post-acute care: the tail wagging the dog?
TRANSCRIPT
Post-Acute Care: The Tail Wagging the Dog?
The Beacon Institute
Sage Growth PartnersMarch 11, 2014
…Market Trends
…CDS and LTC
What I’ll Cover
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…Future State
MARKET TRENDS
The Situation – the “QUINT Witching Hour”
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DEMOGRAPHICSChronic Disease, Aging,
Population Health, Delivery System Supply
CONSUMERISMPatient Engagement,
Transparency, Access, Ubiquity
TECHNOLOGYInteroperability, mHealth,
Structured Data, Risk-Adjusted Payments, Analytics
REGULATION
PPACA, MU, ICD-10, ACO, PCMH, Penalties
ECONOMICSMargins, Cash Flow, Public Sector Stress, Enrollment Expansion, RAC, Denials
Volume to Value Migration Accelerating
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Long-term future
Key driver – upside-down costs
% of Portfolio in Risk-Based Contracts
Porter Research Study 2013
Risk shift
ACO growth
Leavitt Partners 2013
% o
f R
esp
on
de
nts
Global Budget Revenue
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A Tale of Two Industries
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Increasing Demand for LTC Services• 70% of “Baby Boomers” can expect to use some form of long-term care
during their lives
• The population that is most likely to need LTSS—individuals aged 85 and over—is expected to increase by almost 70% in the next 20 years
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Long Term Care Quality – State Report Cards
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http://www.commonwealthfund.org/~/media/Microsite/Files/Reinhard_raising_expectations_LTSS_scorecard_REPORT_WEB_v5.pdf
Maryland’s Performance
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Transitions of Care
Researchers estimated that in 2011, poor transitions caused between $25 and $45 billion in wasteful medical spending through avoidable
complications and unnecessary hospital readmissions.
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Source: http://healthaffairs.org/blog/2012/09/21/health-policy-brief-improving-care-transitions/
CLINICAL DECISION SUPPORT AND LONG TERM CARE
HIT and Long Term Care (Industry Survey)
• 90% offer Internet access to residents
• Nearly 90% have adopted "wander management" technologies to keep residents from wandering unattended
• 83% use point-of-care digital documentation systems
• 80% use user-activated emergency response systems
• About 75% use EHRs
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Source: December 2013 http://www.ihealthbeat.org/articles/2013/12/13/survey-finds-longterm-care-facilities-adopt-ehrs-but-lag-in-hie
Specific Activities by Percent Sharing Information
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Basic EHR Adoption in LTC
ProviderAdoption Rates of Basic (non-certified) EHRs for Some Clinical Processes
Home Health Agencies (HHAs) 43%
Hospice 43%
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Unknown
Long-Term Care Hospitals (LTCHs) 6%
Nursing Homes (SNFs/NFs) 43%
Inpatient Rehabilitation Facilities/Units
4%
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The adoption rates for LTC providers cannot and should not be compared to the adoption rates for eligible hospitals and eligible physicians since they do not measure comparable EHR technology.
Source: 2013 http://aspe.hhs.gov/daltcp/reports/2013/ehrpi.shtml
Why?
• Systems serving the LTC market generally do not have the functionality to support interoperability and HIE.
• There is a lack of available certified electronic health record technology (CEHRT).
• Nationally recognized standards are not yet available to support functionalities and interoperable exchange of data needed to support key care processes and contexts that are unique to LTC.
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THE GO-FORWARD
Chronic Quadrangle
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Affordable Care Act
• 40 provisions of the ACA that apply to LTC and other ineligible providers that either: • (i) require or could support the use of health IT
• (ii) require or imply the exchange of health information.
• Some of the HIE provisions require electronic HIE, while other provisions do not specify the method of exchange (e.g., information exchange could electronic or manual). For example:
• “It is possible new market pressures will be brought to bear on ineligible providers to use technology as provisions that focus on HIE are implemented. While these provisions are expected to advance the use of technology by at least some of the ineligible providers, it is still unknown how widespread this impact will be.”
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Source: June 2013, HHS http://aspe.hhs.gov/daltcp/reports/2013/ehrpi.shtml
Beyond MU?
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National Quality Strategy: The Future of Quality Measurement
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HHS Theory for Sophisticated LTC
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The movement to value - the new gauge for HIT ROI
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1Source: Population Health Management-Hill’s Handbook to the Next Decade in Healthcare Technology, 14 May 2013
Questions?
Thank you
Don McDaniel
410.534.1161
443.904.2882
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