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:
Dr. Joseph G. Ouslander
Professor and Senior Associate Dean for Geriatric Programs at Florida Atlantic University’s College of Medicine
A photo of several elderly women under hair dryers in a beauty salon flashed on the screen, followed by a photo of another elderly woman in a hospital bed.
“If you don’t manage the conditions of elderly people, they’ll end up like this", said Ouslander of the hospital photo.
Believing that “geriatrics is a team sport,” he helped develop the INTERACT program (Interventions to Reduce Acute Care Transfers).
INTERACT helps chart changes that home health aides, CNAs, dietary workers and family members have noticed in patients. The documentation can help:
Mark V. Williams, MD
Professor and Chief of the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine
Details and lessons learned from Project BOOST, a Society of Hospital Medicine-sponsored program that seeks to improve the care of patients as they transition from a hospital to another facility or to home, were shared with Clinical Impact Symposium participants by project leader Mark V. Williams, MD, Professor and Chief of the Division of Hospital Medicine at Northwestern University Feinberg School of Medicine in Chicago.
Williams was an investigator on a 2011 New England Journal of Medicine study looking at rehospitalizations among patients in the Medicare fee-for-service program. The study found:
Miscommunication each time a patient is transferred between healthcare teams – from a hospital to post-discharge homes or their own home, for instance – can create more medical problems, lead to costly hospital readmissions and endanger lives.
Interspersing his passion for dealing with this problem with flashes of humor, Dr. Eric Coleman described his Care Transitions Program. Its primary goals include:
It’s based on forging partnerships by:
There are so many patient education pamphlets sent home with the patient, they could be “used as an ottoman” -- but Coleman questioned whether they are used by the patient. In the hospital, healthcare workers do things for the patient around the clock, “but then after 14 minutes of ‘education’ just before release, they go home and have to do it themselves... Imagine what it’s like to be this person with no health professional around,” he said.
“Care transitions across the continuum” is the focus of this year’s Kindred Clinical Impact Symposium, and the topic could not be more timely or important, according to Kindred’s Chief Executive Officer Paul J. Diaz, and its President and Chief Operating Officer Benjamin A. Breier, who welcomed the symposium’s 400 participants this morning.
In today’s healthcare environment, putting patients and residents in the right place at the right time is imperative, Kindred’s leadership said. Baby boomers are aging, creating a stress on the American healthcare system, and government and healthcare organizations are calling for the management of patients at a lower cost. We are seeing moves toward reducing costly readmissions to acute care hospitals, and managed care and pay-for-performance models of healthcare delivery.
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