Flat is the New Up—How to Deliver Value
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
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