The presence of not one, not two, but three Accountable Care Organizations (ACOs) makes the Dallas-Fort Worth market a truly unique place with distinctive challenges, according to two leaders who know it well, Audra Early, Executive Director for Kindred’s Hospital Division in the Dallas-Fort Worth Market, and Julie Anderson, District Director of Sales and Business Development for the Nursing Center Division in the Rocky Mountain/ Texas District.
“We have three ACOs in Dallas-Fort Worth and they are all operating differently,” Early said.
Plus ACO is a 50/50 partnership between Texas Health Resources (THR) and North Texas Specialty Physicians, a group of 900 doctors, Early said. THR came to the partnership with a group of 500 physicians, so the ACO now features a total of 1,400 physicians. It is a pioneer ACO and they are taking an innovative approach, she said. Plus currently covers 20,000 lives and is adding 50,000 more, making it a dynamic force in the market.
The Las Vegas healthcare market has shifted almost as quickly as the action on a casino table.
There are 13 hospitals and three healthcare systems there. The area has a population of roughly 2 million, with about 83 percent in managed care.
Two years ago, there were 420 individual on-staff doctors. But a year ago, internal medicine physicians consolidated into five “super groups.” Now most of the hospital systems in Las Vegas use contracts with hospitalist groups rather than employing physicians. Physicians generally direct referrals to those that cover post-acute settings, and patients are placed when and where the care is appropriate.
Four years ago, the patient mix shifted from 65 percent Medicaid patients to mostly patients covered by commercial plans and Medicare Advantage.
Before long, Kindred employees will be able to access patient information without being tied to a PC to get it. Mobile devices like iPads and iPhones are part of the company’s transition to “cloud-based” information systems meant to convey and access information quickly – and benefit patients.
Cloud-based means information will no longer be tied to individual computers and servers. It will free information from local sites because it can be stored in a data center anywhere in the world and be accessible to anyone, anywhere and anytime, if the person is authorized to see it.
Kindred’s unique relationship with the Cleveland Clinic was the focus of a break-out session this afternoon at the fourth Clinical Impact Symposium – Care Transitions Across the Continuum.
Kindred and the Cleveland Clinic have formed a partnership that has resulted in improved communication between acute and post-acute providers, and the sharing of useful programs that can benefit patients across the continuum of care.
Some unique characteristics of the Cleveland market have facilitated this collaboration: most physicians in the market are employed by two very “healthy and large” hospital systems, with independent physicians in supporting roles, said Steve Jakubcanin, Vice President of Operations for Kindred’s Cleveland Integrated Care Market. Cleveland has a total managed care penetration of 77 percent, and above-average long-term acute care hospital utilization.
The success of Kindred’s Massachusetts Integrated Care Market, which makes it a model for other integrated care markets and those moving toward becoming integrated care markets, is largely based on receptiveness toward evolution: the evolution from case to care management, and the evolution from “discharging” toward “transitioning” a patient across sites of care.
Representatives from the Massachusetts market Joe Hugar, Division Vice President of Operations for the Boston Integrated Market, and Stacey Hodgman, Senior Director of Care Management for the Boston Integrated Market, explained the growth and development in Massachusetts and its plans for the future at the Kindred Clinical Impact Symposium – Care Across the Continuum.
The ground is changing beneath the nation’s healthcare system. To survive and thrive, Kindred brought in Franke (pronounced Frankie) Elliott in August as its Chief Managed Care Officer. His message: Things will change, but “we can’t move overnight.”
It will take time and be disruptive while experiments and pilot programs are carried out at Kindred operations before making big changes, warned Elliott, who has worked in the healthcare industry, particularly in the area of managed care, for almost 20 years.
In the meantime, however, Kindred will be building capabilities for the future and demonstrating success “before a fundamental shift in policy,” Elliott said.
The changes driving this:
“Today’s payment strategy is built around a fragmented delivery system” – a pay for services model, Elliott said.
Over one-third of the facilities in Kindred’s Nursing Center Division will be using a Web-based application called PointClickCare by the end of the year; the program replaces the traditional paper chart (which can be bulky, disorganized and hard to search) and has already made patient records easier to access and update, while protecting patient privacy.
To access PointClickCare, users must log in with a unique user ID and password, keeping it secure. Once in the system, caregivers can complete their documentation right in the electronic chart.
“Traditionally, caregivers have been able to do some things on the computer but they still had to print the pages off and put them into the paper chart,” said Martha McFadden, Manager of Clinical Systems Development for Kindred Healthcare. “Now, many things can be done and stored online. The feedback we have gotten has been very positive – people just love it.”
William Altman, Kindred’s Executive Vice President for Strategy, Policy and Integrated Care, appealed to participants at Kindred’s fourth Clinical Impact Symposium, Care Transitions Across the Continuum, to share barriers they are facing at the bedside with company leadership, so that they might more effectively work toward solutions with regulators, managed care plans and partners. The 400-participant audience is made up of clinicians and managers form Kindred facilities across the nation.
Today’s healthcare environment is based predominantly on a fee-for-service model, Altman said, but that will be changing. The healthcare landscape of the future will likely be characterized by:
“This transition to future world of integrated care and integrated payment is going to be challenging,” Altman said, and there will be many conflicting messages as we collectively try to navigate it.
Kindred’s PeopleFirst Homecare and Hospice Division is now working with the company Homecare Homebase to implement their software system – HCHB and PointCare mobile; the system will become the division standard and replace traditional paper-based record-keeping. When paired with a mobile device through PointCare, HCHB allows caregivers to have access to patient information on the go.
“Our Homecare and Hospice caregivers see patients in a variety of settings, particularly in clients’ homes, and this mobile technology gives them the ability to access important patient information and input new visit data while working with patients rather than documenting after a visit is complete,” said Christa Simons, Manager of Clinical Systems Development for Kindred Healthcare. “Documenting the visit while working with the patients allows clinicians to be more efficient and accurate.”
This afternoon’s panel discussion at Kindred’s fourth Clinical Impact Symposium addressed the challenges and advances in care transitions management as they affect all four of Kindred’s divisions.
Division executive vice presidents represented the divisions: Traci Shelton from the Hospital Division; Mary Pat Welc and Jim Douthitt from RehabCare; Michael Beal from the Nursing Center Division and Jim McDonald from PeopleFirst Homecare and Hospice. Other panelists were:
Some of the challenges identified were:
While many challenges remain to be addressed as we consider ways to improve transitions of care, advances are being made. Many of these have been or will be presented at this symposium, including the Care Transitions, INTERACT and BOOST programs. Other exciting advances in the field include:
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