“ Building a Shared Foundation for Interprofessional Education and Clinical Practice”

1. “Building a Shared Foundation for Interprofessional Education and Clinical Practice” Lennie Blythe, RN, Union Franciscan ACO Stephanie Laws, MSN, RN, Rural Health Innovation Collaborative Lauren Ford, Physician Assistant Student, Indiana State University

2. Project Background • On March 23, 2010, the Patient Protection and Affordable Care Act (Healthcare Reform) was signed into law. • Healthcare reform focused on two main areas: • Care delivery • Reimbursement

3. Healthcare Reform & Reimbursement • “Value” focus: Payment increasingly tied to quality and cost. • Centers for Medicare and Medicaid Services (CMS)- hospital payments now dependent on outcomes. Physician office payments affected starting 2015. • Commercial- Increased payments to providers dependent on meeting quality standards.

4. Healthcare Reform & Reimbursement • Summary: Healthcare reform focuses on ways to provide better care by giving providers more information and focusing in on quality/value….but how do we get there?? ACCOUNTABLE CARE ORGANIZATIONS (ACOs)

5. What is an Accountable Care Organization? • An Accountable Care Organization is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.“ • ACOs are made up of groups of healthcare providers and provider entities that agree to work together to coordinate care for the patients they serve. • Definition per the Center for Medicaid and Medicare Services (2012).

6. What are the Goals of Accountable Care? • There are three main goals of an ACO, often referred to as the “Triple Aim” • Better health for the population • Higher-quality care • Lower costs of care

8. How do ACOs Help Achieve the Triple Aim? • ACOs focus on providing better healthcare by improving quality and reducing costs across the entire continuum through: • Improved care coordination • Reduced waste (e.g. duplicate testing) • Internal process improvement • Informed patient choices & engaging patients and their families • Chronic disease management • Actionable, timely data (via health information technology and data sharing) • Creation of partnerships across the continuum of care (preventative, acute, post-acute)

9. Who is the ACO & How do Patients Become Part of it? • The ACO is focused on Medicare beneficiaries. Individuals with Medicare as a primary insurer can be “attributed” or assigned to the ACO. • CMS attributes patients to the ACO. The ACO cannot choose which patients are in the ACO. • Patients are attributed to the ACO based on providers. If the provider they see for the majority of the primary care based services joins the ACO, then there is a good chance that the will be attributed to the ACO. • At this time only Medicare patients who have had traditional Medicare (both Part A &B coverage) for at least 12 months can be attributed. Medicare Advantage members cannot be in an ACO

11. 15,000 LIVES

12. Skilled Nursing Facility Opportunity • The west central Indiana demographic (Terre Haute MSA) ranked at or above the 75th percentile doe Normalized SNF Days per 1,000. • Additionally, SNF readmissions within 30 days post-hospital discharge comprised a significant amount for conditions such as pneumonia, CHF, and post-orthopedic care.

13. Partners in the ACO mission…. While the ACO has embraced many community partners the following skilled nursing facilities are the sites of our student-based project: • Meadows Manor North • Meadows Manor East • Providence Health Care • Springhill Village

14. ACO Student Project Developers Center for Health Wellness and Life Enrichment Union Franciscan ACO

15. Pilot Project Overview • The rotation is designed to provide students with autonomous, yet safe, learning opportunities that will enhance the students’ ability and confidence to perform medical assessments; formulate appropriate diagnoses or clinical suggestions based on findings; interpret laboratory and other diagnostic studies; complete comprehensive medical record reviews; and complete medication inventories for assigned patients.

16. Project Goals STUDENT GOALS: • Enhanced knowledge of ACOs • Enhanced clinical confidence and competence • Interprofessional education/collaboration • Workforce readiness ACO GOALS: • Better population health • Higher quality care • Lower costs of care • Decreased readmissions through enhanced continuity. • Decreased length of stay at each nursing home

17. Project Activities • Completing intake assessments for all assigned patients. • Complete weekly rounds and required documentation on assigned patients. • Communication with the assigned ACO Care Coordinator.

18. Pilot – Fall 2013 • 1st Year Physician Assistant Students • Social Work Student (BSW candidate) • 15 participated • Completed 3 simulation experiences • Completed surveys: • Pre/Post ACO Knowledge Assessments • Pre/Mid/Post Clinical Skills Confidence

19. Pilot - Fall 2013 • Meadows Manor East • Meadows Manor North

20. Pilot - Fall 2013 • Providence Health Care • Springhill Village

21. Fall 2013 - ACO Knowledge

22. Fall 2013 – Clinical Skills Confidence

23. Continuation - Spring 2014 • 1st and 3rd Year Physician Assistant Students • 58 students participating • Split into 2 sessions • To complete 2 simulation experiences • To complete pre/post: • ACO Knowledge • Clinical Skills Confidence • Weekly patient rounding • Assigned to same 4 clinical sites

24. Interprofessional Education • Additional student disciplines being integrated: • Behavioral Health • Recreation Therapy • Nursing • Public Health

25. Spring 2014 – Meadows Manor East Chelsea Elwood Brianne Wagenman Mike Finigan Lauren Ford Lindsey Graft Erin Haaff • Session 1 • Session 2 Rachel Sanderson Christopher Schmidt Marcus Schwab Sara Spring Cynthia Shepard Meredith Stackhouse

26. Spring 2014 – Meadows Manor North AmalBeydoun Joshua Chambers Joe Bonomoni Raymond (Ron) Contreras • Session 1 • Session 2 Justin David Jessica (Brooke) Dailey Colt Cansler Kate Pippins Allison Pullar Laura Mitchell Emily McMahon Jordan Pothast Sara Niles Matt Nicholson Emily Marshall

27. Stephanie Tobin Katherine Hill Justin Jacobsen Cody Lawnichak Megan McGary Lynnaire Jastillano Spring 2014 – Providence Health Care • Session 1 • Session 2 EleonorSviridova Cherisa Fletcher Phil SwinkMarkay WilsonJoanne VanderhydeAtiq Zamani

28. Spring 2014 – Springhill Village Carolyn Hanrahan Chase Hayes ErynHasenour Jenifer Fortney Amber Thomas • Session 1 • Session 2 Krista Irwin Sarah Hogue Aaron Heaslet Rachel Hewitt Shelby Howard JasminaSpahic Jennifer Simatovich Jay Swanson Ryan Strom Annemarie Spiezia Brittany Heiser Allison Lipps Brittany Stanek

29. Spring 2014 - Meadows Manor NorthBehavioral Health Elaine Gilbert Stephanie Murphy Kelly Schuder Michelle Ertl Ruth Viehoff Amanda Yeck

30. A Student’s Perspective……

31. In action and onsite…..

32. Next Steps • Continued replication of project to additional skilled nursing facility sites (rural). • Continued evaluation. (quality and cost) • Opportunity for research and publication as it pertains to interprofessional student experiences. • Policy change/management?