IHI Expedition Expedition: Preparing Care Teams for Bundled Payments - PDF document

6/1/2015 June 2, 2015 Begins at 1:00 PM IHI Expedition Expedition: Preparing Care Teams for Bundled Payments Session 6: Case Study - CMS Bundled Payments for Care Improvement Experience Evan Benjamin, MD, FACP Stephanie Calcasola, MSN, RN-BC Jan Mayforth, CPA Douglas Salvador, MD, MPH Molly Bogan, MA 2 Today’s Host Akiera Gilbert Project Office Assistant Institute for Healthcare Improvement 1

6/1/2015 3 Phone Connection (Preferred) To join by phone : 1) Click on the “Participants” and “Chat” icons in the top right hand side of your screen. 2) Click the button on the right hand side of the screen. 3) A pop-up box will appear with the option “I will call in.” Click that option. 4) Please dial the phone number , the event number and your attendee ID to connect correctly . 4 WebEx Quick Reference • Please use chat to “ All Participants ” for questions Raise your hand • For technology issues only, Select Chat recipient please chat to “ Host ” Enter Text 2

6/1/2015 5 Chat Name and the Organization you represent Example: Sam Jones, Midwest Health Please send your message to All Participants 5 6 Expedition Director Molly Bogan, MA Director Institute for Healthcare Improvement 3

6/1/2015 7 Expedition Objectives At the end of this Expedition, participants will be able to: Describe the benefit of transitioning to a value-based purchasing model Understand and apply activity-based cost accounting methodology to at least one care process Demonstrate examples of how to engage stakeholders in building a bundle Describe how to customize care team redesign to deliver optimum care under value-based purchasing 8 Today’s Agenda  Introductions  Session 5 Action Period Assignment Debrief  Case Study: CMS Bundled Payments for Care Improvement Experience  Action Period Assignment  Closing 4

6/1/2015 9 Expedition Sessions Session 1: Volume to Value; Describe the benefit of transitioning Value- Based Purchasing Lead Faculty: Lucy Savitz & Trisha Frick Session 2: Getting Started with Building a Care Bundle Lead Faculty: Trisha Frick & Nick Bassett Session 3: Collecting Data Using Activity-based Costing Lead Faculty: Nick Bassett & Lucy Savitz Session 4: Engaging Stakeholders in Bundle Design Lead Faculty: Trisha Frick & Nick Bassett Session 5: Care Team Redesign Lead Faculty: Trisha Frick & Nick Bassett Session 6: Case Study: CMS Bundled Payments for Care Improvement Experience Lead Faculty: Stephanie Calcasola, Evan Benjamin, Jan Mayfort and Doug Salvador 10 Action Period Assignment Debrief • Build an outline for designing optimum care team end-to-end based on data collected in sessions 1, 2, 3 & 4. Share with others using the chat to All Participants 5

6/1/2015 11 Chat Please chat in one change to your care team that you identified . Please send your message to All Participants 12 Faculty Stephanie Calcasola, Doug Salvador, Jan Mayforth, CPA Evan Benjamin, MSN, RN-BC MD, MPH, Director, Clinical MD, FACP Senior Vice Director of Quality and Vice President of Financial Planning President/Chief Medical Management Medical Affairs and Decision Quality Officer for Baystate Medical Center Baystate Medical Support Springfield, MA Center Baystate Health Baystate Health Springfield, MA Springfield, MA Springfield, MA 6

6/1/2015 Baystate Medical Center’s Experience with Bundled Payments Institute of Healthcare Improvement June 2 nd 2015 Evan Benjamin, MD, FACP Stephanie Calcasola, MSN, RN-BC Jan Mayforth, CPA Douglas Salvador, MD, MPH 7

6/1/2015 Award R e cognitions 2013 Why Do Bundle Payments? 8

6/1/2015 What is a Bundle ● An integrated model to deliver to patients, families, referring physicians and payers substantially improved quality and value for a defined set of health care services by:  Redesign of complex systems to embed evidence based best practices reliably;  everyday patient flow => better outcomes cheaper  Activating patients and families to be engaged in the care processes;  Aligning the interests of the patient, provider, payor and purchaser. 9

6/1/2015 8 Steps to A Bundle 1. Convene the right team 2. Define the episode 3. Develop measures 4. Develop model of care 5. Price the bundle 6. Develop cost reduction opportunities 7. Plan the gain-sharing 8. Develop a continuous process improvement plan Early Work: 2010 Bundle Commercial Pilot Total Hip BMC Bundled Post Implementation Baseline Care Target % Patients readmitted 30 days 0.5 0 0 % Patients discharged to home 68.8 80 88 % Patients with any hospital acquired complication (UTI, HAPU, DVT, Post- 0 0 0 op sepsis, complication of anesthesia, SSI) SCIP Measures (% ACS – all or none) 97.5% 98.5 100 Bundled Cost $24,600 $22,900 Patient Experience 6.78 >8 8.62 HCAHPS* “Overall Rating” Mortality 0 0 0 10

