“Building a Shared Foundation for

Interprofessional Education and Clinical Practice”

Lennie Blythe, RN, Union Franciscan ACO

Stephanie Laws, MSN, RN, Rural Health Innovation Collaborative

Lauren Ford, Physician Assistant Student, Indiana State University

On March 23, 2010, the Patient Protection and Affordable Care Act (Healthcare Reform) was signed into law.

Healthcare reform focused on two main areas:

1. Care delivery2. Reimbursement

Project Background

“Value” focus: Payment increasingly tied to quality and cost.

• Centers for Medicare and Medicaid Services (CMS)- hospital payments now dependent on outcomes. Physician office payments affected starting 2015.

• Commercial- Increased payments to providers dependent on meeting quality standards.

Healthcare Reform & Reimbursement

Summary: Healthcare reform focuses on ways to provide better care by giving providers more information and focusing in on quality/value….but how do we get there??

ACCOUNTABLE CARE ORGANIZATIONS(ACOs)

Healthcare Reform & Reimbursement

An Accountable Care Organization is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.“

ACOs are made up of groups of healthcare providers and provider entities that agree to work together to coordinate care for the patients they serve.

Definition per the Center for Medicaid and Medicare Services (2012).

What is an Accountable Care Organization?

There are three main goals of an ACO, often referred to as the “Triple Aim”

1. Better health for the population2. Higher-quality care3. Lower costs of care

What are the Goals of Accountable Care?

ACOs focus on providing better healthcare by improving quality and reducing costs across the entire continuum through:

Improved care coordination

Reduced waste (e.g. duplicate testing)

Internal process improvement

Informed patient choices & engaging patients and their families

Chronic disease management

Actionable, timely data (via health information technology and data sharing)

Creation of partnerships across the continuum of care (preventative, acute, post-acute)

How do ACOs Help Achieve the Triple Aim?

The ACO is focused on Medicare beneficiaries. Individuals with Medicare as a primary insurer can be “attributed” or assigned to the ACO.

CMS attributes patients to the ACO. The ACO cannot choose which patients are in the ACO.

Patients are attributed to the ACO based on providers. If the provider they see for the majority of the primary care based services joins the ACO, then there is a good chance that the will be attributed to the ACO.

At this time only Medicare patients who have had traditional Medicare (both Part A &B coverage) for at least 12 months can be attributed. Medicare Advantage members cannot be in an ACO

Who is the ACO & How do Patients Become Part of it?

15,000 LIVES

The west central Indiana demographic (Terre Haute MSA) ranked at or above the 75th percentile doe Normalized SNF Days per 1,000.

Additionally, SNF readmissions within 30 days post-hospital discharge comprised a significant amount for conditions such as pneumonia, CHF, and post-orthopedic care.

Skilled Nursing Facility Opportunity

While the ACO has embraced many community partners the following skilled nursing facilities are the sites of our student-based project:

Meadows Manor North Meadows Manor East Providence Health Care Springhill Village

Partners in the ACO mission….

ACO Student Project Developers

Union Franciscan ACO

Center for Health Wellness and Life Enrichment

The rotation is designed to provide students with autonomous, yet safe, learning opportunities that will enhance the students’ ability and confidence to perform medical assessments; formulate appropriate diagnoses or clinical suggestions based on findings; interpret laboratory and other diagnostic studies; complete comprehensive medical record reviews; and complete medication inventories for assigned patients.

Pilot Project Overview

ACO GOALS:

• Better population health

• Higher quality care• Lower costs of care• Decreased

readmissions through enhanced continuity.

Decreased length of stay at each nursing home

STUDENT GOALS:

Enhanced knowledge of ACOs

Enhanced clinical confidence and competence

Interprofessional education/collaboration

Workforce readiness

Project Goals

Completing intake assessments for all assigned patients.

Complete weekly rounds and required documentation on assigned patients.

Communication with the assigned ACO Care Coordinator.

Project Activities

1st Year Physician Assistant Students Social Work Student (BSW candidate)

◦ 15 participated

◦ Completed 3 simulation experiences

◦ Completed surveys: Pre/Post ACO Knowledge Assessments Pre/Mid/Post Clinical Skills Confidence

Pilot – Fall 2013

Meadows Manor East

Meadows Manor North

Pilot - Fall 2013

Providence Health Care

Springhill Village

Pilot - Fall 2013

Fall 2013 - ACO Knowledge

Fall 2013 – Clinical Skills Confidence

1st and 3rd Year Physician Assistant Students◦ 58 students participating◦ Split into 2 sessions

To complete 2 simulation experiences To complete pre/post:

ACO Knowledge Clinical Skills Confidence

Weekly patient rounding◦ Assigned to same 4 clinical sites

Continuation - Spring 2014

Additional student disciplines being integrated:◦ Behavioral Health◦ Recreation Therapy◦ Nursing◦ Public Health

Interprofessional Education

Session 1

Session 2

Spring 2014 – Meadows Manor East

Rachel Sanderson Christopher Schmidt Marcus Schwab Sara Spring Cynthia Shepard Meredith Stackhouse

Chelsea Elwood Brianne Wagenman Mike Finigan Lindsey Graft Lauren Ford Erin Haaff

Session 1

Session 2

Spring 2014 – Meadows Manor North

Emily Marshall

Laura Mitchell

Matt Nicholson

Kate Pippins

Sara Niles

Allison Pullar

Jordan Pothast

Emily McMahon

Amal Beydoun Joe BonomoniJoshua Chambers Raymond (Ron) Contreras

Colt Cansler Justin David Jessica (Brooke) Dailey

Session 1

Session 2 Eleonor Sviridova Cherisa Fletcher Phil Swink Markay Wilson Joanne Vanderhyde Atiq Zamani

Spring 2014 – Providence Health Care

Katherine Hill

Justin Jacobsen

Lynnaire Jastillano

Cody Lawnichak

Megan McGary

Stephanie Tobin

Session 1

Session 2

Spring 2014 – Springhill Village

Jennifer Simatovich Ryan Strom Jasmina Spahic Jay SwansonAnnemarie Spiezia

Brittany Heiser Brittany Stanek Allison Lipps

Jenifer Fortney Chase Hayes Carolyn Hanrahan Amber Thomas Eryn Hasenour

Sarah Hogue Aaron Heaslet Shelby Howard Rachel Hewitt Krista Irwin

Spring 2014 - Meadows Manor NorthBehavioral Health

Michelle Ertl Elaine Gilbert Stephanie Murphy Kelly Schuder

Ruth Viehoff Amanda Yeck

A Student’s Perspective……

In action and onsite…..

Continued replication of project to additional skilled nursing facility sites (rural).

Continued evaluation. (quality and cost) Opportunity for research and publication as

it pertains to interprofessional student experiences.

Policy change/management?

Next Steps