Flat Is the New Up
10/22/13
Flat is the New Up—How to Deliver Value
With Less and Improve PACE Quality in an
Era of Constrained Payment
y
NPA Annual Meeting, Miami, Florida
October 23, 2013
Tom Stitt, CPA, CHFP, VP, Financial Analysis & Reimbursement, HDG
Anne Lewis, MA, Manager, PACE Advisory Services, HDG
Dan Drake, MSA, RN, NHA, Chief Executive Officer, LIFE UPENN
The Future of PACE—Dramatically
Different
1
Managed
g
Care
Health
Care
Reform
Market
Dynamics
Result in increasing pressure to consider a new operating framework
© HDG 2013
1
Flat Is the New Up
10/22/13
Is Flat Really the New Up?
2
When you set the bar too low,
you may get burned
© HDG 2013
Raising the Bar—Openness to Change
3
Change Happens
Anticipate
A
Ch
Change
Monitor Change

Enjoy
j y Change
g
Be Ready to Change Quickly and
Enjoy It Again
© HDG 2013
2
Flat Is the New Up
10/22/13
Resistance to Change Manifests In a
Variety of Ways
4
Attitude/Belief
Expression
Denial
“Things aren’t so bad, we do important work, we will just keep
doing what we do well and everything will be all right”
Entitlement
“Our program is so good, we DESERVE a higher rate and I won’t
give up until I get it!”
Addiction to status
quo
“But we have always done it that way”
Limited resources
“I would be happy to monitor utilization; however, there is just one
of me and I have more important things to do”
Competing interests
“If I really let anyone know how bad things are, I won’t get my
bonus”
Regulatory constraints
“CMS/SAA will not let us do that”
PACE organizations must look beyond day-to-day operations by developing and implementing
changes that take the organization to the next level of performance and success
© HDG 2013
Today’s Focus
5

PACE organizations are being forced to
take a critical look at their
organizational health and performance
Today we will show how PACE
organizations can transform operations
and raise the performance bar through
financial and operational assessment
© HDG 2013
3
Flat Is the New Up
10/22/13
Session Topics
6
Economic Challenges
Financial Assessment
Operational
p
Assessment
Case Study: LIFE UPENN
© HDG 2013
7
Economic Challenges
4
Flat Is the New Up
10/22/13
Economic Challenges Facing PACE Programs
8

PACE programs are fiscally
challenged like never before
The days of 4%–5% annual rate
increases are history
Ability to adapt to economic
environment is crucial
Cost management and revenue
optimization have become just as
important as enrollment growth
© HDG 2013
Threats To Operating Margins
9

Capitation rate freezes or reductions
Medicare
State
sequestration
budget crisis
Changes
to risk adjustment methodology

Competition for enrollment

O h d costs
Overhead

Salary and benefit cost structures
© HDG 2013
5
Flat Is the New Up
10/22/13
Expenses Growing Faster Than Revenues
10
EXPENSES
REVENUES
It’s critically important
mportant to avoid common
PACE organizational pitfalls
© HDG 2013
Common PACE Organizational Pitfalls
11

Lack of proper program oversight
Board
and finance committee members lack knowledge
of PACE
Financial

statements are not reviewed closely
Lack of formal and effective budget process
Departmental
managers not involved in process and not
held accountable for results
Inaccurate
Lack
and unreliable budget assumptions
of sufficient departmental detail
© HDG 2013
6
Flat Is the New Up
10/22/13
Common PACE Organizational Pitfalls
(continued)
12

Unreliable financial reporting
Sloppy
financial statements
Inaccurate
Lack
No

expense categorization
of key statistical data
supporting schedules or variance analysis
I
Incomplete
l t and
d unreliable
li bl data
d t capture
t
Utilization
Lack
data not collected on timely basis
of PACE-friendly information systems
© HDG 2013
Common PACE Organizational Pitfalls
(continued)
13

Lack of consistent monthly financial review process
Variance
analysis
Departmental

accountability
Poor service utilization management
Over-utilization
Providing
P idi
of costly services
higher
hi h llevell off care than
h needed
d d
© HDG 2013
7
Flat Is the New Up
10/22/13
Common PACE Organizational Pitfalls
(continued)
14

Unfavorable contracts
Negotiating
unfavorable rates for services and contract
labor

Inefficient operations
Overstaffed
Lack
areas
of departmental accountability
© HDG 2013
Common Pitfalls: Summary
15

The larger the program
gets the more important it is
gets,
to avoid these pitfalls
The result is usually poor
financial performance…and
lots of stress!
© HDG 2013
8
Flat Is the New Up
10/22/13
What Can You Do?
16
Perform a complete organizational assessment:

Financial assessment

Leadership assessment

Operational assessment
© HDG 2013
17
Financial Assessment
Financial Performance Drivers
Actual to Budget Comparison
Benchmark Analysis
Finance Department Activities
Data Capture
9
Flat Is the New Up
10/22/13
Financial Assessment: Key Components
18

What are the key financial performance
drivers?

