Community ParamedicParamedic Systems of Wisconsin

September 24th, 2015

DHS/MDHHospitalsEMS Medical DirectorsPrimary careHome healthHospicePublic health

Affiliated clinicsFQHC'sCHC Look-alikesCommercial & Gov’t

payersState EMS boardSNF/Transitional careGeriatrics

Partners

Improving Care, Health & Cost

Effective Community Paramedic programs inherently support the Triple Aim framework to optimizing health system performance

Primary Care

Achieving Triple Aim Goals: CP – Connecting the Dots

Primary Care FocusPROVIDERS ARE UNDER INCREASED PRESSURE TO CONTROL COSTS

•Reduce ED utilization

•Reduce admissions and readmissions

•Expand primary care

•Encourage health care home usage for complex patients

•Community benefit plan - broad goals to improve population health

Patient Care

Payer source Primary Care Referral

CommunityParamedic

POPULATION-BASED, PERSON-CENTERED

Community Paramedics meet the need for acute medical care.

They also collaborate to identify patient needs and develop methods for matching resources with those needs to support the overall health of people and their communities.

The Value of CP in Accountable Care

Enabling Legislation, Credentialin

g

Reimbursable CP

Practitioner Services Identified

Implementation –

Stakeholders

ED Utilization

Hot Spotting

Patient Primary Care Plan, Medical

Home

● Linking Primary Care & EMS

CP: ACOsHow ACOs work

Doctors, hospitals, and other health care providers who volunteer to work together in an ACO are able to access medical records to help coordinate care.

Providers also receive data from Medicare (medical history, medical conditions, prescriptions, medical visits) to be better able to improve care and manage financial risk.

When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  

Several models of ACOs exist across the Country…

Health Care Financing Models Fee-for-service payment is reimbursement for specific, individual services provided to a patient.

This model involves payment for specified care coordination services, usually to certain types of providers. The most typical example of this is the medical or health care home model whereby the medical home receives a monthly payment in exchange for the delivery of care coordination services that are not otherwise provided and reimbursed.

Pay for performance can be defined as a payment or financial incentive (e.g. a bonus) associated with achieving defined and measurable goals related to care processes and outcomes, patient experience, resource use, and other factors.

Episode or bundled payments are single payments for a group of services related to a treatment or condition that may involve multiple providers in multiple settings.

The comprehensive care or total cost of care payment model involves providing a single risk-adjusted payment for the full range of health care services needed by a specified group of people for a fixed period of time.

Hospital Stars Rating The healthcare industry is under intense pressure to boost the transparency

of quality data and provide information consumers can use to make more informed decision about their care.

CMS first applied star ratings in 2008 to nursing homes. Last year, the agency rolled out similar programs for home health providers, large group practices and dialysis facilities.

The survey asks patients about factors such as the responsiveness of hospital staff to their needs, the quality of care transitions and how well information about medications is communicated. The survey is sent out within a few days of discharge. It also asks the patient about the cleanliness of the hospital and whether the patient would refer the hospital to others.

Why a Hospital would use a CP Hospitals are at risk for up to 4.5% of their total Medicare payments based on

readmissions (3%) and value-based purchasing (VBP) measures (1.5%). All-cause readmissions are measured for patients discharged with MI, heart failure and pneumonia diagnosis related groups (DRGs). In October 2014, COPD and hip and knee replacements were added to the list of DRGs. The three-year trend for most hospitals has seen increasing readmission penalties.

CMS added the metric of Medicare spending per beneficiary (MSPB). This evaluates the average spent by Medicare for the three days preadmission, during the inpatient stay and for 30 days post discharge. If the MSPB is higher than the state or national average, the hospital may face additional financial penalties. For some hospitals, the financial incentive to reduce high readmission penalties may outweigh the actual payments they receive for the admission.

Partners for EMS in the CP World Integrated Health Care Systems Home Health Care Hospice Hospitals and Payers trying to control utilization Long Term Care

Engaging Potential CP Payers The realignment of fiscal incentives within the healthcare system has created

an environment that encourages providers and payers to work together to right-size utilization.

Providers and payers are often unaware of the true value EMS agencies can bring to their patients through proactive and innovative patient navigation services.

To work in the new environment, you need to become well-versed in healthcare finance, specifically as they relate to the partners to whom you’ll be proposing. Be sure you know things like readmission rates and penalties, value-based purchasing penalties, HCAHPS scores, MSPB and other motivating factors you can use to help build the business case for your CP program.

