The Success and Challenge of Developing A Complete Continuum of Care in an Integrated Delivery System: The Partners Continuing Care Story
David E. Storto President Partners Continuing Care & Spaulding Rehabilitation Network Continuing Medical Education Disclosure
I, David E. Storto, have no commercial relationships to disclose. Objectives 3
. Understand the organizational, political and financial challenges of developing a continuum of care in an integrated system and how to overcome them
. Understand the role of teaching and research in supporting the excellence and reputation of a rehabilitation institution
. Understand the importance of a “one stop shopping” referral relations strategy to ensure continuity of care
3 Mission and Vision Today
4
Mission Partners Continuing Care is committed to delivering compassionate care across the health care continuum to improve quality of life for persons recovering from or learning to live fully with illness, injury and disability.
Vision Partners Continuing Care will be the nationally recognized leader in research and education achieving exceptional patient outcomes and known for delivering a broad range of innovative and integrated health care solutions. We will exercise leadership to shape health policy and to advocate for our patients, their families and our staff.
4 Spaulding Rehabilitation Hospital Today 5
5 “ “My momma used to say that it is important to know where you came from to appreciate where you are going.”
Forrest Gump Massachusetts Rehabilitation Hospital Opened on September 16, 1970 7
7 Spaulding Family Sold the Hospital to MGH in 1984 8
8 Corporate Organization Chart Before Partners Continuing Care
Two Physicians Dana Farber/Partners PARTNERS HEALTHCARE SYSTEM, INC. Cancer Care Appointed by Partners
Partners Community HealthCare, Inc. Brigham and Women’s/ The Massachusetts The North Shore Newton-Wellesley Faulkner Hospitals, Inc. General Hospital Medical Center, Inc. Health Care System, Inc.
The General Hospital Corporation The Salem Hospital The Brigham and Women’s Newton-Wellesley Hospital Hospital, Inc. North Shore Children’s Hospital Massachusetts General • Greater Salem VNA Physicians Organization, Inc. Brigham and Women’s NeWell Medical Delivery Physician Hospital Organization, Inc. Organization, Inc. The McLean Hospital Corporation Union Hospital, Inc.
Newton-Wellesley Hospital Faulkner Hospital, Inc. The MGH Institute of Charitable Foundation, Inc. Health Professions, Inc. Shaughnessy Kaplan Rehabilitation Hospital, Inc. Boston Center for Massachusetts General Health Rehabilitation and Services Corporation Sub-Acute Care Newton-Wellesley Home • Fox Hill Village Charter Professional Health Services, Inc. Services Corporation Village Manor North End Community Health Nursing Home Committee • North End Nursing Home Newton-Wellesley Enterprise, Inc
The Spaulding Rehabilitation Hospital Corporation • ACVNA TLC Nursing, Inc. • MGH/Spaulding HH
Rehabilitation Hospital of the Cape and Islands, Inc. Corporate Reorganization Launched With Key Goals 10 . Enhance the quality and importance of non-acute care within Partners – Increase presence by bringing all providers together in one corporate family – Overcome perception of non-acute providers as subordinated within the System
. Foster development of specialized and dedicated infrastructure for administration – Difficult for acute sector focused expertise to address unique regulatory and business issues facing non-acute providers
. Permit more timely and effective integration providers amongst themselves – Achieve economies of scale and reduction of administrative expense – Minimize counterproductive competition
10 Current Corporate Organization Chart 11
Dana Farber/Partners Partners HealthCare Two Physicians Partners Community Cancer Care Appointed by Partners Health Care
Brigham & Women’s Massachusetts General North Shore Medical Newton-Wellesley Partners Continuing Care Neighborhood Health Care Hospital Center Health Care Health Care System Health Plan
Massachusetts General Spaulding Rehabilitation Network Brigham & Women’s North Shore Newton-Wellesley Community Medical Physicians Organization Hospital Medical Center Hospital Spaulding Rehabilitation Alliance Hospital Boston McLean Hospital Brigham & Women’s Corporation North Shore Newton-Wellesley Spaulding Hospital Physicians Organization Physicians Group Physicians Organization Cambridge The MGH Institute of Health Professions Spaulding Rehabilitation Brigham & Women’s Hospital Cape Cod Faulkner Hospital MGH Health Services Spaulding Nursing Corporation & Therapy Center Brighton Clark House at Fox Hill Village Partners HealthCare at Home Martha’s Vineyard Hospital Home Care
Advanced Clinical Nantucket Cottage Programs & Technology Hospital
Cooley Dickinson Health Care
Wentworth Douglas Hospital Need to Align Financial Incentives Was a Threshold Issue 12
. How do we deal with the fundamental tension between access to PCC and profitability?