How did we compare to budget?

How do we compare to our peers?

What caused variances?

Is
budgeting
financial
I our b
d ti and
d fi
i l reporting
ti
reliable?
Are we capturing the right data?
© HDG 2013
Financial Performance Drivers
19
Revenue
•
•
•
•
Enrollment
Capitation Rates
Risk Scores/Opportunities
Revenue Management Controls
Expense
•
•
•
•
•
Staffing and Benefits
Service Utilization
Contracted Rates
Administrative Costs
Facility Costs
© HDG 2013
10
Flat Is the New Up
10/22/13
Revenue Drivers
20
Rate
A
Accounts
Receivable
Medicaid
Medicare
ESRD
Risk scores
• Government
payments
• Private pay
• Cost share
for SNF
participants
Volume
• Enrollment
• Growth rate
• Payor mix:
y;
MA only;
dual eligible
•
•
•
•
© HDG 2013
Expense Categorical Buckets
21
Medical
Services
•
•
•
•
•
•
•
•
•
•
•
•
Ambulance
Audiology
Dentistry
Dialysis
DME
Drugs
Emergency Room
Home Health
IP (Acute, SNF)
Laboratory
Nutrition
OP Specialists
Admin
Facility
• Accounting/Finance
• Consulting
• Corporate
Overhead
• HR
• Insurance
• Interest
• IT
• Legal
• Management Team
• Marketing
• Memberships
• Quality
• TPA
•
•
•
•
•
•
Depreciation
Housekeeping
Lease/Mortgage
Maintenance
Transportation
Utilities
IDT
Staffing
•
•
•
•
Salaries
Benefits
Education
Travel
© HDG 2013
11
Flat Is the New Up
10/22/13
Key Utilization Statistics
22

Center attendance

S i l workk encounters
Social
t

Therapy encounters

Home care visits (personal care and skilled)

Primary care encounters

Specialist visits

Inpatient admissions/days

ER visits

Nursing home days
© HDG 2013
Actual to Budget Comparison
23
Identify material variances
Drill down to investigate reasons

Variances usually due to:
Staffing
Enrollment
Service
Capitation
rates
Utilization
Contracted
rates
23
© HDG 2013
12
Flat Is the New Up
10/22/13
Budget Comparison Example
24
July to October 2012
Category
Budget
Actual
FY 2013
Budget
Actual
Census
451
443
457
438
MA Cap
$3,716
$3,699
$3,714
$3,695
MC Cap
$3,549
$3,592
$3,555
$3,830
Revenue
$13,062,000
$12,829,000
$39,915,000
$39,340,000
Expense
$13,278,000
$13,359,000
$40,092,000
$39,382,000
($216,000)
($530,000)
($177,000)
($42,000)
(1.7%)
(4.2%)
(0.4%)
(0.1%)
Net Revenue (Expense)
Operating Margin
© HDG 2013
Budget Comparison Example: Next Steps
25

Perform departmental comparison of actual to budget
Actual
dollar amounts
PMPM
amounts

Identify material variances at departmental level

Drill down to determine key performance drivers
Enrollment
Utilization
Staffing
Rate
© HDG 2013
13
Flat Is the New Up
10/22/13
Benchmark Analysis
26

Compare actual results to national and
t t averages
state
Review expenses and utilization statistics
Identify areas of strength and potential
opportunity
Act quickly to investigate and resolve
material variances
© HDG 2013
Benchmark Analysis Review Process
27
Analyze financial and
other performancerelated data
Conduct interviews and
meetings to discuss data
issues and analysis
results
Compare data to
national and state
benchmark data for all
programs and a subset
with programs of similar
size
P f
Perform
operational
i l
assessment to analyze
areas of variance and
determine other areas
of opportunity
Convert data to format
allowing consistent
comparison to industry
benchmark data
© HDG 2013
14
Flat Is the New Up
10/22/13
Benchmark Analysis: Challenges
28

