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“AN OPPORTUNITY TO INTEGRATE NUTRITION

SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM” KIMBERLY K. DELP, RN BSN

January 26, 2017

“AN OPPORTUNITY TO INTEGRATE

NUTRITION SERVICES IN YOUR

LOCAL HEALTHCARE SYSTEM”

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WELCOME

Ask Questions Using the Box on the

Control Panel

OBJECTIVES

• Integrate your nutritional support program into a

healthcare delivery model.

• Determine what data/outcomes will allow the

effectiveness of your program’s nutrition interventions

to reduce the use of healthcare costs.

• Identify ways you can make it easier for healthcare

entities to work with you.

• Learn how to successfully approach the evaluation of

your nutrition intervention program.

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OUR HEALTHCARE DELIVERY MODEL

• Healthcare providers i.e. Hospitals, Social Workers,

Case Management, Physicians, Home

Health/Hospice Providers

• Insurers/Contracts

• Community Stakeholders

• Funders i.e. Foundations, Donors

• Patients & Caregivers

OUR PARTNERS

COMPELLING RESEARCH – WHY?

• Long-term expenditures 219.9 billion, 346 by 2040

• 18.2 % expenditures in Community Based Services

• 2/3 healthcare dollars spent on chronic illness

• >65 yrs. 68% deficient in 2 or more ADL’s

• 35% will enter a SNF before they die

• >85 yrs. Is the fastest growing population

NATIONAL DATA

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POST ACUTE NUTRITIONAL SUPPORT − WHY?

• Malnutrition is common upon admission and declines

during hospitalization

• Poor nutrition increases the risk of re-hospitalization

• Common conditions for unplanned 30-day

readmissions include: Myocardial Infarction,

Congestive Heart Failure and Pneumonia

(CMS AHRQ QualityNet)

BACKGROUND

HEALTHCARE MODEL − GOALS

• Reduce unplanned hospitalization

• Prevent Hospital, Skilled Nursing Facility (SNF) and/or

Homecare Healthcare penalties

• Identify early interventions

• Educate payers that Community Based Services are

cost effective

• Start services quickly

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HEALTHCARE DELIVERY MODEL − GOALS

• Integrate nutritional support into Managed Long Term

Services & Supports

• Prevent SNF admissions - long and short term

• Develop Value Add/Early interventions

• Reduce utilization of Hospital & Urgent Care

• Centralize ordering & contracting

CONTRACTS WITH INSURERS

POSITIONING YOUR PROGRAM IN THE COMMUNITY

• Find funding to start/maintain early intervention

• Help support clinical integration into your program

• Secure donations and marketing support

• Engage in pilot & research projects

• Provide assistance with documenting results

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POSITIONING YOUR PROGRAM IN THE COMMUNITY

• Perceptions & Expectations of clients and caregivers

• Relationships of delivery staff to recipient

• Value of frequent “touches”

• Cost effective

OUR HEALTHCARE DELIVERY MODEL

• Define program as “nutritional support”, not as meal

delivery

• Develop “Standards of Care”

• Activate a “Change of Condition” tool

• Document alerts, interventions & outcomes

• Compare and report results (hospitals, insurers etc.)

• Educate internal/external staff about reporting

protocols

ACTION STEPS

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“CHANGE OF CONDITION” TOOL – WHY?

• Standardize Alerts i.e.

- Health Status

- Falls

- Loss of Caregiver

- Appearance

- Living Arrangement,

- Poor Nutrition

- Emergency

• Report and Record Alerts

• Assure prompt Follow Up

OUR “CHANGE OF CONDITION” TOOL

• Find an intervention specialist (clinical & social)

• Define protocols for interventions

• Record interventions

• Calculate impact of interventions

• Report interventions in cost savings

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“CHANGE OF CONDITION TOOL” – IMPORTANT STEPS

• Develop staff education

• Secure buy-In

• Assure staff understands alerts and feedback on alert

• Make it a simple process

OUR “CHANGE OF CONDITION” APP

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POLLING QUESTION 1

Question: How does the delivery driver of your Meals

on Wheels program report an observed change of

condition in a client?

