Value-Based Care StrategiesHow Multi‐Organization Partnerships Generate Speed to Success

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Nina PlataVP of Population Health

Rodrigo Giacinti, MHAOperations Director, West Region

Bobbie Kumar, MD MBA FAAFPDirector, Complex Care Management & BPCI-A Physician Lead

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Agenda1.Partnership Overview2. Locations (Central Valley)

3. Value Based Care Program Description

4. Implementation Process

5. BPCI-A Operational Impact

6. Lessons Learned

7. Key Opportunities

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Partnership Overview

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SignifyHealth is the largest episodes of care company

✓ 400Employees

2011Founded

4,130Physicians Initiating Episodes

1,644SNFs in

Performance Networks

485Hospitals from which Episodes are Initiated

100%BPCI Classic

Partners Generating Savings

46%Market Share

bundles selected

Physician GroupsAcute-Care Hospitals

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We see over 6.4 million patients annually

1,400Advanced providers

2,500Physician partners

2,000Scribes

300+Practice locations

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History/Coverage:

Faith-based, nonprofit integrated health system serving the West Coast and Hawaii

Adventist Health is a faith-based, nonprofit integrated health system serving morethan 80 communities on the West Coast and in Hawaii. Founded on Seventh-day Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care agencies, hospice agencies and joint-venture retirement centers in both rural and urban communities.

Our compassionate and talented team of 37,000 includes associates, medical staffphysicians, allied health professionals and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope. Together, we are transforming the American healthcare experience with an innovative, yet timeless, whole-person focus on physical, mental, spiritual and social healing.

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Our mission

Living God’s love by inspiring health, wholeness and hope.

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• Tehachapi• Bakersfield• Tulare• Hanford• Selma

Region: Central California Region is made up of 9 hospitals and more than 130 clinics:

• Reedley• Lodi• Sonora• Delano• New: Dameron

Stockton

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Adventist Health in the Central Valley is made up of four hospitals and more than 40 clinics in more than 60 sites across Kings, Fresno, Tulare, Kern and Madera counties.

More info may be found on our website here:https://www.adventisthealth.org/about-central-valley/

Market

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Locations

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1.Adventist Health Hanford (Hanford, CA)

2.Adventist Health Reedley (Reedley, CA)

3.Adventist Health Tulare (Tulare, CA)

4.Adventist Health Selma (Selma, CA)

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Value-Based Care (VBC) Risk and Scope

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Value-Base Care Mix• Counties Served: Fresno, Tulare, Kings

County• Adventist Health Tulare• Adventist Health Hanford • Adventist Health Reedley• Adventist Health Selma

Participating Hospitals

• Risk Track 1• Covered Lives: 29,000• Future Goals: 200,000 lives by 2022• Performance Network SNF’s: 15 sites• Performance Network HHA’s: 3 sites

Adventist Health (ACO)

• Covered Lives: 1,000• Number of Bundles: 11• Performance Network SNF’s: 15 sites• Performance Network HHA’s: 3 sites

Vituity and Remedy (BPCIA)

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Implementation Process

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VBC Providers are Rewarded for Improved Outcomes

Anchor Admission40%

Long-term Care2%

Inpatient Rehab2%

Skilled Nursing20%

Home Health6%

Readmissions14%

Outpatient Care5%

Part B/DME10%

Average Cost Distribution:

40% + of spend occurs after hospital discharge.

Operational Levers:1. Next Site of Care Decisions2. Post-Acute Stay Duration3. Patient Readmissions4. Select Post Acute Network

Anchor admissions are not targeted for cost reduction.

Source: Cost distribution example from the July 2018 reconciliation for episodes initiated between 2017Q1-2017Q4 by all Model 2 and Model 3 providers.

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The table below captures the role of our partners in each implementation domain necessary for successful implementation.

Expectations for Partnership

Program Leadership

Program Administration

Analytics

Technology

Care Redesign

Vituity Program Offerings• Physician & Advanced Provider

Education• Patient Care Navigation• 24/7 Telemedicine Emergency

Physician Access

SignifyHealth• Patient ID Identification• Technology• Software Platform• Best Practices• People• Real Time Analytics and

Reporting• Partnering with top 10% SNF in

the nation

Adventist Health• 24/7 RN Coverage• Star Rating of 3 or higher• Successful surveys by state or other

accrediting bodies• Weekend Admissions (2hr)• 75% participation in meetings• Implementation of Evidence Base

Protocols• Availability of therapies 6 days a week• Acceptance of admissions regardless

of payer source• Willingness to share data and outcome

metrics

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Tailoring the Implementation Approach

Develop a set of questions to better understand how to design and stand up your program:

1. Governance & decision-making

2. Integration of BPCI-A with other programs

3. Technology ecosystem4. Physician engagement5. Post-acute ecosystem 6. Executive leadership7. Program management

After selecting your risk, tailor your prioritized care redesign initiatives to the current priorities of each site to optimize speed-to-success (e.g., next site of care, readmissions)

Planning Discussions Speed-to-Success Initiative

Take considerable time to understand the ecosystem of each hospital

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Operational Impact

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Operational Impact

SNF LOS

-12.0%Avg. SNF LOS (days)

Reduction

26.4 Avg. SNF LOS (days)

Reduction

Patient Readmissions

-5.2%Avg. 90-day Readmission

Rate Reduction

-7.7%Avg. 30-day Readmission

Rate Reduction

ACO

BPCIA

Next Site of Care Decisions

+8.3%Avg. HHA Utilization

Increase

20 Days2020 Goal Avg. SNF

Discharge Rate Reduction

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BPCIA Bundle Selection

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Partnership Evolution

2018Partnership Start• Assessment

and discovery• Goal Alignment

and stakeholder buy in

• Evaluation of resources needed

• Internal and External Education

2019 Execution• PAC Network

Development and Workflow Optimization

• Technology Alignment and Adoption: Internal and External user training and tech adoption

• Care Pathways• Data Analysis

and actionable priority insights

2020Goals• Telehealth

Medicine (Vituity)• Transitions of

care education for clinical and operational stakeholders

• Realign objectives by utilizing data (claims) and optimize quality of care

• Review current strategies

Pressure Points • Lagging Data• Placing SNFist

at selected sites

• Alignment with independent providers

• Region/markets are vastly different

• Changes to CMS Regulation requirements and reimbursement

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Lessons Learned

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We summarized our lessons learned into 3 categories:

TechnologyCare RedesignProgram Partnership 321

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Lessons Learned – Program Partnership

1.Executive leadership engagement is critical

2.VBC must be an organizational priority and resources

3.System-level & hospital-level engagement

4.Clear partnership structure and role clarity

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Lessons Learned – Care Redesign

1. Operational Focus on Core Levers:2. Piggyback on Existing Initiatives 3. Importance of Hospital Case Management4. Focus on IDT and transitions of care

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Lessons Learned – Data Integration & Technology

1. Timeliness of data integration 2. Data feed quality3. Technology supports but does not guarantee

program success4. Upstream workflows drive downstream data quality

and timeliness

Questions?

Raise your hand or submit a question at www.menti.com and enter code 80 39 38

Thank You

Rodrigo Giacinti, MHA, Operations Director West, SignifyHealth, rgiacinti@remedypartners.comNina Cornell Plata, RN, BSN, MS, Vice President of Population Health, Adventist Health, platanc@ah.orgBobbie Kumar, MD, MBA, FAAFP, Director of Complex Care Management, Vituity, bobbie.kumar@vituity.com