Unreliable financial reporting
Inaccurate
general ledger assignments
Chart
of accounts not consistent with PACE industry
standards
Sufficient

expense detail is not available
Incomplete and unreliable data capture
No
centralized data repository
Manual
Key
recordkeeping
utilization data elements not tracked
© HDG 2013
Benchmark Comparison:
PMPM Expenses
29
FY 2013
ABC Category PACE Transportation $ 350
Meals $ 150
Social Services
$ 100
Therapy
$ 100
Adult Day Center
$ 450
Home Care
$ 1,150
Pharmacy
$ 600
Primary Care
$ 600
Specialist/Diagnostics $ 400
Nursing Home
$ 1,100
Hospital $ 700
Housing $ ‐
Administrative
$ 1,200
Insurance $ ‐
Facility
$ 350
DME/Supplies
$ 200
Depreciation/Interest $ 50
Total
$ 7,500
PACE PMPM EXPENSE ‐ BENCHMARK COMPARISON
National Benchmark
State ‐ Similar Size
Variance
Median Variance % Median Variance Variance
$ 400 $ 50
13%
$ 450 $ 100
22%
$ 100 $ (50)
‐50%
$ 150 $ ‐
0%
$ 100 $ ‐
0%
$ 150 $ 50
33%
$ 200 $ 100
50%
$ 200 $ 100
50%
$ 350 $ (100)
‐29%
$ 700 $ 250
36%
$ 500 $ (650) ‐130%
$ 900 $ (250) ‐28%
$ 550 $ (50)
‐9%
$ 500 $ (100) ‐20%
$ 500 $ (100)
‐20%
$ 500 $ (100) ‐20%
$ 350 $ (50)
‐14%
$ 250 $ (150) ‐60%
$ 600 $ (500)
‐83%
$ 850 $ (250) ‐29%
$ 550 $ (150)
‐27%
$ 500 $ (200) ‐40%
$ 100 $ 100
100%
$ ‐
$ ‐
0%
$ 700 $ (500)
‐71%
$ 900 $ (300) ‐33%
$ 50 $ 50
100%
$ 50 $ 50 100%
$ 150 $ (200) ‐133%
$ 300 $ (50) ‐17%
$ 100 $ (100) ‐100%
$ 100 $ (100) ‐100%
$ 50 $ ‐
0%
$ 50 $ ‐
0%
$ 5,350 $ (2,150)
‐40%
$ 6,550 $ (950) ‐15%
State ‐ All
Variance
Median Variance % $ 500 $ 150
30%
$ 150 $ ‐
0%
$ 150 $ 50
33%
$ 150 $ 50
33%
$ 600 $ 150
25%
$ 450 $ (700) ‐156%
$ 650 $ 50
8%
$ 400 $ (200) ‐50%
$ 350 $ (50) ‐14%
$ 950 $ (150) ‐16%
$ 450 $ (250) ‐56%
$ 100 $ 100
100%
$ 800 $ (400) ‐50%
$ 50 $ 50
100%
$ 400 $ 50
13%
$ 150 $ (50) ‐33%
$ 100 $ 50
50%
$ 6,400 $ (1,100) ‐17%
Note: Lines shaded in red represent areas of concern
© HDG 2013
15
Flat Is the New Up
10/22/13
Benchmark Comparison:
Administrative Cost
30
Category Salaries Benefits Purchased Services
Other
Total Expense
PMPM Expense
% of Total Admin Exp
p
% of Total Exp
Admin $ 250,000
$ 85,000
$ 35,000
$ 427,400
$ 797,400
$ 450
38%
6%
PACE ‐ ADMINISTRATIVE COST RECONCILIATION
Communi
Corp cations Finance HR IT Marketing Allocation $ ‐
