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