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Boca Raton, FL | Orlando, FL | Potomac, MD | Boston, MA | Guaynabo, Puerto Rico Bloomington, MN | Iselin, NJ | Montvale, NJ | Magnolia, TX | Austin, TX
Herbert J. Sims & Co., Inc. 106 East Sixth Street, Suite 900, Austin, Texas 78701www.hjsims.com
Member FINRA/SIPC
March 5, 2014
Operations:Analyzing Multiple Paths to Strengthening Operations
Innovative uses of Technology in Senior Living
Presented by:
Jill Sorenson, Sr. VP/Sr. Director of Operations Management
• EMR
• Dashboard (LCS Insight)
• Touchtown – Resident Tablets
• Telehealth
• It’s Never 2 Late
• Robots in Senior Living Community
• Many communities have seen a significant increase in RUG rates as a result of more accurate ADL tracking
• Carillon in Lubbock, TX saw an increase of over $60/day • Average census 22 Medicare residents = $469,920
increased revenues• For all LCS communities who have implemented EMR,
we are seeing an AVERAGE payback in EMR software, hardware and training costs of less than 1 year
EMR
Dashboard – “LCS Insight”
Dashboard – “LCS Insight”
Dashboard – “LCS Insight”
Dashboard – “LCS Insight”
• Being used for:– Daily check-in – Dining Room reservations– Work Orders
• Next on the list:– Activity sign-up– Guest Room reservations
Resident Tablets
Resident Tablets
Resident Tablets
• Telemedicine project with El Camino Hospital and The Forum at Rancho San Antonio, Cupertino, CA– To provide follow up medical assessments from
the residents home– Follow up on skin conditions (rashes, wounds)
are the most indicated at this time
Telemedicine VGo Robot
– Follow up on minor medical issues, such as blood pressure checks, that gives a visual of the patient and, in turn, provides the health practitioner a more complete picture of the residents status in general
– Allows the community health staff, RN, LVN or CNA, to be present during the visit, to be an advocate for the resident as well as collect accurate information for further orders from the physician and ensure these orders are followed and understood by the resident
Telemedicine VGo Robot
• Gives our residents access to a variety of technological, memory-stimulating activities such as– email access– Skype– TV game shows– instructional videos– pictures of different places in the world– Music
• Residents can use the touchscreen, laptop, or get assistance from team members
• We also encourage family members to get involved so they can have quality visits with their loved ones
• The Forum at Rancho San Antonio is piloting a project as a beta test site with a local company
• Using GPS technology, the robot:– Delivers packages to resident units from the front
desk– Delivers drinking water or extra blankets to residents
in SNF after call light triage
Robots for other uses in Senior Living
Robot use in Senior Living
• Technology in senior living, like all other industries, is constantly evolving and will continue to impact the way we do business
• We are seeing new ways to innovatively use technology to improve quality of life for residents and increase operating efficiencies
In summary
• THANK YOU!• For additional information, feel free to contact me:
Jill Sorenson
Life Care Services
Questions
ACCOUNTABLE CARE ORGANIZATIONS
LeadingAge MarylandJill Schumann
March 5, 2014
Portfolio criteria◦ Better healthcare◦ Better health◦ Reduced costs
Process◦ Solicit ideas for new models◦ Select the most promising models◦ Test and evaluate models◦ Spread successful models◦ Share info at innovation.cms.gov/initiatives
CMS – CMM Innovation
Sampling of initiatives◦ ACO◦ Bundled payments◦ Comprehensive Primary Care Initiatives◦ Financial Alignment Initiative◦ FQHC Advanced Primary Practice Demonstration◦ Graduate Nurse Education Demonstration◦ Health Care Innovation Awards◦ Independence at Home Demonstration◦ Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility
Residents◦ Innovation Advisors Program◦ Medicaid Emergency Psychiatric Demonstration◦ Medicaid Incentives for the Prevention of Chronic Diseases◦ Partnership for Patients◦ State Demonstrations to Integrate Care for Dual Eligibles◦ Strong Start for Mothers and Newborns
CMS- CMMI
John Holahan, PhD, Director of the Health Policy Research Center at the Urban Institute said, “Price is what you pay. Benefit is what you get. Value is the relationship between the two.”