$ 122,000 $ 68,600 $ ‐
$ 68,600 $ ‐
$ ‐
$ 39,200 $ 20,000 $ ‐
$ 20,000 $ ‐
$ ‐
$ 1,000 $ ‐
$ ‐
$ ‐
$ ‐
$ 88,600 $ 15,000 $ ‐
$ 88,600 $ ‐
$ 797,400
$ 88,600 $ 177,200 $ 88,600 $ 88,600 $ 88,600 $ 797,400
$ 50 $ 100 $ 50 $ 50 $ 50 $ 450
4%
8%
4%
4%
4%
38%
1%
1%
1%
1%
1%
6%
Total $ 509,200
$ 164,200
$ 36,000
$ 1,417,000
$ 2,126,400
$ 1,200
100%
16%
© HDG 2013
Benchmark Comparison:
Utilization
31
PACE UTILIZATION STATISTICS ‐ BENCHMARK COMPARISON
FY 2013
National‐Similar Size
State‐Similar Size
Best Practices
ABC Variance
Variance
Variance
Category PACE Median Variance % Mean Variance % Median Variance % Center Attendance Per Member Per Week 2.50
2.25
‐0.25
‐11%
2.00
‐0.50
‐25%
2.25
‐0.25
‐11%
Transportation Trips PMPM 20.00
20.00
0.00
0%
20.00
0.00
0%
19.00
‐1.00
‐5%
Social Work Encounters PMPM
1.50
2.00
0.50
25%
1.00
‐0.50
‐50%
2.00
0.50
25%
Therapy Encounters PMPM
1.50
3.50
2.00
57%
1.50
0.00
0%
3.50
2.00
57%
Skilled Home Care Visits PMPM
1.50
1.00
‐0.50
‐50%
1.00
‐0.50
‐50%
1.00
‐0.50
‐50%
No Data Available
Personal Care Hours PMPM
18.50
11.00
‐7.50
‐68%
12.00
‐6.50
‐54%
Primary Care Encounters PMPM
3.00
0.75
‐2.25
‐300%
1.25
‐1.75
‐140%
1.00
‐2.00
‐200%
Specialist Visits PMPM
1.25
0.90
‐0.35
‐39%
1.10
‐0.15
‐14%
1.00
‐0.25
‐25%
ER Visits Per Member Per Year
0.40
0.50
0.10
20%
0.60
0.20
33%
0.45
0.05
11%
ST & LT NF Days Per 1000 Members 50,000 25,000 ‐25,000 ‐100%
50,000
0
0%
25,000 ‐25,000
‐100%
ST & LT NF Days as Percent of Cap Days ST & LT NF Days as Percent of Cap Days
15.0%
10.0%
‐5.0%
5.0%
‐50%
50%
15.0%
0.0%
0%
10.0%
‐5.0%
5.0%
‐50%
50%
ST NF Days Per 1000 Members
5,000
5,000
0
0%
10,000
5,000
50%
5,000
0
0%
ST NF Days as Percent of Cap Days 2.0%
1.5%
‐0.5%
‐33%
2.5%
0.5%
20%
1.0%
‐1.0%
‐100%
LT NF Days Per 1000 Members
50,000 25,000 ‐25,000 ‐100%
40,000 ‐10,000
‐25%
20,000 ‐30,000
‐150%
LT NF Days as Percent of Cap Days
15.0%
5.0%
‐10.0%
‐200%
10.0%
‐5.0%
‐50%
5.0%
‐10.0%
‐200%
0.80
0.60
‐0.20
‐33%
0.75
‐0.05
‐7%
0.50
‐0.30
‐60%
Acute Admissions Per Member Per Year Acute Days Per 1000 Members 4,000
3,500
‐500
‐14%
5,000
1,000
20%
2,500
‐1,500
‐60%
Note: Lines shaded in red represent areas of concern
© HDG 2013
16
Flat Is the New Up
10/22/13
Benchmark Comparison:
Staffing
32

