Fred Benjamin AHCA/NCAL Regional Multifacility Council Chair President LTC Division, Lexington Health Network

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3 Fred Benjamin AHCA/NCAL Regional Multifacility Council Chair President LTC Division, Lexington Health Network

4 The Two Big Unfixables Aging and Dying. A Discussion about Being Mortal

5 Is More Better? Prolonging Life At The Expense Of Quality Of Life David Gifford, MD MPH Senior Vice President for Quality & Regulatory Affairs

6 Churning at End of Life Home Hospital 20% 1 SNF 2.2M Medicare admissions 23% 1 50% 2 45% 2 Assisted Living Nursing Home 19% 4 20% 3 1. Mor et al., CMS NHC site 3. Commonwealth Jencks NEJM Analysis of SNF Claims ER 5% 5 Death

7 A third use LTC but account for 87% of Costs Costs of Long-Term Care Services 2007

8 Elderly want to stay in their home 1 Surveys of community elderly show a strong aversion to nursing home; in a study of a large sample of seriously ill persons >70 years old, 29% indicated that they would rather die than enter a nursing home. 7 In contrast, Families often opt for nursing homes because they fear leaving their relatives at home where some untoward event may occur. 1 1 Kane RL & Kane RA. What Older People Want From Long-Term Care, And How They Can Get It. Health Affairs, 20, no.6 (2001):

9 WRAPPING OUR CHILDREN IN BUBBLE MAY PROTECT THEM FROM INJURY BUT AT WHAT EXPENSE?

10 Rehospitalization Marker of Increased Mortality Hospitalized beneficiaries who have an early hospital readmission nearly 3 times more likely to die within 1 year (one-year mortality = 38.7 % vs patients who were not readmitted = 12.1 %; p<0.001). Lum et al. J Gen Intern Med 2012; 27(11):

11 Mobility levels following hospitalization hospitalized for major surgical procedure hospitalzed for non-surgical reasons Ann Intern Med Mar 17; 150(6):

12 6 month Survival after ICU care Control intervention ICU admission Rate Controls vs Intervention 34% vs 61% Guidet B. et al. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France A Randomized Clinical Trial JAMA. 2017;318(15):

13 Five Questions to Explore 1. What is your understanding of where you are and of your illness? 2. What are your fears and worries for the future? 3. What are your goals and priorities? 4. What outcomes are unacceptable to you? What are you willing to sacrifice and not? 5. What would a good day look like? From Atul Gwande s book: Being Mortal

14 Play the film -

15 10-Minute Break

16 Gail Sheridan Chief Clinical Operations Officer Tealwood Senior Living

17 BEING MORTAL PHIL FOGG

18 AGING DYING

19 AGING UNFIXABLES DYING

20 PATIENT vs PERSON

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22 LIFE JOURNEY

23 CHAMPION OF EACH JOURNEY

24 L I V E T H E B E S T R E S T O F T H E I R L I V E S CHAMPION OF EACH JOURNEY

25 L I V E T H E B E S T R E S T O F T H E I R L I V E S W H E R E H A V E T H E Y C O M E F R O M? H O W D I D T H E Y G E T H E R E? W H E R E A R E T H E Y N O W? H O W D O T H E Y W A N T T O L I V E T H E B E S T R E S T O F T H E I R L I F E?

26 HAPPINESS vs WELL-BEING P O S I T I V E E M O T I O N E N G A G E M E N T P O S I T I V E R E L A T I O N S H I P S M E A N I N G + P U R P O S E A C C O M P L I S H M E N T

27 P R O G R A M S TO S U P P O R T W E L L - B E I N G

28 H E A LT H P L A N I - S N P M A N A G E D C A R E F O R L O N G - T E R M L I V I N G P O P U L A T I O N I N L O N G T E R M C A R E

29 P A T I E N T R E S I D E N T H I S T O R Y E N D O F L I F E P L A N N I N G F O C U S O N H E L P I N G I N D I V I D U A L L I V E B E S T R E S T O F T H E I R L I V E S

30 N E W C H A P T E R S A S P I R A T I O N A L R E H A B R E C O V E R Y RE- E X P E R I E N C E B U C K E T L I S T

31 V I TA L L I F E F O U N D AT I O N B A C K P A C K T O S C H O O L J O U R N E Y O F H E R O E S M E M O R I E S I N T H E M A K I N G M U S I C + M E M O R I E S V I T A L V O L U N T E E R S

32 INTENTIONAL FOCUS

33 E A S I E R W H E N Y O U R E A L LY K N O W S O M E O N E

34 Phil Fogg, Sr

35 T H E B E S T R E S T O F YO U R L I F E H A S U N I Q U E M E A N I N G TO E AC H P E R S O N

36 L I V E T H E B E S T R E S T O F T H E I R L I V E S CHAMPION OF EACH JOURNEY

37 Risk Bearing Opportunities Cleo Kitt, Director of Special Projects-Operations and Executive Director of LifeWorks Advantage Jason Lee, CEO, Arkansas Superior Select/Tribute Health Plans David Norsworthy, CEO, Central Arkansas Nursing Centers,

38 38 Risk Bearing Opportunities: I-SNP Operations Risk Bearing Opportunities: I-SNP Operations From the LifeWorks Advantage Perspective Cleopatra Kitt, MPH Director of Special Projects-Operations Executive Director of Lifeworks Advantage Medical Facilities of America, Inc.

