5/5/2015

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Lynette L. LadenburgChief Strategic and Financial Officer

May 19, 2015

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ACO Start DateACO Start DateACO Start DateACO Start Date Number of ACOs*Number of ACOs*Number of ACOs*Number of ACOs*

April 2012 27

July 2012 89

January 2013 106

January 2014 123

January 2015 89

In January 2015

19 active Pioneer ACOs

405 MSSP ACOs

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� Where Are Bundled Payments Happening?

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� ACO’s

o PolyClinic

o Franciscan

o Providence, Swedish – Employer ACO - Boeing

� Partnerships around the state

o Whatcom

o Pierce

o Thurston

o Yakima

o Spokane

o King and South King

o Kitsap

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� Collaborative efforts with WSHA, Qualis and other

interested parties.

o Tool Kit (completed)

o Focus changing now to new efforts

o Major payers sit on these committees

� Committees/Groups

o Standardizing Case Management in WA

o Readmissions Committee

o SNF Standardize Discharge Project

o Safe-Tables

o State committees

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� On-site physicians

� INTERACT for SNF, AL and Home Health

� 5-Star Rating

� RN Staffing 24/7 – Hospitals training nurses

� Cost Analysis – Knowing your costs by diagnosis

� Data Driven

o Readmission rates < 10%

o Insights available through LeadingAge

� Nurse Navigator

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� Care Continuumo Long-term Care

o Assisted Living

o Housing/Independent Living

� Community Partnerso Hospice

o Palliative Care

o Home Health

o Home Care

o Adult Day Services

o PCP’s

o Clinics

o Transportation

o Other Services

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� Changing roles for nurses

o RN: Hospitals hiring BSN’s – ADRN’s available in workforce

o LPN: Due to increased acuity at all levels in community based

agencies

o Emerging role of Medication Assistants in SNF

� New positions/re-design of current roles

o Patient Navigators

o Nurse Navigators

o Advocates/Coach

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� Inpatient hospital use will continue to decline; outpatient use will

grow

� Single source providers will be very challenged to survive without

some degree of affiliation, partnership or collaboration.

� Coordination of service across all levels will be crucial and

continuum-oriented efforts will achieve the greatest value

� Cost efficiency and quality will grow evermore critical

� Acuity will keep pushing downward along the continuum

� Commercial payers and managed care will rule the world

Empower your Teams!Empower your Teams!Empower your Teams!Empower your Teams!

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1.1. Create Create Consensus of the ChangeConsensus of the Change

2.2. Develop a Clear Plan and StrategyDevelop a Clear Plan and Strategy

3.3. Build the Right Change TeamBuild the Right Change Team

4.4. Tear Down BarriersTear Down Barriers

5.5. Communicate ConstantlyCommunicate Constantly

6.6. Foster Competency and LearningFoster Competency and Learning

7.7. Anchor and Anchor and CelebrateCelebrate

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If you’re late to the game, strategic considerations should take If you’re late to the game, strategic considerations should take If you’re late to the game, strategic considerations should take If you’re late to the game, strategic considerations should take precedent over tactical moves:precedent over tactical moves:precedent over tactical moves:precedent over tactical moves:

1. Have a crystal clear understanding of who and where you are and craft a clearly defined vision for where you want to be.

2. Get out into your market, be informed about changes and the implications of payment and delivery reform – LEARN!

3. Seek out collaborations and partnerships with other like-minded providers or organizations.

4. Craft and understand your value proposition – it will inform and oftentimes define the tactical steps to follow.

Source: THE CAMDEN GROUP

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� The right team may not be your leadership team The right team may not be your leadership team The right team may not be your leadership team The right team may not be your leadership team –––– it might need it might need it might need it might need to look broader than that.to look broader than that.to look broader than that.to look broader than that.o Involve members across the organization, both horizontally and vertically – different viewpoints are critical

o Look for people with good communication skills and those are inspirational to others

o Resident services staff are essential – they will be your advocates among other staff

� Ideal team members include people who:Ideal team members include people who:Ideal team members include people who:Ideal team members include people who:o Challenge the status quo

o Are generally optimistic

o Not adverse to hard work

o Build relationships well

Source: THE CAMDEN GROUP

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� Consumer

o People are living longer at home

o Delay moving into communities

o Arriving with a higher level of acuity

� Focus on Triple Aim

o Improve patient experience

o Improve health of populations

o Reducing the per capita cost of health care

� Technology

o Opportunity for new lines of service/revenue

o Trusted Advisor

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Tacoma Lutheran Retirement Community

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Therapeutic Tech CenterTherapeutic Tech Center

Product &

Service Line

Opportunities

Tacoma Lutheran Retirement Community

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�Sessions per montho Physical Therapy 45

o Occupational Therapy 55

o Speech Therapy 5 – 10

Approximately 60% of the caseload uses the Tech Center

Avg. Caseload 40

Avg. Sessions 4.5

�Revenue $105,000 annually

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The Innovations HomeThe Innovations Home

Tacoma Lutheran Retirement Community

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• Adaptability• physical space

• Affordability

• Accountability • data driven results

“Living Laboratory – lets you see, touch, feel

and experience technologies”

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• Customer Satisfaction

• Community Expert

• Preferred Provider

• Market Niche

• Partnerships

• Marketing Tool

• Trusted Advisor

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� Led us to share consultation and our technology insights

� Retirement Communities looking to be unique

� Better environment for residents

� Effective way to improve census

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To Do…To Do…To Do…To Do…

Not to Do…Not to Do…Not to Do…Not to Do…�Buy-in from the

top

�Build a team of

innovative

thinkers (have at least one that will challenge your ideas)

�Take Risks

� Impulsive

purchases

�Don’t wait for

funding – ROI

$$$$

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�Age Differently Consulting and Age Differently Consulting and Age Differently Consulting and Age Differently Consulting and

Management ServicesManagement ServicesManagement ServicesManagement Services

o Working with members - technology footprint

o Innovation Homes

o Technology Rehab Centers

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�Therapeutic Tech Center

� Innovations Home videos @

www.agedifferently.com

or www.tacomalutheran.org

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Four Areas of Technology� Safety

� Health and Wellness

� Social Connectedness

� Electronic Documentation

CAST� Toolkits

� Hackfest

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� Fit Brains

� Lumosity

� Tetris

� Sudoku2

� Memory Block

� Stroop Effect

� Brain Lab

�Word Search+

�Word Jigsaw

�Brain Challenge

�Words Chain Challenge

�Chain of Thought

�This is to That