Current and Emerging CMS Payment Models - PowerPoint Presentation

Current and Emerging CMS Payment Models Intersection between Hospice, Palliative and Primary CarePart 2 Leading Person-Centered Care 1

High Level Agenda Understanding the SIP program – Recap from Part 1 SIP Patient Cohorts – What will they look like?Assessing your Current Service OfferingAreas of Focus – Succeeding in SIP under a Hospice Paradigm Leading Person-Centered Care 2

Impact of Administrations on Medicare Deficit Projections Even including a significantly higher GDP growth rate, current administration projects higher health care spending and higher Medicare deficits Leading Person-Centered Care3 Trump Administration Obama Administration

Eligible Regions and Reimbursement Leading Person-Centered Care 4

SIP Eligibility Practices participating in the SIP program provide the following services: An interdisciplinary care team that includes physician/nurse practitioner, care manager, RN, and social worker. Can also include behavioral health specialist, pharmacist, community services coordinator, and chaplainComprehensive, person-centered care management ability, including ability to assess social needs of patientsRelationships with community and medical resources and supports in the community help address social determinants of health, medical, and behavioral health issuesWellness and healthcare planning Family and caregiver engagement 24/7 access to a member of the care team Leading Person-Centered Care 5 Hospices are uniquely positioned to succeed in this new program

Leading Person-Centered Care 6 SIP Opportunity vs. Annual Medicare Deaths (By State) # of Medicare beneficiaries

Current and Emerging CMS Payment Models Intersection between Hospice, Palliative and Primary CarePart 2 Leading Person-Centered Care 7

SIP Benefits for Hospice Mission – Advancing care for the seriously illNew Service Line – Unlock new earning potential while diversifying programmingIntegration into the Care Continuum – Further ingrain your organization into community networksPositioning for MA Carve-In – Formal relationships built with payers Referral Pathways – Establishing relationships with patients through SIP carries over into other service lines, like home health and hospice Building readiness for Value-Based Contracts – Metric-driven, incentive-based payment model prepares you to take on new opportunities Improved Relationship with Providers – Building mutually beneficial relationships where patient referrals go both waysLeading Person-Centered Care 8

Assess your Breadth of Services What is the scope of your current service offering? Leading Person-Centered Care 9 Mature Non-Hospice Services Some Non-Hospice Services Hospice-Only

Assess your Breadth of Services Hospice-Only Services No non-hospice services offeredPerhaps a hospice residenceFunded through hospice benefits and fund-raising Leading Person-Centered Care 10 Hospice-Only

Assess your Breadth of Services Some Non-Hospice Services Developing non-hospice service lines, but not a significant percentage of staffing/budget currentlyCommunity based palliative or advanced illness programs, mostly telephonic support, provided by hospice staffLimited funding resources (grants, donations, foundations, bequests, research) Leading Person-Centered Care 11 Some Non-Hospice Services Hospice-Only

Assess your Breadth of Services Mature Non-Hospice Services Established service lines with dedicated staffingIn-patient and community palliative, care transitions, PACE, advance directive consulting services, advance illness management, in-home medical visits, behavioral health clinics, DSRIP, telemedicine, home careFunding through contracts, direct insurance submission, some risk-based arrangements Leading Person-Centered Care 12 Mature Non-Hospice Services Some Non-Hospice Services Hospice-Only

Polling Question- Which of these best describes your organization today: Hospice only?Some Pre-hospice servicesMany, mature pre-hospice servicesLeading Person-Centered Care13

Staffing Current roles and utilization Care Provision Broader care plan scope Documentation Adapting current EMR capabilities On-Call Non-hospice needs after hours Data Analytics Harness the power of your data Budgeting Maximizing program viability Culture Expansion of mission Marketing Establish program identity and voice Networking & Contracting Integrate with the healthcare continuum Areas of Focus Leading Person-Centered Care 14 SIP works regardless of where you are today Hospices can focus on serving different SIP patient cohorts based on current capabilities

