Case Study - Ohio's Hospice

A Lincoln Healthcare Leadership Event

Case Study: Ohio Hospice Inc.: The Challenges and Rewards of Building a Hospice Partnership

Kent Anderson, MHA/MBAPresident/CEO,

Hospice of Dayton

Kerry HamiltonPresident & CEO,

Hospice of Central Ohio


New Care Continuums for Success in a Changing Health Care Landscape

Or ……


SHIFT HAPPENS


Bundled Payments for Care Improvement (BPCI) Initiative

On January 31, 2013, the Centers for Medicare & Medicaid Services (CMS) announced the health care organizations selected to participate in the Bundled Payments for Care Improvement initiative, an innovative new payment model. Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care.


WHY

“Great organizations change before they have to change. Lucky organizations catch up to change. The rest are history.”

Sinclair Community College President

Migrating to Total Cost AccountabilityCharting the Path of Payment Reform

Source: Advisory Board interviews and analysis.

Continuum of Payment ModelsEpisodic Cost Accountability Total Cost Accountability

Partial Capitation

Pay-for-Performance

Bundled Payments

Shared Savings

Traditional Fee-for-Service

Provider Risk

FullCapitation

Minimal Substantial


WHY•Assessing our Core Competencies– Frail– Elderly– Chronically ill (terminal)– In all settings

•Cost Effectively– Low hospital utilization– Less prognostic testing– Less futile intervention

•Better Outcomes – Lower symptom burden– Prospective intervention


Health Care in America

•87% of older adults have at least one chronic illness

•68% have two or more

•Higher than most developed countries

The New Logic of PartnershipIntent of Mergers and Affiliations Rapidly Evolving

Source: Post-Acute Care Collaborative interviews and analysis.Objectives of Partnership

“New Market”

Partnership Value

Scale Scope ReachGeographi

cClinicalOperation

alFinancial

Consolidate local position

Centralize supply purchasing

Merge back office functions Increase

operational efficiency

Integrate services across care continuum

Develop care management competencies

Stake regional footprint

Establish national network


Only the strong survive (remain relevant)

•Only the strong, innovative, high quality, low cost, data integrated, value-based and value creating, data rich hospices survive

•Regulatory burden will only increase

•Reimbursement will not keep pace with cost pressures


Relevancy – That is the Question

Will you or won’t you be relevant in VBP?

CASE IN POINT…….

Disruption is Here


• Mortality rates among the fee-for-service Medicare population fell 16% from 1999 to 2013. Patients were 45% less likely to die during their stay; 24% less likely to die within a month of admission; and 22% less likely to die within a year, the study in the Journal of the American Medical Association (JAMA) reported.

• Lead cardiologist Harlan Krumholz, lead author of and a professor at the Yale School of Medicine said that’s equal to more than 300,000 fewer deaths a year in 2013 than in 1999. The study was based on records from more than 68 million patients in Medicare, the federal health insurance program for people age 65 and older.

• Among fee-for-service patients, hospitalization rates fell 24%, with more than 3 million fewer hospitalizations in 2013 than 1999, Krumholz said. When patients were admitted to the hospitals, they were 45% less likely to die during their stay; 24% less likely to die within a month of admission; and 22% less likely to die within a year, the study found.

MORTALITY RATES DROPPING FOR MEDICARE POPULATION


Deaths: Now & Then 2060


Ohio’s Hospice Value Proposition

• Optimizing Care & Services – Outcomes and

Consistency (Highly Reliable Organization)

• Optimizing Resources – Strengthening Mission

• Optimizing Mission & Brand

• Scale to become a risk bearing organization

• Preeminent post-acute chronic illness provider

Not-for-ProfitNot-for-profit status and

20 or more years of experience.

Hospice CertifiedHospice-certified nurses and doctors on staff and

available 24 hours per day.

Palliative CarePalliative-care consultants

who can begin care if you’re not yet ready for

hospice.

Inpatient UnitAn inpatient unit, where

patients can go if symptoms can’t be managed at home.

Wherever You Call HomeAbility to provide care in

nursing homes and assisted living residences.

Approved By MedicareMedicare approval.

How to Choose a Hospice Provider


Questions?

Kerry Hamilton Kent AndersonPresident & CEO President & CEOHospice of Central Ohio Ohio’s Hospice741.788.1403 [email protected] [email protected]

Case Study - Ohio's Hospice

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