pneumonia & AMI
Expanding reform - beyond 2012
Federal savings $940m / 4 yrs.
Calculations
Decisions
Avoiding 30-day re-admits
Monitoring outside hospital walls
Information escalation procedures
Delivery, training, service, etc.
Build, buy or outsource
ACOs evolved from:
CMS PGP demonstration
CMS HCQ demonstration
HMOs
ACOs have many forms:
Continued Care Network (CCN)
"Pioneer / shared $"
"Unofficial"
Etc.
Initially 100's of organizations
>500 applicants annually
106 ACOs added in 2013
Applicants
32 initially Medicare contracted (2011)
>250 Medicare recognized ACOs (2013)
Pioneer & CMS ACOs
100's more - payor sponsored
Non-government sponsored
Unoffical ACOs
Partnership structure
Joint Operating Committee
Evolving protocols
calculation I
calculation II
2013 penalties capped at 1%
penalties grew.......
2% in 2014 & 3% in 2015
re-admit rates
the
BIG
questions
What are they looking for?
When is this happening?
It has started
How can my RPM help?
How do we get more business?
Remember!
(2000)
(Today)
As of 2012, 60% of hospitals lose money on caring for Medicare patients and reimbursement is only getting stricter. Home care has been successfully utilizing remote patient monitoring for over a decade, successfully meeting CMS challenges and demands.
Home care "established" RPM
30% of HHAs use RPM
Continued growth
Early problem detection
Increased efficiencies
100,000s monitored daily
Double-digit ER reductions
Already versed with challenges ACOs are just beginning
Reimbursement?
Study results (+/-)
Changes in payment
Patient health ownership
Care, when it is needed
Patient & technology management
Prevent 30-day re-admissions
Thank You!
Brett A. Quas
Tiffany Schubel - Bosch Telehealth
Peter Blanchard - Bethany Health
Paul Spencer - Froedtert Health
Dr. Robert Hieb - Froedtert Health
Nationally on average 12% - 14% of patients discharged are sick enough and eligible to require home health care, yet many hospitals discharge a much lower rate. Determining rates of hospitals in your service area, and using RPM technology to focus on those below the national average can significantly increase business.
ACOs are seeking to build a Continuing Care Network (CCN). Using joint operating committees they are creating virtual connections with trusted post-acute partners in the community. The partnerships open doors for home care with technology that were not previously available.
www.connectedhealthcaresolutions.com
Forward moving agencies are integrating into the Continued Care Network (CCN) with hospitals & ACOs, reviewing patient discharges. By putting the analysis in the right hands, home health is improving healthcare quality, increasing business and reducing costs.
In addition to ACOs, world-wide distributors of health care products and services to office-based practitioners are actively pursing providers of remote patient monitoring and services. These fortune 500 companies continually seek new technology products and services they can provide to their customer, RPM is viewed as one of their leading growth segments.
2,225 hospitals penalized
$227 million in penalties
2% 2014 / 3% 2015
Expanded diseases
COPD, Knee & Hip
Build, buy or partner?
First Year Numbers
85% HHAs - proprietary
Costs & services
Near & long term
54 of 114 lowered expenditures
29 generated $126m savings
Re-approach
Don't wait for them to come to you
The environment has changed, so should your approach
Analyze CMS results
Partners
Value / expertise strengthening the gap
Improve shared savings
Penalty avoidance
Technology
Medical environment is technology friendly
Technology has a proven history
Services &
Management
Patient
Information
Equipment
Etc
Technology as a solution
The right care at the right time & place
Reducing 19%, 30-day re-admissions
Financial - $230 mil
Sharing protocols
Removing post-acute information gaps
Continual improvement tool - EHR integration
Avg >$100k per hospital penalty
That's 800 - 1,000 monitor months
Improve savings
Experience
Years of technology use
Reducing the learning curve
Proven protocols
Results
30-day re-admissions
Outcome Improvements
Cost reductions
HH compare
Technology for improvement
Technology for savings & growth
(acute myocardial infraction)
Anne Frechette, RN
www.vnhs.org
Director - Dartmouth Institute
Excess readmission ratio
$280 Million in fines assessed
> 2,000 hospitals to be penalized
~$230 million in penalties
18 hospitals penalized 2%
>150 penalized 1% or more
Thank You!
Brett A. Quas
Tiffany Schubel - Bosch Telehealth
Peter Blanchard - Bethany Health
Paul Spencer - Froedtert Health
Dr. Robert Hieb - Froedtert Health
www.connectedhealthcaresolutions.com
Anne Frechette, RN
www.vnhs.org
(Avoiding Penalties & Sharing in Savings)
Reduction
Full transcript