39 AGENDA 39 LifeWorks Advantage Risk and Rewards Operations

40 LifeWorks Advantage 40 LifeWorks Advantage is a Medicare Advantage Instutionalized Special Needs Plan (I-SNP) LifeWorks Advantage is limited to Medicare beneficiaries who are long-term residents in one of our nursing centers throughout the Commonwealth of Virginia

41 Lifeworks Advantage 41 Service Area

42 Goals of the Plan 42 Position MFA to access premium dollar directly Own and control data Leverage MFA Model of Care to drive better outcomes for patients Transformation platform: proprietary technology + change management protocols Superior growth opportunity and financial model

43 Risks and Rewards 43 Market Summary Provider Networks Medicare Advantage Regulations Star Ratings Integrations with Current Systems

44 Skilled Nursing Facilities 44 SNF Market Snapshot Gov t Reimbursement Industry Pressures Industry Response Industry Pressures Spend Margin Medicare $29.8B 12.6% Medicaid $46B 1.60% Variation in Medicare Margins 75 th percentile: 21% 25 th percentile: 2.4% Skilled Services Under Pressure Primary focus of bundles is SNF spend CMS dropping therapy as element of Medicare reimbursement Significant utilization decrease due to cumulative impact of MA growth, bundles, ACOs, MSSP etc. Managed Care Environment Government programs will continue to expand Medicaid Managed Care Expansion Medicare Advantage Growth Experience diminishing returns of current market forces - Continue to invest in skilled services and referral streams - Manage cost basis for long stay patients Utilize political influence with new administration and state decision makers Pursue SNP Model

45 Long Term Care Industry is Poised for a Significant Shift to Value-Based Care 45 Government Goals - 90%of Medicare payments link to quality/value by Significant focus on reducing post acute spend Payer Goals - Medicare Advantage poised for growth; safe haven - Focus on Medicaid managed care expansion Population Growth - Increase in 85+ population accelerates in Alzheimers/Dementia comprises 1/3 of 85+ population Provider Goals - Invest to control own destiny - Capture value from care coordination Projected Market for Long Term Care Value-Based Care Services 2.7 million long term care residents $98B in healthcare spend Available market at 9-10% of spend $9.4B + Total Addressable Market

46 Operations 46 Infrastructure Policies INTERGRATION of Systems Resource Requirements Financial Plan Metrics to Measure Performance

47 Financial Plan 47 Outline a high-level financial plan that defines your financial model and assumptions. Enrollment Projections Bureau of Insurance License Medical Loss Ratio (MLR) Catastrophic loss

48 18 Month Application: 48 Transformation Cycle July 2015 Thru Feb 2016 June 2016 June- December January 2017

49 Policies and Integration of 49 Systems Current System Policies Clinical Model of Care Pharmacy Information Technology Billing

50 Resource Requirements 50 Resource Requirements: Personnel Technology Finances Marketing Professional Fees Services

51 Metrics to Measure 51

52 Superior Demonstrated Outcomes Lifeworks Advantage Executive Dashboard Executive Summary Period: 1/1/2017 thru 6/30/17 Data as of 11/1/

53 VALIDATION 53

54 MFA s Goal is to Capture and Create Value 54

55 Benefits of an Effective 55 Compliance Program Promotes patient safety and ensures the delivery of high quality patient care Helps ensure proper submission and payment of claims Reduces billing mistakes Improves outcomes from Medicare claims reviews Reduces potential for Fraud, Waste and Abuse

56 56 Key Issues Near term Identify if you need a partner to help develop a D-SNP or I-SNP based on your organizations assessment Understand CMS Guidelines for Medicare Managed Care Special Needs Plans Identify the project lead times Prepare financial assumptions

57 LifeWorks Advantage Partner: 57 AllyAlign Health Unique offering across clinical and financial continuum for LTC residents Full continuum of data and proven outcomes Physician/NP/SNF-owner driven MOC for high risk institutional population Performance-driven network alignment Purpose-built shared services model

58 58 Key Issues Long-term Understand the impact on the care of your patients across the long-term care continuum Understand the risk and rewards on your company s financial health.

59 The Road Ahead 59

60 Requisite for Growth 60 Buy into Model at Facility Level Care Team Formulation Demonstrated outcomes; Gain share distributions Follow on wave of membership

61 Resources

62 Questions & Discussion 62 Cleo Kitt, MPH Executive Director of LifeWorks Advantage

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