. How do we reconcile system benefit vs. “every tub on its own bottom” within the Partners financial framework?
. Is there a more viable way to deal with our extremely “hard to place” patients development of the “value transfer” concept?
12 Make Yourself Necessary to Someone Ralph Waldo Emerson 13
Acute Post-Acute
LOS Access Leakage Throughput
. PCC assumed greater risk of adverse selection (financial and clinical) in exchange for “value transfer” and recapitalization Partners Continuing Care Request for Facility Investments and RECAPITALIZATION
Partners Finance Committee Meeting November 13, 2008 Acquisition of Youville Hospital Today Spaulding Hospital Cambridge 15
15 16 Authorization to Proceed with Construction of a New Spaulding Rehab Hospital 17
. 132 private inpatient beds — 120 adult beds — 12 pediatric beds . 264,000 sf above ground, 115,000 sf underground . 5 inpatient floors over a 3 floor base of outpatient, support services, and public spaces
. Designed as a model hospital for accessibility, both inside and out . Incorporates the latest sustainable and energy efficient technologies and will obtain at least a LEED Silver rating
17 Boston Marathon Bombing Survivor Roseann Sdoia on Patient Move Day to New Hospital 18
18 The Celebration With the Boston Pops 19
19 Partners Continuing Care Spaulding Network 20 Inpatient Rehabilitation Facilities (IRF) Spaulding Rehabilitation Hospital . 132-bed inpatient rehabilitation facility (IRF) hospital . 2,500 inpatient admissions . Harvard teaching hospital and leader in rehabilitation research . Ranked by US News & World Report as one of the best rehabilitation hospitals Spaulding Rehabilitation Hospital Cape Cod . 60-bed IRF . 1,100 inpatients
Long Term Acute Care Hospital (LTAC)
Spaulding Hospital Cambridge . 180-bed LTAC hospital . 2,100 inpatient admissions
Skilled Nursing Facility (SNF) Spaulding Nursing and Therapy Center Brighton . 123-bed SNF . 1,100 admissions
20 Spaulding Outpatient Network 21
. 25 site locations . 15.5% EMASS market share
21 Spaulding Residency Training and Education 22
. 24 Residents in PM&R – Highly competitive match results . 6 Fellows 2 Spinal Cord Injury 2 Brain Injury 1 Pediatrics 1 Sports Medicine . Multiple teaching affiliations in nursing and rehabilitation therapy
22 Teaching, Research, Innovation and Centers of Excellence 23
. Awarded all three Model Systems . Recognized by Doximity as the Grants in brain injury, spinal cord #1 Residency in PM&R for and burn rehabilitation overall reputation
2018 Teaching, Research, Innovation and Centers of Excellence 24
. Conducted the first ever “Rehab Medicine Hackathon” with Massachusetts Institute of Technology
24 Philanthropic Commitment to Invest in Research 25
. In “silent-phase” of $75M Campaign to create the Spaulding Research Institute . More than half way toward goal . Received leading gift of $10M
25 Spaulding Is Leveraging Its Competitive Geography 26
Exploit Opportunities for Innovation
26 Spaulding Is Leveraging Its Competitive Geography 27
27 Spaulding Is Leveraging Its Competitive Geography 28
28 Spaulding Is Leveraging Its Competitive Geography 29
29 Spaulding Is Leveraging Its Competitive Geography 30
30 #2 US News & World Report Best Rehabilitation Hospital Rankings 32
2018 2000 Shirley Ryan AbilityLab 1 1 Spaulding Rehabilitation Hospital 2 14 TIRR Memorial Hermann 3 3 Kessler Institute of Rehabilitation 4 4 University of Washington Medical Center 5 2 Mayo Clinic 6 5 Rusk Rehabilitation Center 7 7 Craig Hospital 8 6 Shepherd Center 9 18 Moss Rehab 10 12
32 Partners HealthCare at Home 33
Home Care . Merger of what once were 30 individual agencies . 27,000 admissions per year . Each day, more than 3,600 people are under care . 1,400 employees
Advanced Clinical Products and Technologies . Lifeline: Personal emergency response system offering 24/7 two-way communication to a monitoring center to help patients live safely at home – Over 4,000 subscribers . Telemonitoring: Remote patient monitoring which decreases the risk of patients unexpectedly returning to the hospital – 300 congestive heart failure patients per day . Medication dispensers: pre-loaded medications at the touch of a button
