The Evolving Healthcare Arena: Embracing Change Stephen Burns

The Evolving Healthcare Arena: Embracing Change
Stephen Burns, OTR/L and Melissa Tilton, BS, COTA/L, ROH
Introduction
The primary goals of ACOs include improving outcomes and
improving efficiency of services by reducing duplication of services.
OT/OTAs play a vital role in this and are charged with balancing the
delivery of high-quality care, managing reimbursement and
controlling costs. This session will explore one providers’ model to
ensure the goals of the patient and the ACO are both supported
Learning Objectives
1. Identify the legal definition and historical background of Accountable Care
Organizations, as well as the OT Practitioner’s role as a member of the
health care team.
2. Discuss the challenges and benefits encountered in providing care to
patients enrolled in ACOs in SNF settings, as well as observed impacts of
the ACO on the Care Delivery Process.
3. Discuss one company’s model and use of objective measures to address
these challenges, with the goals of improving care, reducing cost and
decreasing re-hospitalizations.
Definition
Accountable Care Organization (ACO): Groups of doctors, hospitals,
and other health care providers, who come together voluntarily to
give coordinated high quality care to the Medicare patients they
serve.
Background
• Coordinated care helps ensure that patients, especially the
chronically ill, get the right care at the right time, with the goal of
avoiding unnecessary and costly duplication of services as well as
preventing medical errors.
• When an ACO succeeds 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.
• It is estimated that as much as 30% of health care costs (over $700
billion per year) could be eliminated without reducing the quality
of care or related outcomes
• The US has the highest number of preventable deaths (over 110
per 100,000) of any industrialized nation.
• “The American healthcare system is a dysfunctional mess.”
(Ezekiel Emanuel, MD, National Institutes of Health)
Current Challenges
Apples to Apples Data Calculations
• Re-hospitalization Rate Calculation Formula
• Risk Adjustment for Acuity
Our Model
Our Outcomes
Triple Aim
• Focus on improving quality, improving the patient experience
and cost effectiveness
Managing Length of Stay to Expectations
• Patient expectations
• Organization expectations (ACO, Physician Group, etc.)
• Clinician expectations
• Current business expectations (census, occupancy, etc.)
Choosing High Quality Post-SNF Providers
• Successful Care Transitions = High Quality Outcomes
• Transparent Post-SNF Relationships for Patient Outcome
Management
• Strategic Alignment with multiple partners
Outcome Management Post Discharge
• Transitions of care/care coordination (vs. silos)
• 30 – 60 – 90 responsibility
• Possible pay for performance incentives (United, Aetna, etc.)
Clinical Impact
• Change in staffing and scheduling
• Ratios of OT/OTA
• Eval response time
• Requirements for structured supervision/collaboration time
• Utilization of objective measures and functional implications
• Your strategy is to be the occupational therapy provider of choice
Universal Goals and Benefits
• Moving towards Population Health Management v. Episodic Care
• Appropriate utilization of resources and technology in appropriate
settings (HIE, EMR, etc.)
• Eliminate redundancies (Labs, Medications, etc.)
• Develop metrics/measures/data
We measure functional outcomes to benchmark performance and
progress of:
• Individual patients
• Rehab departments
• Facilities
• Payor and diagnosis
• Identify opportunities for improvement
Outcome Measures
• The MBI and FIM and the are most widely accepted outcome
measures in physical rehabilitation
• MBI measures the patient's functional ability without distortion
of family and social function
• The values assigned to each item in the MBI are based on the
amount of physical assistance required to perform the task
• Each item is weighted based on impact to burden of care
• Total score is predictive of burden of care and discharge
disposition
• A score of 100 indicates that the patient is independent of
assistance from others in the ADL categories
References