creating community partnerships to navigate …...2 discussion outline healthcare industry trends...
TRANSCRIPT
Creating Community Partnerships to Navigate Payment Reform
Rusty Quynn Managing Director
BB&T Capital Markets
Monday, April 24th 2017
Robb Cohen VP of Governmental Affairs
PopHealthCare
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Discussion Outline
Healthcare Industry Trends & Drivers
Maryland Medicare Waiver Overview, Status & Outlook
Payer and Hospital/Health System Landscape
Impact on Long Term Care and Senior Living
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Healthcare Industry Trends & Drivers
Continued growth in US Healthcare expenditures as a % of GDP Annual per capita costs vs comparable Western countries Annual per capita cost variance by age vs comparable Western
countries
Increasing life expectancy
Chronic disease and End of Life issues
Current political uncertainty regarding healthcare reform, BUT
Alternative Payment Models (APMs) are here to stay
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How Did We Get Here?
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Health Care Spending
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The Statistical Elephant in the Room
Source: Commonwealth Fund - Mirror, Mirror on the Wall
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Annual Per Capita Healthcare Costs by Age
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Healthcare Costs Are Concentrated
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Life expectancy from 0-2000 Average age of death in years
“We’re not living too long . . .
we’re dying too long”
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Waiver Overview, Status and Outlook
Phase 1.0: (2014 – 2018) Global Budgets for Hospital Care
Workgroups (Multi-Stakeholder)
Advisory Council
Integrated Care Network / Care Coordination
Consumers
Physician Alignment & Engagement
Payment Models
Performance Improvement & Measurement
Data & Infrastructure
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Waiver Overview, Status and Outlook
Phase 1.0: (2014 – 2018) Global Budgets for Hospital Care (continued)
Targets: Per Capita Costs
Medicare Hospital Savings
Medicare Total Cost of Care Savings
All-Payer MHAC (MD Hospitals Acquired Conditions) Quality Improvement
Medicare Readmission Reductions
Globally Budgeted Revenues
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Waiver Overview, Status and Outlook
Phase 1.5: (2017-2018) Health Services Cost Review Commission (HSCRC) and Centers for Medicare Medicaid Medical Innovation (CMMI) working on tools and infrastructure and plans to move to Phase 2
Progression Plan: Foster Accountability
Align Measures and Incentives
Encourage & Develop Payment & Delivery System Transformation
Ensure Availability of Tools to Support Transformation Goals
Consumer Engagement
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Waiver Overview, Status and Outlook
Phase 1.5: (2017-2018) HSCRC and CMMI (continued)
Duals ACO (Accountable Care Organization for the M’care and M’caid Dually Eligible)
Comprehensive Primary Care Model (a program to enable gain sharing with physicians for reducing avoidable admissions)
Care Redesign Amendment (an agreement between the State and CMMI to help with rules and regulations to support Maryland’s unique payment system)
Population Health Improvement Plan (a statewide initiative to invest in population health)
Chesapeake Regional Information System for our Patients (CRISP) (a not for profit that helps share patient data for care coordination)
High Risk Medicare Beneficiaries
HSCRC rate update requirements include SNF / post-acute integration (undefined)
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Waiver Overview, Status and Outlook
Phase 2: (Scheduled For 1/1/2019) would include all M’care Covered Costs
Hospitals accountable for all Medicare costs
Non-Hospital costs of other payers not necessarily regulated; hospital costs still globally budgeted
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Payer and Hospital/Health System Landscape
Maryland vs National Payment Models
MACRA (Medicare Access and CHIP Reauthorization Act) MIPS: Merit-Based Incentive Payment System APMs: Alternative Payment Models
Maryland Global Budgets; leading to Total Cost of Care
ACOs (Medicare and Commercial)
Medicare Fee For Service: various pay for performance models
Medicare Advantage transferring to risk-based payments
Medicaid?
Commercial Pay For Performance
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Payer and Hospital/Health System Landscape
Acute Care Providers
3 Large Systems
Many Smaller Alliances / Systems
Commercial Insurers
Medicaid
8 MCOs, 1.2m
Half provider based (4 MCOs, 600k lives)
Medicare (950k)
Fee For Service
ACO (250k?)
Medicare Advantage (108k: 66K Medicare Advantage + 42K Kaiser Cost Plan)
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Payer and Hospital/Health System Landscape
Strategies For the Health Systems, Payers, etc.