ACO Models NationallyMedicare Shared Savings Program The Shared Savings Program will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients firstAdvance Payment ACO Model (35) intended to help smaller ACOs have the capital to invest in the infrastructurePioneer ACO Model (23) a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program; moves from a shared savings payment model to a population-based payment model

Advance Payment

ACOs

Pioneer ACOs

ACO: CP Value

MEDICARE ACOMEDICAID ACO Withholds

ER 5%

Medical Home-Care coordination payments for managing complex chronic conditions

Improve financially on Medical Assistance reimbursement

Avoid Withholds

Increase Patient Satisfaction Scores

Quality Measures

Reduce avoidable readmissions

Opportunity to share in the savings produced

Opportunities for CP to impact the ACO achievement of Triple Aim Goals: Improved Patient Care, Enhanced Patient Experience, Reduced Cost of Care

A high-level look at a a functioning Community Paramedic Program and its support of Accountable Care

ACO: CP in ActionYear 1 and 2: Over 16,500 CP patient visits Referrals from ED/PCP/CC/HH Enhanced diabetes management ‘Hub’ huddles increase continuity of care Charting & In-basket Epic messaging: real

time with provider for follow up/guidance Lab contact for analysis and direction CC’ing all charts to care coordinator and

PCP Closed loop communication with patient

and family Link additional community services into

pt goal setting process CP follow up upon D/C can increase

information relay to PCP D/C lab review and med compliance offers

decrease risk of re-admin

Patient Populations Polypharmacy High ED utilization Anti-coagulation patients Not quite homebound: ineligible

for HH services PCP feels it would help pt to have

additional resources HCH patients needing services Continued wound care needed CP Clinic in Chem Dep facility Bariatric patients Surgical follow-up

North Memorial CP Medicaid Demo

High-risk patients served by North Memorial are getting home visits from community paramedics, who help them avoid the emergency room by providing care in coordination with their doctor’s offices and clinics. North Memorial uses data from the Department of Human Services to identify those who are most at risk and includes them in its groundbreaking community paramedic program.

Bonus Payments of: $800,000, $1.5 million in year 2.

Initial Data Review-Population

Public to Commercial Reimbursement

● Medicaid-approved CP services paved the way for Commercial Payer interest● Fee schedule base with the introduction of risk● Shared savings settle up● Total Cost Of Care (TCOC) opportunity

CP Payment & Delivery Modeling● Community Paramedic solutions span health care finance, government reimbursement modeling and care delivery innovations.

● In the brave new world of PMPM, capitation and shared savings for total cost of care, and a drive for the premium dollar, CP offers new solutions across the continuum of care and types of services….

Fire Hospital Private Systems

● From initial 911 call to primary care integration

CPs = Accountable Care Partners

● Viable option for improving the experience of care, improving the health of populations and reducing per capita costs of health care ● Bridge existing health care gaps, avoid duplication ● Reduce the cost of overall health care expenditures● Reduce stress on vulnerable patients and improve care coordination● Reduce hospital readmissions and emergency department utilization and avoid penalties

Introducing: The Community Care Connections Program

● Support clinical care by closing the loop with your patients once they’ve been discharged.● Communicate more effectively with your patients by enhancing your “frequency of touch” with them: when, where and how they wish to be contacted.● Shape the engagement strategies that drive targeted behavioral change.● Reduce unnecessary healthcare expenses and inefficiencies in care management practices.● Improve the results of chronic condition and disease management programs.

The Community Care Connections Program

● The use of two-way mobile, online and email communications● Fully secure tools, HIPAA-compliant services● Campaigns that inform and engage patients to drive compliance with post-discharge and ongoing care management services● Permission-based mobile channels drive up to 95% opt-in rates and less than 3% opt-outs

Patient SurveysStreamline your surveys:• Lower costs vs. paper systems: pay

only for completed surveys• Real time reporting can be customized

quickly• Improved response rates let you survey

more of your patients

Sample survey:• Text “EMS SURVEY” to 30123Sample reporting: • http://lil.ms/p09

Community Care Connections Addresses Readmission Issues 1. 50% of Medicare patients don’t have ongoing access to a

physician2. 30% of readmissions occur as a result of improper medication

management MedicationMonitoring

Patient Education

About Disease

Established

Physician Relationshi

ps

QuestionsContact:

Buck McAlpinBuck.McAlpin@NorthMemorial.com(763) 213-2645