Empowering $10 per hour lay caregivers to prevent $10,000 hospitalizations Care at HandAndrey Ostrovsky, M.D.CEO, Co-Founderandrey@careathand.com443-857-8199*

Medicare-Medicaid Dual Eligibles are disproportionately high utilizers of acute care hospitals*Care at HandSource: CMS Policy Brief: Dual Eligible Beneficiaries and Potentially Avoidable Hospitalizations. Segal M. 2011. Jencks SF, er al. NEJM 2009; 360 (14):14181428.

Duals are hospitalized twice as often as general Medicare patients Care at Hand

Duals account for a disproportionate share of Medicare and Medicaid spending*Care at HandSource: Jacobson G, Neuman T, & Damico A. Medicares Role for Dual Eligible Beneficiaries. APRIL 2012. Kaiser Foundation. Care at Hand

Duals spending isnt just on hospitalizationsTop PMPM Costs for Duals*Care at HandSource: Milligan C. Innovations in Integrated Care: New Opportunities to Better Serve Dual Eligibles. February 23, 2011. Hilltop Institute. MedicareMedicaid Care at Hand

Acute care: largest contributor to Medicare spendingPost-acute care: fastest growing cost*Care at HandSource: Chandra et al. Large Increases In Spending On Postacute Care. Health Aff). 2013 May; 32(5): 864872.Medicares expenditures on post acute care increased by 100-250% Care at Hand

The biggest opportunity to bend cost curve is improving post-acute care*Care at HandRelative Daily Cost of CarePer Capita Health Care Utilization - FFSacute health declineTime Care at Hand

*Care at HandRelative Daily Cost of CareWhat if we could utilize existing non-clinical home care providers in a clinically meaningful way?Time Care at Hand

Current standard of home careLay Caregiver(Home Care Agency)Care Coordinator(Payer)

Primary Care Provider VisitEmergency Dept/ AdmissionHome Visit byNurseCall into Home by Care Coordinator*(Cost to Payer)Care at Hand(Cost to Payer)(Cost to Payer)(Cost to Payer) Care at Hand

Care at Hand Value PropositionLay CaregiverCompletes Survey(Home Care Agency)Care CoordinatorReceives Alerts(Payer)

Primary Care Provider VisitEmergency Dept/ AdmissionHome Visit byNurseCall into Home by Care Coordinator*(Cost to Payer)Care at Hand(Cost to Payer)(Cost to Payer)(Cost to Payer) Care at Hand

*Fewer Frequent Flyers were readmitted after Care at Hand was introducedCare at Hand42.6% Decrease in 30-day readmissions in addition to CCTP Care at Hand

*Decrease in Frequent Flyer readmissions impacted overall readmission rate for CCTP program at ESMVCare at Hand20.6% Decrease in 30-day readmissions among all CCTP enrollees at ESMV19.1% baseline 30-day readmission rate among 6 participating hospitals prior to CCTP program starting at ESMV Care at HandSource: ESMV CCTP Data 2013.

*Frequent Flyer admission rate cut in half after Care at HandCare at Hand45.9% Decrease in admission rate among frequent flyers in addition to CCTP0.57-0.82 admissions/person-year is the typical range for duals; rates in this pilot are higher because sample population is comprised of frequent flyersSource: Milligan C. Innovations in Integrated Care. 2011. Hilltop Institute. CMS Policy Brief: Dual Eligible Beneficiaries. Segal M. 2011 Care at Hand

*Care manager subjective measure of admission prevention highly correlated with CMS claims dataCare at HandCare managers suspected only 8% more admissions than documented by CMS claims data26 expected admissions after Care at Hand introduced based on pre-intervention admission rate of 4.33 admissions/person-year for 6.0 patient years Care at HandSource: ESMV CCTP Data 2013.

Care at Hand creates real-time care coordination*Care at Hand Care at Hand

*Care at HandRelative Daily Cost of CareApproximate cost savings from Care at Hand Time= $131,000- Care at Hand

Next steps: Empower ASAPs/AAAs/CCTP sites to secure more business*Care at Handhigh value MLTSS = risk-bearing payers + care coordinators + (home care x )Dual special needs plansMedicare managed careACOsICOsCare managers internal to payersArea Agency on Aging (AAA)ASAPsCCTP Sites Care at Hand

enabling frail elderly to age in placeMore important than getting more business or saving tax dollars*Care at Hand Care at Hand

andrey@careathand.com*Thank you!angel.co/care-at-hand Care at Hand

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