Outlook for Dual Eligible Population (M’care and M’caid)
Coordination with Long-Term Care and Senior Housing
Admission and readmission reductions (short and long stay populations)
Transitions to Community that will prevent readmissions
Work collaboratively with those who have the risk, including payers, health systems, and ACOs (Fee For Service & possible Pay For Performance Agreements)
Manage total cost of care (SNF, LOS, physician costs, etc.)
“Know Your Numbers”: admissions, readmissions, total cost of care, etc.
Participate proactively in state’s waiver related initiatives: Duals ACO, CRISP data exchange, hospital / post acute integration, Comprehensive Primary Care Model
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Impact on Long Term Care and Senior Living
Mitigating payment reform risk and succeeding in alternative payment models will be critical
Success in any episodic payment model is based on the ability to manage and control post-acute care spend
Managing post-acute care must include an effective care transition process, the ability to monitor care, and visibility into progress against expected outcomes
up to
60% of episodic spending occurs post-acute
19 19 Source: Brandeis University analysis of Medicare claims data.
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Cost Variations
Source: Authors’ analysis of standardized payments from 2011 Medicare claims. Notes: Each component of histogram represents the amount of variance, in percentage terms, explained by each component of spending, using a generalized linear regression model with total 30-day spending as the dependent variable. Percentage of variance explained does not sum to 100 because of covariance terms. CHF is congestive heart failure. COPD is chronic obstructive pulmonary disease.
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Episodic Management
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What To Do Next
Identify the pace of change in your market place considering Accountable Care Organizations (ACO), Bundled Payment Initiatives, Episodic Payment Models (EPM) and other alternative payment models.
Understand existing relationships and affiliations among acute care and post-acute care providers
Know what hospitals are generating your performance
Understand the short and long-term risk associated with potential changes in referral patterns to alternative post-acute providers, e.g., home health, inpatient rehab, etc.
Create a Compelling Value Proposition to Communicate to Your Referral Sources
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Post Acute Care Industry Consolidation
Likely to result in fewer but larger providers
Consolidators may vary depending on the market
Hospital driven (MedStar, Hopkins, UMMS)
Physician driven
Insurer driven (CareFirst, etc.)
Pace of change will depend on:
Relative size / concentration of buyers and sellers
Excess capacity in the market
Preferred provider “narrow networks” will form based on a range of formal and informal agreements
Key Q: Do you need to “own it” or just “have access” to it?
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Partnership Structures
Relationship of Control to Benefits and Risk
Low
High
Low High Risk / Benefit
Staff/Professional Development
Joint purchasing, Managed Care Contracting
Management Services Agreement/Operational Support
Pharmacy, Therapy Services, Hospice
Control over certain aspects - Religious teachings
Reserved Powers Model
Asset Transfer
Acquisition/Disposition
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Findings from Recent Harvard Housing Study
Over the next 20 years, Population 65+ will grow from 48 million to 79 million Population 80+ will grow from 12 million to 24 million Number of 65+ Households will increase from 29.9 million to 49.6 million Number of 80+ Households will increase 7.8 million to 16.2 million
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2015 2035
Population, In Millions
Age 65+
Age 80+
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2015 2035
Households, In Millions
Age 65+
Age 80+
Source: Projections & Implications for Housing a Growing Problem: Older Households 2015-2035, released December
2016 by the Joint Center for Housing Studies of Harvard University
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A Few Statistics
“The following stats have changed over the same time when the
economy has had a steady rise in home and stock prices.”
(Time Magazine, April 2016):
59% say Social Security will be a major source of retirement income Up from 42% five years ago
46% say leaving money to heirs is important Down from 63% five years ago
24% feel confident they will have enough in retirement Down from 37% five years ago
Average Baby Boomer goal is to have $45,500 a year in retirement income Average retirement portfolio has $136,200 in assets which is
approximately $9,129 per year or a $37K shortfall (BlackRock)
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What Lies Ahead
Growth in number of lower income adults Demand for Affordable Housing will increase
The home will increasingly be a site of Long-Term Care
Rising cost burdens will impact both Owners & Renters
QUESTIONS?
Rusty Quynn
BB&T Capital Markets
Managing Director
202.528.1925
Robb Cohen
PopHealthCare
VP for Governmental Affairs
410.967.2526