6/1/2015 Current Bundle Initiatives Center for Medicaid & Medicare Innovation (CMMI) Total Joint ● Total Hip & Knee Replacement ( DRGs 469, 470) ● CABG (DRGs 231-236) ● Colorectal – Active July 2015 (DRGs 329, 330 & 331) ● Oncology Care Model – LOI submitted; June 19 th application is due Commercial Health New England ● Obstetrics (Planning Phase) ● Total Joint (Contract finalization) Building the Improvement Infrastructure 11

6/1/2015 Developing Model of Care: Total Hip Care Model Quality Metrics (Sample) Measure Description Data Time Comparison Source Period Standard NQF Discharge Anti- Society of Current STS Mean Lipid Treatment Thoracic available Surgeons quarter (STS) NQF CABG 30-day Premier QA All patients National Mean readmission CMMI Claims isolated CABG SCIP Antibiotic Timing Premier Index CMS Benchmarks QMR surgical episode Post – Acute # of patients Chart Index Internal Provider discharged to Abstraction discharge Pref Providers 12

6/1/2015 Reducing Variation in Care Post-Acute Opportunity DRG 470 -Major Total Joint w/o MCC Time Total ALOS # Cases SNF* National Well Frame Volume (%) Benchmark Managed Benchmark 7/09- 447 3.4 300 (67.1) 47.9% 37.5% 6/10 7/10- 448 3.5 325 (68) 47.9% 37.5% 6/11 7/11- 228 3.4 228 (68) 47.9% 37.5% 6/12 *Does not include LTC and Acute Rehab 13

6/1/2015 Post-Acute Model Redesign Post-Acute Work Summary  BH Strategic Post-Acute Care Committee  Post-Acute Preferred Partnerships  Bundle Navigator Role  Post-Acute Care Oversight Work Group  Transitions in Care/Cross Continuum Collaboration/Readmission Prevention Goals of Strategic Partnerships BH Strategic Post-Acute Care Committee ● Creating the overarching strategy for Post-acute care (PAC) for the BH hospitals ● Providing a single point of decision making around PAC relationships ● Assuring that the strategy is consistent with other BH approaches to PAC ● Creating a Preferred Provider Partnership Network 14

6/1/2015 Post-Acute Preferred Partnerships Quality and Operational Performance Collaborative Partner Facility Profiles ● Facility demographics ● Quality performance (star rating, readmissions, falls, etc.) ● Provider model ● Services (dietitian, rehab, 24/7 access) ● Citizenship ● Patient satisfaction ● Staffing ● Professional Development (certification) ● Environment aesthetics Bundle Navigator Role ● Provide oversight of care coordination and quality monitoring working in partnership with case management, post-acute partnerships. ● Work to develop and ensure streamlined operations, patient satisfaction and care navigation in the episodes of care bundle model. ● Knowledge around national best practice standards, transitions of care, regulatory rules and requirements for post-acute care; skilled in improvement methods and project management; proficient in data management (excel, access, database mining) 15

6/1/2015 Post-Acute Oversight Team ● Established relationships with key leaders in post- acute facilities  Leadership and clinical compliment stakeholders ● Monthly meetings  Education and sharing around bundle, care design, improvement opportunities  Care pathway redesign  Quality outcome and expectations (structure, process and outcome deliverables)  Bundle performance 16

6/1/2015 Transitions in Care ● Risk screening on index admission ● Targeted intervention for high risk patients ● Standardized education tools ● Medication reconciliation ● Follow up phone calls ● Appointments made before discharge ● Active cross continuum teams ● Automated readmission notification EMR ● PAC Performance Improvement Teams Determine Opportunities for Cost Savings ● Savings from 2 sources  Over entire bundle episode – savings would accrue 100% to insurer without gainsharing arrangement • Based on reducing cost through better management of in- hospital services billed outside the DRG (MD consultations), reduced readmissions and reduction in post-acute services (both % of patient receiving service and cost of services received)  Costs incurred while patient is in hospital – savings would accrue to hospital without a gainsharing arrangement ● Use benchmarking to identify areas of opportunity  Premier Bundled Payment Collaborative provided benchmarks on readmissions and post-acute services  Premier Quality Advisor – DRG LOS and Cost benchmarks  Internal data from decision support system – comparisons between providers and service item level detail comparisons. 17