ACOs are part of a wider trend to coordinated and integrated care, population health, value-based focus, provider responsibilities for dollars, quality and outcomes
Value-Based Purchasing
Formal provider organizations that take responsibility for care of a defined group, with care evaluated on quality metrics
Pioneer Model, Advanced Payment, Medicare Shared Savings Program
Patient centered care, coordination of care, performance incentives based on benchmarks
December 2013- 360 ACOs caring for 5.3million beneficiaries
Medicare Accountable Care Organizations
Legal entity Responsible for Parts A and B of Medicare ACOs -providers jointly accountable for the health of
patients -financial incentives to cooperate and save money; trying to reduce fragmentation
Still Fee for Service, but eligible for shared savings & in some cases risk of loss (MSR & MLR benchmarks established)
Shared savings individualized based on size of population & other variables, but generally between 2 – 3.9%
Use EHR, care coordination, prevention, patient engagement & outcomes focus to reduce costs and improve care
Medicare ACOs – Key Features
Evaluated on 33 quality measures Providers choose at-risk or no-risk Must serve at least 5,000 Medicare fee-for-
service patients, & participate for three years Must have governing body representing ACO
providers, suppliers & beneficiaries & which can hire/ fire executive
Primary care physicians are required to belong exclusively to one ACO, but other provider types can belong to multiple ACOs
Medicare ACOs – Key Features
Evidence-based medicine, EHR, patient engagement, quality measures, cost, care coordination are required components
Providers who are participating in another shared savings program or demonstration under fee-for-service Medicare are not eligible to participate in shares savings ACO
With a patient’s permission, ACOs may request beneficiary claims information from CMS
Medicare ACOs - Key Features
ACO professionals in group practice arrangements
Networks of individual practices of ACO professionals
Partnerships or joint ventures between hospitals and ACO professionals
Hospitals employing ACO professionals Other Medicare providers and suppliers Critical access hospitals, FQHCs, rural
health clinics can independently participate in Shared Savings Program
Medicare ACOs can include:
Fee for service Medicare patients who see ACO providers maintain all Medicare rights, including right to choose any doctors and providers that accept Medicare.
Patient can decline to have data shared within the ACO
Key difference from HMO – ACO patients are not required to stay in the network; trying to avoid the consumer backlash of the 1990s
ACOs from a patient perspective
Leavitt – new paradigm Measured outcomes of AC – experience of care;
population health; reduce cost of health care Process-level care management – oversee
provision of clinical care; infrastructure to coordinate care across continuum; use IT to manage population health
Aligned financial structures – bear financial risk for measured health of population; align financial & professional incentives for high quality health outcomes
Leavitt
ACO- managed care 2.0?
ACOs cover people in all 50 states In majority of states penetration is 1% - 10% Oregon is at 25% - Medicaid Coordinated
Care Organizations More than half of ACOs are physician-led
serving fewer than 10,000 beneficiaries Growth in number of ACOs & covered lives
slowed in 2013, likely because:◦ Tapped out market for trailblazers◦ No proven model to follow◦ Payer delays
◦ Leavitt
Growth of ACOs
Pioneer model – early mixed results; of 32, 9 opted out in July 2013
NAACOS survey – need average of $4m of start-up capital; biggest problem areas – CMS data, IT and data analysis issues, quality reporting
Early results MSSP ACOs -5.8% lower costs Still early to evaluate – working on systems,
alignment, IT General consensus that ACOs or similar
arrangements are viable
2013 Updates
Medicare ACOs about 52% of ACOs (8/13) Commercial ACOs – insurers, health
systems, provider groups not serving Medicare; set own quality metrics
Potential conflicting intersection – high deductible plans and commercial ACOs
Medicaid ACOs – Oregon is the leader; four other states are developing Medicaid ACOs; others are in the pipeline
Other ACOs
ACO /Provider partnership to provide services to entire population
ACO /Provider partnership to address specific concerns or cost drivers (such as ER utilization, drug adherence, readmissions)
ACO /Provider partnership to treat specific members (such as home health monitoring for people with diabetes)
Non-ACO relationships with health systems or others- readmissions; chronic disease mgt; population health
Possible scenarios for aging services
Healthy behaviors, primary & secondary prevention◦ Wellness programs, chronic disease management, evidence-based
programs, monitoring & assistive technology, consumer incentives Right treatment at the right time in the right setting
◦ Effective evidence-based clinical interventions in the least restrictive/ expensive/ disruptive setting; reduced hospitalizations & readmissions
Healthcare delivery capacity – acuity; specialized care Care coordination
◦ Care management, reduced redundancy, good transitions, EMR, behavioral health, medical home
Data tracking and analysis; IT and analysis investments Cost effectiveness and cost containment
◦ Reduced FFS, benchmark costs, provider financial risk assumption, aligned incentives, connect cost-quality-outcomes
Big themes aging service providers should address and measure:
General: Staffing – turnover, agency use, interpreter
service, primary care RN/LPN onsite System continuity – offer group’s preferred
providers to patients at discharge Quality improvement – collaborative QI
work, warm hand-offs, outcomes tracking, regular joint meetings
