2020 Performance Commission Coaching Implementation Through March 31, 2011

1. 2020 Performance CommissionCoaching Implementation Through March 31, 2011 John Van de Wetering, Chair President Emeritus of SUNY Brockport

2. Measure of Success – Targets for 2011 • Reduction of hospital readmission trend by 12% • Reduction of avoidable ED visit trend by 5% Measure of Success – Targets for 2014 • A 25% reduction in Hospital Admission trend A reduction of 2,981 Hospital Admissions Rate decrease to 1,046/100,000 from 1,395 / 100,000 • A 15% reduction in Avoidable ED Visit trend A reduction – 17,572 visits Rate decrease to 23,651/100,000 from 25,344/100,000

3. Self – Reported Aggregate Coaching Data *Based on coaching organizations data tracking, not health plan data

4. Community – Wide Coaching Success To Date Targets - By December 2011: • 18 Active Coaches (Currently have 14 trained Coaches; exceeding the initial goal for March by 2 trained Coaches) • 5 Active Hospitals (Currently have 4 Active Hospital Systems) • Two payers active in all 5 hospitals (2 Systems - 2 payers) • 2500 people will have received coaching (351 Jan – March ) • Readmission rates and ED rates of coached patients compared with community (Dependency - Claims Availability) • Physician follow up visit within 0-7 days of discharge (Dependency – Claims Availability)

5. Community Wide Coaching Success To Date • Eligible patients • Excellus – All lines of business >18 with Preventable admission • MVP – All lines of business > 18 with Preventable admission • Monroe Plan – Medicaid Managed Care with Preventable admission • Active Coaching Relationships as of June 2011 • SMH-Highland and Monroe Plan (MP) and VNS (MVP) • RGH and Lifetime Care (Excellus) and Monroe Plan (MP) • Unity / Park Ridge and Lifetime Care (Excellus) • Lifetime Care plans to extend into Newark – Wayne Hospital • VNS plans to extend into Unity Hospital

6. Community Wide Coaching – Learning Collaborative April and June 2011 • 11 Coaches attended representing Lifetime Care, VNS, Monroe Plan, Lifespan, Jewish Family Service, Livingston County Office of the Aging and HCR • Supervisors/Administrators invited to observe skill development after Coaches met as a team • GOALS: • Improving patient acceptance while in hospital • Improving hospital Staff Acceptance of Coaching

7. Learning Collaborative Lessons Learned • Patient Identification takes time • Establishing a rapport with hospital Staff takes time • Medicaid population requires Coaching Plus • Literacy can be a significant barrier to success • The hospital team (discharge planners, care managers and nurses) will be the most successful promoters of coaching to patients and are instrumental in increasing acceptance rates A Barrier for Patients Accepting Coaching: • Patients are concerned about Coaches going into their home

8. Next Steps • Obtain readmission and ED data on those not accepting coaching or not completing the program • Finalize fourth quarter 2010 and first quarter 2011 from claims data • Secure ED data from health plans • Center for Medicaid and Medicare Services Community - Based Care Transitions Grant

9. Finger Lakes Health Systems Agency The triangle represents our agency’s role as a fulcrum—the point on which a lever pivots—boosting the community’s health by leveraging the strengths of all stakeholders. The fulcrum is also a point of equilibrium, reflecting our ability to balance the needs of consumers, providers and payers on complex health matters. The inner triangle also evokes the Greek letter delta—used in medical and mathematical contexts to represent change—with a forward lean as we work with our community to achieve positive changes in health care. Give me a lever long enough and a fulcrum on which to place it, and I shall move the world. —Archimedes 1150 University Avenue • Rochester, New York • 14607-1647 585.461.3520 • www.FLHSA.org