33 Partners Continuing Care How We Are Organized
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. One Board of Trustees
. One Executive Management Structure
. A Fully Integrated Continuum of Care
. One Brand
34 Partners Continuing Care Our Brand Architecture Today 35
35 “One Stop Shopping” With Unified Liaison Workforce 36 . We have integrated the referral and admission process across PCC to seamlessly move patients through the health care continuum . Integrated screening and work flow processes allow liaisons to evaluate patients for any level of care within PCC and from any location:
- Hospital - Physician’s office - Skilled nursing facility - Home - Outpatient center
One-Stop-Shop Approach
36 “The future ain't what it used to be”
Yogi Berra CMS and MedPAC Concerned About Post-Acute Spending 38
38 The Current Focus on Reducing Total Medical Expense Is Changing How We Think About Acute Length of Stay 39
Readmissions LOS Access
New Performance Metrics . More than just access: now it’s readmission rate and access . Requires greater coordination and capabilities ―Shared process improvement ―Integration into hospital readmission reduction programs ―Enhanced post-acute clinical management
39 Shift to Value and Population Health with Increasing Risk 40
. Aging population projected to increase volume of cases to post-acute care – Largest volume increases expected in home and outpatient settings . Value-based systems, will push patients to the lowest cost care setting . Increased provider risk will heighten need for medical expense management and require improved coordination and integration of care across the entire continuum
PHM FFS PHM
40 Aligning PCC Strategy with Partners Under Health Care Reform 41 eCare System Vision
Care redesign Patient affordability Population Health
Desired System Outcomes
Reduce cost and increase value Strong quality and financial performance
PCC’s Role
Provide full Lower cost Decrease ED Reduce acute Improve quality outcomes continuum of care venues of care utilization readmissions and patient satisfaction
PCC Strategies, Goals and Initiatives
41 Consolidate Inpatient LTAC and SNF Owned Assets 42
Spaulding North Shore Spaulding Cambridge
Spaulding North End
Spaulding Brighton Spaulding West Roxbury
42 Skilled Nursing Facility Collaborative 43 Waiver of 3-day qualifying stay and continued restriction on access to IRF/LTAC is likely to increase utilization of SNF.
. Unite local AMC and community hospital efforts into a uniform, integrated approach to SNF care . Establish a collaborative network of qualified SNFs, reducing the overall number of SNFs used by PHS from 500 to 50−70 providers . Improve SNF quality, reduce readmissions, LOS and overall episode costs
Buy vs Build?
43 SNF Collaborative Performance 44
ALOSALOS ReadmissionReadmission Rate Rate 19.2% 20.2 20.7 17.5 17.1 18.1% 17.6% 16.5%
CY16 CY17 CY16 CY17 SNF Collaborative Non-Collab SNFs SNF Collaborative Non-Collab SNFs
Data Source: MCR ACO Claims data for patients discharged from PHS Acutes to SNFs
44 Invest and Grow Outpatient Rehab 45
Outpatient Visits Growth 464,881 409,211 425,449 364,942 379,880 321,911 328,086 298,451
FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 Q3ann
. In FY18, visits grew 9.3%, performing ahead of budget and exceeded the “stretch” goal established in the Business Plan of 6.4% growth . Over 46,000 new patients will have been seen in the 25 OP Centers by year end
45 Invest In Home Health Services 46
Overall admissions have increased 5.2% year over year
5.2% growth
33,279 31,648
FY17 FY18 Q3ann
46 Innovative Programs to Support Population Health 47 Mobile Observation Unit (PMOU) & Home Hospital Pilots
. Staffed by PHH, these programs have the following key objectives: – Reduce unnecessary admissions to the acute hospitals – Intervene in Emergency Department to identify patients who can return home – Deploy NP to home of patients to assess their clinical needs in coordination with their Primary Care Physicians
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