Compare staffing data to best practices benchmarks
Staffing analysis, along with the expense and
utilization analyses, used to supplement the
operational assessment
© HDG 2013
Finance Department Activities
33
Perform assessment of the finance department to determine:

I the
Is
h d
department providing
idi reliable
li bl and
d accurate financial
fi
i l data?
d ?
Is there a formal budget process that involves all departmental
directors?

Is financial reporting reliable and accurate?

Is there a formal monthly financial review process in place?

Are departmental directors provided financial tools needed to
monitor performance?
Are departmental directors being held accountable for their
departmental budget?
Is finance committee providing sufficient oversight?
© HDG 2013
17
Flat Is the New Up
10/22/13
Data Capture
34
Reliable and accurate data is critical for financial reporting and
performance measurement:

Is there a centralized data repository?
Is utilization data accurate and
complete?
Are the right systems in place to
capture the right data?
Is
I program participating
ii i
in DataPACE2?
Is TPA providing reliable reports
for performance measurement and
IBNR calculations?
© HDG 2013
35
Operational
Assessment
p
18
Flat Is the New Up
10/22/13
Operational Assessment:
It Takes Courage to Face Facts
36

Definition: A detailed review of all
or selected aspects of business
functioning
Purpose: To analyze areas of
performance and identify strength
and opportunities for improvement
How: Can be conducted internally
or by an external party
Where: Is preferably conducted on
site at the business
© HDG 2013
Elements of an Effective Operational
Analysis
37
Conduct Data Assessment
Identify Priorities
Examine Causative Factors
Formulate Findings and Conclusions
Develop Specific and Actionable Tactics for
Improvement
© HDG 2013
19
Flat Is the New Up
10/22/13
Setting the Stage: Data Assessment
38
Review outside
benchmarks to
determine area of
variances

Expense
Utilization
Staffing
g levels

Transportation

Meals

Social Services

Rehab Therapy

Hospital
Supportive
H i
Housing

Administrative

Insurance

Facility
Home Care

DME/Supplies

Pharmacy

Pi
Primary
C
Care

Adult Day
Center
Specialist/
Diagnostics

Depreciation/
Interest
Utilization
Review and
M
Management
t
Data Capture
Budget and
Financial
Reporting

Management

IDT
Staffing/
Contract Labor
Nursing Home
Resist the impulse to accept data at face value and act prematurely;
carefully consider all possible explanations for identified variances
© HDG 2013
Identify Priorities
39

Operational assessment can be a time-consuming
venture therefore,
venture;
therefore it is important to prioritize areas
for further investigation
Priority areas include:
Combined
significant expense and utilization outliers
Significant
g
expense
p
outliers
Significant
utilization outliers
Significant
staffing outliers
© HDG 2013
20
Flat Is the New Up
10/22/13
Example: Benchmark Comparison of
Areas of Performance
40
Variation to State Benchmark
Expense Utilization
Adult Day Center
19%
*31%
Supportive Housing
107%
Home Care
800%
27%
NA
Home Care Visits
NA
68%
Home Care Hours
NA
45%
LT NH Days per 1,000
Nursing Home Expense
Significant expense and
utilization variances make
supportive housing priority
area for further investigation
25%
20%
Red shading indicates negative variance
Green shading indicates positive variance
* Center attendance
Assumption: Home care expense and utilization is low and is not being utilized to
support and maintain participant residence in less-expensive housing alternatives
© HDG 2013
Examining Causative Factors
41

Interview staff and leadership involved with the
target issue

Maintain a nonjudgmental attitude

Ask open-ended questions

Drill down for details

Listen for unanticipated information
Observe processes to obtain additional information,
e.g., IDT process
Refine assumptions
© HDG 2013
21
Flat Is the New Up
10/22/13
Example: Interview Findings
42
Interviews with staff revealed the following information
about supportive housing services:

45% of program participants live in supportive housing
IDT prematurely authorizes supportive housing placement
as a way to address concerns about participants who may
be living marginally in the community
Home care is not readily available to maintain
participants in lower levels of care
PACE center is underutilized as a support option for
community-dwelling participants
© HDG 2013
Pulling It All Together:
Formulating Findings and Conclusions
43

Synthesize and analyze information

Develop preliminary findings

Based on interviews and observations, identify:
Strengths
Opportunities
for improvement

Consider inter-relationship of findings

Develop recommendations:

May include several strategies for implementation

Each strategy must include actionable tactics
© HDG 2013
22
Flat Is the New Up
10/22/13
Example: Analyzing Information
44
Variation to State Benchmark
Expense Utilization
Adultlt Day
Ad
D Center
C t
(ADC)
19%
*31%
Supportive
Housing (SH)
107%
800%
Home Care (HC)
27%
NA
Home Care Visits
Home Care Hours
LT Nursing Home
(NH) Days per
1,000
Nursing Home
Expense
NA
NA
68%
45%
25%
20%
Preliminary Finding
ADC is underutilized
Broad Recommendation
Utilize ADC supportt services
Utili
i
to maintain home residence
IDT over-relies on SH without
exhausting other options to avoid
institutional placement
HC is underutilized and may not
be available to maintain
participant home residence
Same
Increase availability of HC to
support participants living in
their homes
Same
Same
Same
Increase oversight of SH
placement
Continue to judiciously utilize
NH utilization is positive and may
SH in lieu of permanent NH
be attributable to SH services
placement
NH rates are high
Consider opportunities to
reduce NH rate if available
© HDG 2013
Example: Analyzing Information (continued)
45
Reduce supportive
li i placements
living
l
Increase day center
attendance
Increase
availability of
home care
Conclusion: Supportive housing expense and utilization can be reduced by
increasing access to home care as well as utilization of PACE center services to
support participants in lower levels of care
© HDG 2013
23
Flat Is the New Up
10/22/13
Example: Key Findings and
Recommendations
46
Reduce Reliance on Supportive Housing
Findings
Summary Tactics
45% of participants
reside in supportive
housing
• Develop and consistently utilize supportive housing placement
guidelines to guide IDT authorization of services
Unavailability of home
care services in adequate
amounts or at required
d /i
days/times
• Expand availability of medically necessary home care services
required to preserve participants in their homes and prevent or
delay supported living placement
• Expand home care service availability to Saturdays & Sundays
Day center services are
not utilized as a way to
support independent
living arrangements
• Prioritize day center attendance with focus on maintaining the
functioning of non-institutional participants as a way to reduce or
delay transfers to higher levels of care
• Create administrative review panel that reviews and approves
all supportive living placements prior to implementation
© HDG 2013
Example: Summary of Financial Impact
47
1
3
5
6
7
9
11
12
14
15
17
18
19
20
21
Recommendation
Impacted Area
Reduce transportation
p
expense
p
& improve
p
efficiencyy
Reprioritize day center attendance
Adjust home care staffing
Restructure primary clinic operations
Adjust primary care staffing to benchmarks
Reduce nursing home utilization to benchmarks
Reduce supportive housing utilization
Reduce interpreter services by 10%
Reduce insurance costs by 10%
Implement DME cost control measures
Actively review and manage service utilization
Improve data capture
Improve budget and financial reporting
Empower center directors
Strengthen interdisciplinary team functioning
Transportation
p
Adult Day Center
Home Care
Primary Care
Primary Care
Nursing Home
Housing
Administrative
Insurance
DME/Supplies
Admin-UR
Admin-IT
Admin-Finance
Various
Various
Total Quantifiable Recommendations
Est. Impact
$500,000
$
,
N/A
$500,000
N/A
$460,000
$200,000
$320,000
$37,000
$30,000
$23,000
N/A
N/A
N/A
N/A
N/A
$2, 070,000
© HDG 2013
24
Flat Is the New Up
10/22/13
Operational Assessment:
Strengths and Weaknesses
48
Strengths

Weaknesses
Availability of comparative
benchmarks:
National
State
Program age
Program size
Objective analysis

Significant benchmark
variation
Reliability and validity of
data reported
Not all programs
participate in DataPACE 2
Subjective analysis
© HDG 2013
Getting Buy-In At All Levels
49

Share positive findings

Be nonjudgmental—the
B
j d
l h
message may be hard to
hear

Governing
Executive
body
leadership
Department
D
Direct
leadership
l d h
care providers
Support
staff
Participants

Acknowledge strengths
and weaknesses of the
process
Be open to audience
critique
If new information is
received,, investigate
g
further
Openly and widely share
findings and present
recommendations
© HDG 2013
25
Flat Is the New Up
10/22/13
Positioning for Successful Performance
Improvement
50
Link performance improvement initiatives to QAPI
work plan
p
Broadly involve key stakeholders in the
improvement process
Prioritize improvement initiatives based on return
on investment—low-hanging fruit first!
Develop actionable tactics to ensure goals are met
Utilize performance dashboard to monitor ongoing
performance
© HDG 2013
Monitoring Performance: Dashboards
51