Articulated expectations for skilled nursing facilities (Massachusetts Pioneer ACOs)
Pre-admission Screening/admission – decision in 2 hours,
late evening & weekend admissions, direct admits from ER/home/clinician office
Medical coverage – assign patient to group’s attending physician
Care transition – develop a process to receive a “warm hand-off”
Articulated expectations for skilled nursing facilities
During stay Facility environment – meds & DME
available on patient arrival; work space & printer/internet for MDs & APCs; wireless internet for patients
Care systems – shared protocols/tools; mental health coverage; palliative care; stat radiology & lab in 4 hours; stat prescriptions in 6 hours; therapies available 7 days/wk; assessments done quickly
Articulated expectations for skilled nursing facilities
During stay Care Coordination/ Planning – notice to all
parties 48 hrs in advance; meeting within 3 days; clearly articulated discharge plan; consistent interdisciplinary meetings
Extensive facility case manager responsibilities including discharge planning, coordinating with the Group’s care managers
One point person for rehab and clinical updates
Articulated expectations for skilled nursing facilities
Discharge and post-discharge Medication reconciliation and education Advance directive documentation Communication of discharge paperwork to
the Group Standard discharge planning checklist Selection of transfer facility – back to
original acute care facility unless contra-indicated
Articulated expectations for skilled nursing facilities
Reporting expectations Bed screen outcomes INTERACT or other QI Summary Clinical program specialties Patient satisfaction results Staffing Survey and deficiency/ Joint Commission
results QI process measures as established by Group Functional improvement scores
Articulated expectations for skilled nursing facilities
Evidence-based clinical pathways used by ACO
Data sharing with ACO Drug utilization management Follow patient through multiple levels of care Specialized care transitions programs Health care capacity in housing settings Member health monitoring & risk
identification Preventive & routine care in low cost settings Population health for CCRCs
Implications and Opportunities for Aging Services Providers
Opportunities for ALL settings and levels of care Support, encourage, develop mechanisms to share
learning from early adopters Blinded (or not) benchmarking studies Grant funded demonstration projects Library of evidence-based interventions Academic partnerships for applied research Develop “mystery shopper”, peer review, etc. Promulgate approaches: Interact; Collage; locally
developed Tele-health programs Programs for physicians, nurse practitioners, PAs Develop preferred relationships with firms that can assist
Opportunities
Hospice of Michigan signed a three-year contract with the Detroit Medical Center ACO to use the hospice provider's product known as @HOMe support, an advanced illness-management service the company developed 10 years ago. As part of the agreement, Hospice of Michigan will provide at-home care services for nearly 200 patients and hopes to add another 200 patients by year's end. The @HOMe resource includes 24/7 telesupport services; home services; emergency room and hospital transition coaches; and outcomes analytics and predictive modeling. (2012)
ACOs and Hospice/ Home Health
AL beginning to contract with ACOs for rehab
Example – providers in NJ developing a rehab unit, hiring sub-acute nurses, investing in EHR, tracking readmissions, partnering with home health and therapy through hospital or other companies
Also positioning for other pilots & readmission prevention for the 3 conditions
States are liberalizing AL regulations to allow for higher acuity
ACOs and Assisted Living
1. Become masters of Medicare system2. Understand your hospital CEO’s world3. Understand impact on your physicians4. Align your medical director leadership for the future5. Know impact on discharge planners (accountability
for readmissions?)6. Your competitors are now your partners7. Take care of sick people8. Assess your clinical prowess & make changes9. Monitor your performance & share results10. Educate your direct customers
Roebuck, Health Dimensions Group
10 Steps to Success in ACO World
Increase skills in population management – wellness, chronic disease management
Know your costs sliced by many variables Interoperable electronic health records Measure, measure, measure and analyze Use evidence-based approaches; tune up
clinical care; care coordination, transitions Pre-acute as well as post-acute Relationships – health systems, physicians,
ACOs… Plan for continuous change
Steps to take:
Leavitt Partners Center for Accountable Care Intelligence – www.leavittpartners.com
National Association of ACOs – www.naacos.com
L & M Policy Research – www.lmpolicyresearch.com
Becker’s Hospital Review (free e-letter) www.beckershospitalreview.com
CMS and CMMI websites www.cms.gov and www.innovations.cms.gov
Resources
Maple Knoll Village and
The University of CincinnatiIntraprofessional Innovation Smart House
Presented By:
Ken Huff of Maple Knoll Communities &
Chris Edwards of The University of
Cincinnati College of Nursing
Maple Knoll Village
• Continuing Care Retirement Community (CCRC)
• 143 Independent Living Villas• 125 Independent Living Apartments• 62 Assisted Living Apartments• 156 Nursing Beds
Maple Knoll Village:
A cutting edge leader of technology in Senior Care
WMKV 89.3 and 89.9FM
A leading resource for older adults•Broadcast from the halls of Maple Knoll Village and one of the few stations in the country owned by a CCRC
• A 410 watt station with local broadcast for nostalgia including music, classic radio comedy and drama, Good Morning Local News broadcasting from Channel 12 and information programs.
