POPULATION HEALTH & DISCHARGES Presented By: Kerry Dunning, MHA, MSH, CPAR, RAC-CT A portion of these materials were produced in partnership with the Iowa Department of Public Health for the Iowa Small Hospital Improvement Program (SHIP) Grant FY 18 Contract #5888SH01 and the Georgia State Office of Rural Health for the Georgia Small Hospital Improvement Grant FY 18. WEBINAR ETIQUETTE •All attendees are in “Listen Only” mode • Questions or comments? - Open “Questions” pane in dashboard - Type in comments or questions - Comments will be monitored - Questions will be addressed at end of the webinar 1
WEBINAR RESOURCES • This webinar will be recorded and emailed to you to share with others on your team, as well as posted on your program dashboard. • Handouts are available for download in the handouts pane and will also be posted to your program dashboard after the webinar. CONTINUING EDUCATION As an IACET Authorized Provider, HomeTown Health, LLC offers CEUs for its programs that qualify under the ANSI/IACET Standard. HomeTown Health, LLC is authorized by IACET to offer 0.1 CEUs for this program. In order to obtain these units, you must: • Attend webinar/view recording in its entirety within 30 days • Pass online quiz with 80% or better. • Complete webinar evaluation. Following this webinar, all attendees who have viewed the recording in its entirety will receive an email with a link to the quiz and evaluation. Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs. 2
CONTINUING EDUCATION HTHU provides over 300 courses online, over 100 Webinars a year, and various live training conference and workshops. Accredited Education from the International Association for Continuing Education & Training (IACET). (Who accepts the IACET CEU? Full list at www.iacet.org) • American Association of Respiratory Therapy • National Board for Certification in Occupational Therapy, • American Board of Medical Microbiology Inc. (NBCOT) • American Society for Clinical Laboratory Science • National Council for Therapeutic Recreation Certification • American Society for Quality • National Registry of Emergency Medical Technology • American Speech-Language-Hearing Association (EMT) • Board of Certified Safety Professionals • National Registry of Microbiologists • • The Child Care Development Associate National National Society of Professional Engineers Credentialing Program • Society for Human Resources Management • Clinician’s View (Occupational, Speech, and Physical • State of Georgia, FL and Iowa Board of Professional Therapy) Engineers • Federal Emergency Management Agency • The American Association of Integrative Medicine • • Georgia, Massachusetts and Ohio Board of Nursing The American College of Forensic Examiners Institute • Georgia Professional Standards Commission • The American Council on Pharmaceutical Education • Human Resources Certification Institute (for their • The American Psychotherapy Association Professional in Human Resource Designation) • The International College of The Behavioral Sciences • National Association of Rehabilitation Professionals in • The National Board for the Accreditation of Occupational the Private Sector Therapy (NBCOT) • National Association of Social Workers ACTION ITEM: GROUP PARTICIPATION Are you on this webinar with a group? If so, please enter: first/last names & email addresses in the question pane. 3
AGENDA Welc lcome, me, Introduc oductio tions s & Program ogram Stephan hanie ie Love – HomeT meTown wn Health lth Goals als Educatio ation/T /Traini aining: Populati lation on Kerry Dunnin ing – Kerry Dunning, ing, LLC Health lth & Dischar scharges es Upcomin Up oming Events ts & Resou sources es Stephan hanie ie Love – HomeT meTown wn Health lth Trainer Biography Kerry Dunning, MHA, MSH,CPAR, RAC-CT and Series Trainer Kerry Dunning has 25 years experience in health care consulting and over 30 years in the industry. She specializes in the post-acute market working with hospital based skilled nursing and swing bed programs, critical access hospitals, freestanding skilled facilities, inpatient/outpatient rehab programs, inner city teaching hospitals and rural health care systems. From the beginning of her career, Kerry has been involved in cutting edge projects – working with Yale-New Haven/Bridgeport Hospital and CMS on ED direct admits to skilled nursing (1989-91); on a team with Tulane and the World Health Organization to open the first nursing home in Russia (1997-99); as part of a start-up therapy company (1989-1993) providing services in skilled nursing with a goal of returning residents to home; providing guidance to a team from Shandong University (China) on inpatient rehabilitation services (2006-2009); and for many years providing bed need analysis, market analysis and copacetic service line development for rural healthcare and multi-faceted urban systems. Her most recent planning project analyzes the need for long term care, skilled nursing, assisted living, memory care and swing beds in 2025 and 2035 for a hospital systems. She is currently working with the Illinois Critical Access Hospital Network (ICAHN) and others to develop quality measures for CAH swing beds. Kerry has provided webinars and workshops for HomeTown Health and ICAHN for over 15 years, worked with other state associations, as an instructor at the University of North Florida, and currently is the swing bed trainer for rural health care systems and state agencies. 4
Disclosure of Proprietary Interest Kerry Dunning, LLC does not have any proprietary interest in any product, instrument, device, service, or material discussed during this learning event. The education offered by Kerry Dunning in this program is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant in Iowa, Georgia and Florida. Care Management Series Program Goals The goal of the Population Health Program is to provide training, resources and support on rural population health across the hospital team, and to promote collaboration through the gathering and sharing of best practices and case studies of successful population health initiatives and innovations in rural hospitals across six primary population health focus areas. The purpose of the Quarterly Care Management Webinars to provide training, education, and resources to promote care integration and coordination (specifically during discharges, medical care transitions, and medication reconciliation) that facilitate patient- centered care, improved patient experience, improved clinical outcomes, compliance, and efficient resource use. 5
POPULATION HEALTH & DISCHARGES Presented By: Kerry Dunning, MHA, MSH, CPAR, RAC-CT LEARNING OUTCOMES DEFINE RECALL discharge related the importance of guideline terminology discharges to the patient such as transition experience. planning and community care transitions. COMPARE DESCRIBE the focus of discharges from a • discharge planning as a traditional discharge to multiple continuous process rather than types of patient care settings that an event. may be involved at various points • the integration of caregivers, in the treatment of a given patient. patients and patient. representatives 6
What t you ou to told us: us: Dis Discharge Pla Plannin ing Hospital case manager is ‘on call’ for after - hours discharges and difficult patient care situations. Hospital has a discharge call-back program and includes the following, but not limited to: Emergency room visits, D/C from nursing floors, and Outpatient visits. Nursing staff utilizes a discharge assessment tool to determine patient readiness for discharge. Discharge program includes making appointments for follow-up visit with medical providers and/or therapy services as needed. Population Health Challenges Options • Workforce in silos – clinical • Networks & Alliances and financial • Data: patient by diagnosis; • Lack of patient data trends return to hospital patients; provided to Case Managers cost per stay/ episode • Traditional physician training • Amass clinical talent • Industry in transition from • Focus on quality with shared fee-for-service to quality and savings performance reimbursement • Defining population health • Regulations stifling innovation across the system(s) • Federal, state, reimbursement • Changing regulations with changes, etc. outcomes 7
Move from payor-led Care Management to Population Health Management • Must have data specific to: • Current Patient Status Resources to help • Patient chronic and newly diagnoses diagnoses patients stay “healthy” • Patient outcomes and/or • Network of community resources Give patients the • Value-based care resources they need • Hospital readmissions Tri riple le Aim The role between population health and discharge planning/ outcomes/care transitions: • Three components to the Triple Aim: • Improve the experience of care • Improve the health of populations • Reduce the per capita costs of healthcare Performance Improvement • Improving measurement and analytics • Identifying, deploying and monitoring the effectiveness of quality improvements • Using a data-driven approach to implementing evidence-based best practices 8
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