Provides a quick snapshot of performance
Compares your performance against like
organizations, national norms, or goals
© HDG 2013
26
Flat Is the New Up
10/22/13
Sample Dashboard: Inpatient
52
6,000
Hospital Days/1,000
5 000
5,000
5,053
4,000
3,925
3,000
2,923 3,018
2,000
2,667
1,816
1,000
2,356
1,663
-
FY11 FY11 FY12 FY12 FY12 FY12 FY13 FY13
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Sample PACE
3,925 2,923 3,018 1,816 5,053 2,667 1,663 2,356
National PACE Avg (Full Risk) 3,500 3,500 3,500 3,500 3,500 3,500 3,500 3,500
Sample PACE
National PACE Avg (Full Risk)
Linear (Sample PACE)
© HDG 2013
Sample Dashboard: Long-Term Care
53
SNF % Cap Days By Type
07/11 0.3%
0%
23%
05/110.0%
1%
20%
04/110.0%
2%
21%
03/110.0%
20%
02/11 0.4%
19%
01/110.0%
20%
12/10
2%
24%
06/110.0%
2.1%
4%
4%
3%
2%
19%
11/10 1.1%
2%
18%
10/10 0.5%
18%
09/10 0.9%
17%
3%
1%
08/10 0.5%
18%
07/100.0%
19%
0.0%
5.0%
2%
3%
10.0%
15.0%
20.0%
25.0%
30.0%
Skilled % Cap Days
07/10
0.0%
08/10
0.5%
09/10
0.9%
10/10
0.5%
11/10
1.1%
12/10
2.1%
01/11
0.0%
02/11
0.4%
03/11
0.0%
04/11
0.0%
05/11
0.0%
06/11
0.0%
07/11
0.3%
Custodial % Cap Days
19%
18%
17%
18%
18%
19%
20%
19%
20%
21%
20%
23%
24%
Respite % Cap Days
3%
2%
1%
3%
2%
2%
3%
4%
4%
2%
1%
0%
2%
Skilled % Cap Days
Custodial % Cap Days
Respite % Cap Days
© HDG 2013
27
Flat Is the New Up
10/22/13
Self-Reflection
54

Do I know how my performance
compares?
Do I utilize and share performance
dashboards with the IDT?
Do I have effective internal controls?
Do I have an internal performance
improvement plan that is actively
monitored and refined?
How rapidly does my program respond
to changes?
© HDG 2013
55
CEO, Coca-Cola
© HDG 2013
28
Flat Is the New Up
10/22/13
56
Let us not be content to wait to see what will happen, but
give us the determination to make the right things happen.
Peter Marshall
57
Case Study: LIFE UPENN
29
Flat Is the New Up
10/22/13
Our History
58

LIFE UPENN was founded by University
of Pennsylvania’s
Pennsylvania s School of Nursing in 1998
Only
PACE Program owned and operated by a school
of nursing
Membership of 430 covering 13 zip codes

Since 1998, LIFE has been providing a lifetime plan
for all-inclusive
all inclusive care to help eligible frail,
frail elderly
residents of West Philadelphia
LIFE program promotes independence and the highest
level of functioning while allowing choice and dignity
for our members and their families
© HDG 2013
LIFE UPENN’s Past History
59

Strong census growth; Net 1.5 per month

Strong Medicare reimbursement

Strong Medicaid reimbursement

Positive bottom line with revenue to support
renovations, program growth, and innovative
programs
p
og a s for
o membership
e be s p
© HDG 2013
30
Flat Is the New Up
10/22/13
A New Reality
60

Increased death and disenrollment rate due to
program’ss age
program

5% Medicaid reduction in Pennsylvania

Sequestration (Medicare -2%)

Competition growth of new insurance plans in the
Philadelphia
ade p a marketplace
a e p ace
Reduced financial performance
© HDG 2013
Identifying and Facilitating Change
61
Identify opportunities
Enlist outside consultation
Gather analysis and construct a plan
Implement plan
Conduct ongoing analysis of the
marketplace
© HDG 2013
31
Flat Is the New Up
10/22/13
Opportunities & Implementation
62

Staff according to PACE benchmarks

Conduct focus groups for census building

Restructure financial reporting

Bring subcontracted programs in-house

Change morning meeting from a large group meeting
t smallll di
to
directt tteam meetings
ti
Hold weekly utilization meetings for hospitalization,
SNF, and nursing home members
© HDG 2013
Results
63

Program back to profitability

Hospitalization rate declined

Quality indicators improved due to a more-focused
team approach on a daily basis
Continue to monitor internal and external threats in
the
e PACE
C market
a e
© HDG 2013
32
Flat Is the New Up
10/22/13
64
Questions & Answers
65
© HDG 2013
33
Flat Is the New Up
10/22/13
Contact Information
66
Anne Lewis
Manager, PACE Advisory Services
Health Dimensions Group
406.669.3332
[email protected]
Tom Stitt, CPA, CHFP
VP, Financial Analysis and
Reimbursement
Health Dimensions Group
763 225 8639
763.225.8639
[email protected]
Dan Drake
Chief Executive Officer
LIFE University of Pennsylvania
School of Nursing
215.898.4417
[email protected]
© HDG 2013
34