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January 28, 2014

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Mission and Regulatory Requirements Health at Home Mission

To provide high quality, culturally competent home health services to residents of SF, resulting in reducing reliance on institutionalization and supporting independent living in the community

Regulatory RequirementsMedicare Conditions of Participation for Home Health

Agencies Professional Advisory Board

Meets annually to review program highlights, performance improvement and approve policies & procedures

California Title XXII, CA Health and Safety Code

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Program Highlights - FY 12-13New Administrator, Maggie RykowskiTransitioned oversight and leadership from SFGH to LHHRecipient of two grants from the SFGH Foundation which resulted in improving HAH clients functional status and promoting independence in the community

1) Provision of prescription eye glasses for vision impaired HAH clients

2) Provision of microwaves, small refrigerators and emergency food to HAH clients who are nutritionally compromised.

Implemented full Wi-Fi access for field clinicians to facilitate timely communication across the continuum of care and also as a precursor to establish and maintain a paperless documentation system.Health Commission Award for Fiscal Responsibility given to Lily Ng, Business Manager

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Key Program Statistics FY 12-13

PAYER # of VISITSMediCare 387 33% 7002Medi-Cal 154 13% 1891

Medi-Cal Managed Care 371 32% 5900HIV CARE Contract 78 7% 1336

Others (IHSS Workers) 24 2% 277Uninsured/HSF 149 13% 2693TOTAL 1163 100% 19099

# OF CLIENTS

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HAH Key Program StatisticsFY 12-13 FY 11-12

# of Visits 19,099 19,841

# of Clients 1,163 1,096

Average LOS (days) 44 49

Average visits/episode 12 13

Average cost/Client $6,029 $6,481

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2012 OSHPD DATAOffice of Statewide Health Planning and Development (OSHPD) 2012

report - San Francisco Home Health Medi-Cal Visit Data

Facility Name Medi-Cal Visits % HEALTH AT HOME 8717 49.15%

UCSF HOME HEALTH CARE 6588 37.15%

SUTTER VNA 1714 9.66%

AMERICAN CAREQUEST 412 2.32%

CROSSROADS HHA 220 1.24%

SELF-HELP HOME CARE AND HOSPICE 56 0.32%

BAY AREA CARE TEAM INC 16 0.09%

INCARE HOME HEALTH SERVICES 7 0.04%

HEALTH LINK HOME HEALTH AGENCY 5 0%

AVALON HOME HEALTH INC. 0 0%

KAISER SF - GEARY - 0 0%

ON LOK SENIOR HEALTH SERVICES 0 0%

NORTH CAL HOME HEALTH CARE, INC. 0 0%

TOTAL Medi-Cal Visits (San Francisco) 17735 100%

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2012 OSHPD DATAPayer Mix Comparisons

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HAH Budget

FY1213

Labor expenses $6,585,546

Operating Expenses $426,161

TOTAL EXPENSES $7,011,707

Revenue $2,742,942

General Fund (GF) $4,268,765

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HAH Funding Source

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HAH Funding SourceTotal

Payer # of Clients # of Visits Payer Revenue Gen FundsRevenue By Payer Subsidy

MediCare 387 7002 $1,574,034 $225 $142Medi-Cal 154 1891 $125,763 $67 $301Medi-Cal Managed Care 371 5900 $424,054 $72 $295HIV CARE Contract 78 1336 $521,450 $390 $0Others (IHSS Workers) 24 277 $20,680 $75 $292Uninsured/HSF 149 2693 $76,961 $29 $339Totals 1,163 19,099 $2,742,942

Reimb Per Visit

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Top Five Diagnosis

1. Rehab procedures and aftercare 19%

2. Diseases of the Circulatory System 16%

3. Disease of the Musculoskeletal System &

Connective Tissue 11%

4. Neoplasms 9%

5. Symptoms, Signs and Ill-Defined Conditions(e.g. Abnormality of Gait, Urinary Retention & Cachexia) 8%

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SFGH IP29%

SFHN COPC & Specialty Clinics

59%

Community/Other

7%

SNF1%

LHH4%

Referral Sources(n=1,250)

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GMC30%

FHC13%

Ward 869%

HUH8%

TWC11%

SEHC6%

PHHC4%

Curry SC3%

MHHC6%

OTHER COPC Clinics

10%

HAH Referrals from SFHN COPC Clinics(n=700)

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Asian/PI17%

African American

26%

Caucasian25%

Hispanic/Latino16%

Others16%

HAH Clients by Race/Ethnicity

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Staffing

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HEALTHAT

HOME

CAAVG

NAT’L AVG

How often patients receiving home health care needed any urgent, unplanned care in the hospital emergency room – without being admitted to the hospital.

11% 11% 12%

How often home health patients had to be admitted to the hospital

15% 15% 16%

Quality

Preventing Unplanned Hospital Care

Home Health Compare

Reporting period: 7/2012-6/2013

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Client Satisfaction

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Above and Beyond

Annual holiday gift bag project. Donations from:

Safeway, Sports Basement, Trader Joes, Falletti’s Food, Rainbow

Grocery & Staff

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Challenges, Opportunities and Goals for 2014

•Increased focus on reducing reliance on general fund through efficient service utilization management, cost reduction, skill mix changes, maximized referral base and increased revenue

•Impact of ACA implementation in 2014:•Inclusion in health plan contracts•Barriers of authorization process and waiting time•Challenges of patient education and choice•Effects on census and reimbursement

•ICD-10 implementation in 2014

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•Management of increased demand for HAH rehab services

•Increase coordination and collaboration with SFGH discharging planning team to better serve patient needs.

•Implementation of electronic signature

•Efficiency and Operations improvement

•IT integration and upgrade of HAH IT position to align with DPH IT structure

•Preparing for upcoming license renewal survey (early 2015)

Challenges, Opportunities and Goals for 2014

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Questions/Comments