•The station is also broadcast worldwide from their website at www.wmkvfm.org.
The University of Cincinnati
Intraprofessional Innovation Smart House
Maple Knoll Village: Safety and Wireless Connect
•Wi-fi is a critical part of Maple Knoll’s mission to offer residents the safest and most comfortable environment
•In 2008 Maple Knoll installed Healthsense technology throughout its 54 acre campus
•This advanced technology provides care solutions for all levels of care. In conjunction with Maple Knoll’s wi-fi it allows for remote monitoring, improves emergency response, and upgrades older nurse call systems, and also provides wellness management solutions such as ActiveTrax, a wireless wellness system that allows nutrition tracking and creates customized workouts.
The University of Cincinnati
Intraprofessional Innovation Smart House
Maple Knoll Village: Meru Uninterrupted Care Network •This separate and secure network enhances care and safety of residents and improves staff productivity by enabling our IT department to create separate Wi-Fi channel layers. These channels are:
•Life Critical: This allows staff to access medical information and resources for patients wherever and whenever they need it, such as in their home.
•Mission Critical: Supports and strengthens patient location tracking system, IP phone systems and business operations, nurse call systems and electronic medical records.
•Consumer Critical: Offers residents the option to use electronic devices such as tablets and laptops anywhere on campus and still receive wifi signals.
UC was founded in 1819 and offers students a balance of educational excellence and real-world experience. UC is a public research university with an enrollment of more than 42,000 students.
UC CollaborationABOUT THE COLLEGE OF NURSING•Founded in 1889 and became the first college to offer a BSN in 1916.•Rankings
– Best Online Nursing Programs = #37Best Graduate Nursing Programs = #64U.S. News & World Report
– Online Master of Science in Nursing = #6TheBestColleges.org
– Online Master of Science in Nursing = #10BestNursingMasters.com
– Online Nursing Degrees = #18 SuperScholar.org
2013 STUDENT ENROLLMENT
Total Enrollment: 2,641
2013 GRADUATE ENROLLMENT
UC CollaborationCOLLEGE VISION•Through the creative leveraging of technology, UC College of Nursing will lead the transformation of health care in partnership with the people we serve.
UC CollaborationTHE COLLABORATION•Collaborative model of partnership between a CCRC and academic setting•Technological advancements in a patient’s home setting that is preparing the future workforce
UC Collaboration
FLO-BOT•InTouch Remote Presence Robot•Patient assessment•Specialist “treat” from remote locations•Quicker intervention•Fewer trips to ER•Better care at a lower cost
UC CollaborationV-GO•Lower cost•Patient education, monitoring, and remote communication•Student workforce telehealth development
UC Collaboration
HUMAN PATIENT SIMULATORS•High fidelity hands-on experience in low-risk environment
FALL DETECTION SENSORS•Partnered with UC College of Engineering and Applied Science•Predict and prevent falls
UC Collaboration
RESIDENT RESPONSE•“I consider myself tech savvy and I am excited to see how the new technology brought forth by UC will improve our health care.”
-Emmett White, Maple Knoll resident (93 years old)
•“I’ve seen the automobile and aviation come into being and heck, when I was a kid, we used the neighbor’s new phone because our house didn’t have one yet. To see this, to see robots that assist and care for us, it’s truly amazing.”
-Simon Strong, Maple Knoll resident (92 years old)
•“When can I sign up?!”-Don Johnson, Maple Knoll resident (77 years old)
UC Collaboration
WHERE ARE WE GOING?
UC Collaboration
QUESTIONS?
For additional Information:
http://www.necn.com/01/21/14/Telehealth-evolving-doctor-patient-servi/landing.html?blockID=861974&feedID=11110
https://www.dropbox.com/s/6egmwkjctwzjm3r/5872_Nursing_Engineering.mp4?n=172444271
http://www.merunetworks.com/press-releases/2014/maple-knoll-village-retirement-community-selects-meru-uninterrupted-care-network-enhance-care-safety-satisfaction-seniors.html
Contact Information for the Maple Knoll – UC Intraprofessional
Innovation Smart House
Dr. Debi SampselChief Officer of Entrepreneurship and InnovationUniversity of CincinnatiCollege of [email protected]
Kenneth W. HuffExecutive Vice President &Chief Financial Officer 11100 Springfield PikeCincinnati, Ohio [email protected]
Chris Edwards, MS Assistant Dean for Information Technology & Communications Director, Center for Academic Technology and Educational Resources University of Cincinnati College of Nursing 513.558.5233 [email protected]