Data Analytics Leading Person-Centered Care 15 Make use of CMS CCLF claims files You must be able to determine which patients need which care (high, medium, and low intensity) Build patient cohorts based on prognosis You can’t be successful if you treat every patient the same

Cohort Descriptions Leading Person-Centered Care 16 Cohort Prognosis Objective Near-Term Hospice Appropriate < 6 months Stabilize patient Transition to hospice in the near-term Medium-Term Hospice Appropriate 6 – 12 months Stabilize patient Transition to hospice within 12-month SIP window Primary Care Focused > 12 months Stabilize patient Transition to PCP

Staffing Leading Person-Centered Care 17 Near-Term Hospice Medium-Term Hospice Primary Care In-home visits by a mix of RN, SW and/or NP Mix of in-home and telephonic RN support RN support (telephonic, if possible) MD for Hospice Certification MD/NP oversight Social work Social work, as needed <-------------------- Care Coordination --------------------> <-------------------- 24/7 On-Call Coverage -------------------->

Care Provision Leading Person-Centered Care 18 Near-Term Hospice Medium-Term Hospice Primary Care Near-term transition to hospice care, including items such as patient/family education Care management required over longer time period Meaningful clinical care expected to be delivered by PCP and/or specialist Incorporate treatment plans and symptom burden Some primary care may be needed Near-term transition to primary care Remove common barriers Educate patient/family on hospice Educate on site of service

Documentation Leading Person-Centered Care 19 Near-Term Hospice Medium-Term Hospice Primary Care Advance Directive Advance Directive Advance Directive Hospice Care Plan Care Plan, includes curative care Care Plan, includes curative and wellness care Goals of Care / Proxy / POA Telephonic and in-person interactions for Part B billing Telephonic and in-person interactions for Part B billing Referrals to specialists instead of acute Referrals to specialists and primary care

On-Call Coverage Leading Person-Centered Care 20 Near-Term & Mid-Term Hospice Primary Care Hospice on-call model Non-clinical on-call model, telephonic only Includes triage and appointment scheduling for specialists and primary care

Budgeting and Modeling Leading Person-Centered Care 21 Number of Patients Cost of Care Primary Care Cohort Medium-Term Hospice Cohort Near-Term Hospice Cohort Maintaining a budget for the SIP population is paramount Your reimbursement is the same for each cohort, but your cost of care is very different Average monthly cost of care for entire SIP population should be less than $275

Culture Leading Person-Centered Care 22

Marketing Leading Person-Centered Care 23 NewCo. Now is the time to start thinking about how you will market the SIP program Messaging and word choice should be carefully considered on all patient-facing collateral and scripting Consider new, non-hospice branding for SIP, especially if you are currently a hospice-only organization

Networking & Contracting Leading Person-Centered Care 24 Near-Term Hospice Medium-Term Hospice Primary Care <-------------------- Contracting with non-Medicare payers for SIP --------------------> <-------------------- Electronic referral capabilities, internal and external -------------------> <------------ Fill identified gaps in care continuum ------------> Build relationships with specialists Build relationships with primary care

Acclivity Can Help You Get Started We will support you in the application process (which is non-binding), including providing template responses We will analyze the raw patient claims files provided by CMS, determining patient acuity and micro-stratifying patients into SIP cohortsWe will assist with modeling incremental staffing requirements and potential financial returns, based on best-practice SIP care modelsWe will conduct an IT gap analysis, including EHR and reporting requirements We will identify and support outreach to potential community partners to fill care gaps (if any) We offer guidance around discussions with non-Medicare payers who opt into the program We provide access to industry thought leaders and best practices surrounding SIP program Once the program begins, Acclivity provides ongoing support, analytics, workflow, and reporting capabilities to ensure your success Leading Person-Centered Care25 SIP Assessment Engagement Letter

QUESTIONS AND ANSWERS Do you have more questions?Send them to info@acclivityhealth.comLeading Person-Centered Care26