Response: (multiple answers)

• Alerts a MOW staff member of their observation

• Notifies through an electronic or mobile alert system

• Utilizes a paper log to be entered in MOW database

• We do not have a formal process/protocol

HEALTHCARE COST REDUCTION

• “Change of Condition” alerts

• Interventions i.e. Referrals to primary care physicians

(PCPs), home healthcare, home modifications,

transportation, referrals to county programs,

medication management.

• Develop a system to record and document

• Identify planned vs. unplanned hospitalizations

DATA COLLECTION

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HEALTHCARE COST REDUCTION

• Follow up on undelivered meals promptly

• Document interventions that decrease SNF/hospital

admissions

• Document interventions that keep folks in their own

homes

DATA COLLECTION

HEALTHCARE COST REDUCTION

• ALERT: Gerri is a 84 year old female living alone c/o foot pain and

difficulty ambulating. Health status alert posted from delivery staff.

• INTERVENTION: Call from intervention specialist finds wound and

fall risk. Discussion with PCP and orders obtained for home health

RN, Physical Therapist and wound care all covered by medical

insurance.

• RESULTS: Prevention of hospitalization due to early intervention.

CASE SCENARIO

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POLLING QUESTION 2

Question: Do you evaluate the outcomes (impact) of

your interventions?

Response:

• Yes

• No

COMPONENTS OF AN EVALUATION TOOL

• How the “Change of Condition” is implemented?

• How is the intervention perceived by the recipients?

• To what extent has the “Change of Condition”

monitoring been successful in achieving goals of

preventable hospital/SNF admissions and getting

timely attention to seniors’ health issues?

THREE QUESTIONS THAT NEED ANSWERING

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COMPONENTS OF AN EVALUATION

• Compare data for regular MOW clients to CoC pilot

group

• Compare early interventions results

• Obtain input from program staff and recipients

• Compare admission rates for SNF/Assisted Living

Facility (ALF)/Hospitals at 30, 60 & 90 days (avg. cost

per event)

• Plan for scalability

KEY FACTORS

PILOT PROJECT

• 150 individuals discharged from 2 hospitals

• 30 days nutritional support & “Change of Condition”

monitoring

• Diagnosis of Congestive Heart Failure, s/p Myocardial

Infarction (MI) and Pneumonia

• Goal: Prevent re-hospitalization within 30 days

POST ACUTE NUTRITIONAL SUPPORT PROGRAM

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POST ACUTE NUTRITIONAL SUPPORT − RESULTS

• 150 enrolled, 88 urban hospital, 62 suburban hospital

• Median age 74, 63% female, 71% not married

• 40% received additional services of home healthcare

upon discharge.

• Most common insurance was Medicare or Medicare

Advantage plan

• Meal started within 5 days, only 9% cancelled

POST ACUTE NUTRITIONAL SUPPORT − RESULTS

Total sample, over 30 days following discharge

− 2.7% were treated in emergency departments; and

- 11.3% were readmitted to the hospital

Readmission rate comparison

- Congestive Heart Failure - 15.1% (national rate 20.2%)

- Myocardial Infarction − 9.1% (national rate 17%)

- Pneumonia − 10.5% (national rate 17.4%)

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POST ACUTE NUTRITIONAL SUPPORT − SUCCESS

• Only 9% discontinued the program prior to 30 days

• Readmission rates for Medicare sentinel conditions

were lower with patients receiving nutritional support

and using CoC

• Education for healthcare providers achieved

• Continue to get inquiries from hospitals

POST ACUTE NUTRITIONAL SUPPORT

• Not all patients were approached

• No access to claims to categorize/index hospitalizations

• Difficult to determine which element was responsible for

reductions in readmissions (meals, CoC, RN calls)

• No comparison with discharges without MOW/CoC

• MOW does not have an “EASY” access referral system

LESSONS LEARNED

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POLLING QUESTION 3

Question: What changes will MOW programs have to

make to effectively work with healthcare entities?

Response: (multiple answers)

• Expand meal choice

• Track consumer hospitalizations

• Simplify service and reporting processes

• Design flexible delivery times/days

QUESTIONS?

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ENGAGE WITH THE LEADERSHIP ACADEMY ONLINE!

Join our Linkedin Discussion!

- https://www.linkedin.com/groups/7062647

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- @MOWAcademy

Next Academy Webinar – February 7, 2017

Topic: THE LEADERSHIP KALEIDOSCOPE –

ADAPTING TO A DIVERSE WORKFORCE