7 Ways a Trump Presidency Impacts Post-Acute Care

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By Shane Reeves, CEO of TwelveStone Health Partners

With a Trump administration well into its first 100 days, those involved with post-acute care are busily reading the tea leaves brewing in Washington. Here’s a look at the likely changes coming to the post-acute care landscape:

  1. Hospitals are in the hot seat; post-acute care must be ready for the downstream effects
    Congress is unlikely to fully repeal the ACA, but the individual mandate is certainly on the chopping block. These and other anticipated legislative changes will lead to a rise in the uninsured seeking charity care at hospitals.

    Readmission penalties will likely increase as a cost and quality control measure. With 11 percent of readmissions driven by medication non-adherence alone, hospitals should look to post-acute care to provide the necessary on-site care coordination needed to keep readmissions in check.

  2. The move to value-based care continues unabated; bundles and risk reimbursement models are here to stay
    According to Modern Healthcare’s1 post-election health care CEO survey, the vast majority of executives are confident the ACA-driven march to value-based care will continue. By some estimates, value based and bundled payment systems will replace the fee-based system in less than 15 years. By 2018, the Center for Medicaid Services announced2 it wants half of all payments to be delivered through alternative payment models like bundles. With private plans following in Medicaid’s bundled payment footsteps, acute and post-acute care providers must work even more closely together to align patient care plans.
  3. Home based care, and the demand for telehealth, will explode
    An aging population, many with long term care insurance, will choose to receive in-home care for their chronic care needs, and if indicated, for hospice care. Some of these services, especially for those in rural areas, will be provided via telehealth. Look for new policies to establish authority for non-physician practitioners to certify Medicare coverage, as well as create a stand-alone telehealth benefit for remote monitoring of home-based patients.
  4. The patient as consumer gains momentum
    If the individual mandate goes away, Congress will have to devise a way for people to buy insurance and avoid risk plan issues. “If you don’t have an employer mandate and an individual mandate, the market would self-destruct,” says Jim Lott3, a professor of health policy at the University of Southern California and Cal State Long Beach. Allowing insurers to cross state borders to widen their risk pools is one regulatory change under consideration. Tax deductions for health insurance policies and tax-free Health Savings Accounts are also part of the mix. All of these changes drive the patient further into the role of managing their own healthcare spending. As an example, customized packaged pharmaceuticals delivered to the doorstep will change the game by giving patients a new tool that will assist them in adhering to complicated medication regimens and staying out of hospital emergency rooms.
  5. Increasing access to cross-border medication
    When US citizens cross the Canadian border to fill prescriptions at half the cost of comparable drugs in their home state, the case for reasonable pricing of drugs comes into sharp focus. On the campaign trail, Trump indicated his support for allowing international medication purchases, which could help moderate pricing in the US.
  6. Scales tip from skilled nursing homes to assisted living and home health
    The number of skilled nursing homes in the United States has flat lined at about 15,000. The National Investment Center for Seniors Housing & Care4 reports that skilled nursing home occupancy experienced a significant decline, down to 86.8 percent in 2016. That’s the lowest since 2005. It’s predicted that by 2021, the number of skilled nursing homes could shrink by 20 percent.

    Currently, 90 percent of skilled nursing home revenues are from Medicare and Medicaid. Look for Medicare and Medicaid to cut costs by shortening patient stays and consolidating or bundling reimbursements. They’re also likely to shift reimbursement to lower cost models such as home care and assisted living facilities.

  7. Pharmacists address medication non-compliance
    Pharmacists, especially those serving the post-acute care sector, must demonstrate their value along the care continuum. That won’t be too difficult. Nearly 50 percent of all medications aren’t taken as prescribed, and by some estimates a third of all prescriptions are never filled. Pharmacists are on the front lines of containing medication non-compliance, which is estimated to cost $100-$289 billion annually.

    There’s much more to be deciphered once a Trump administration is fully underway. One thing is clear: acute and post-acute providers will need to coordinate care more than ever before. Beyond that imperative, the only certainty is a continuation of change—and a lot more of it.

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Praise and Thanksgiving

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By Shane Reeves, CEO of TwelveStone Health Partners

After such a difficult election season, it only seems right to stop, reflect and think about why we even have Thanksgiving. It originated as a harvest festival and has been celebrated nationally on and off since 1789, after a proclamation by George Washington.

Thanksgiving has been celebrated as a federal holiday every year since 1863, when, during the American Civil War, President Abraham Lincoln proclaimed a national day of “Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens.” The first Thanksgiving lasted three days—and we think we overeat!

Washington’s proclamation, like many documents developed by the Founding Fathers, was riddled with gratitude for the blessings that had been bestowed on the United States of America based on the favor shown to our government and citizens. It calls for a government that is a blessing to all people based on “wise, just, and constitutional laws.”

At this time, after this election, let us all pray for our elected leaders and remind ourselves how blessed we are to live in this great country. We certainly have room for improvement, but taking a moment to express gratitude for what we do have is certainly right. Take a moment to read the words of Washington below as they are now more important than ever.

Blessings to you and your family,

Shane Reeves

Thanksgiving Proclamation

Issued by President George Washington, at the request of Congress, on October 3, 1789

By the President of the United States of America, a Proclamation.

Whereas it is the duty of all nations to acknowledge the providence of Almighty God, to obey His will, to be grateful for His benefits, and humbly to implore His protection and favor; and—Whereas both Houses of Congress have, by their joint committee, requested me “to recommend to the people of the United States a day of public thanksgiving and prayer, to be observed by acknowledging with grateful hearts the many and signal favors of Almighty God, especially by affording them an opportunity peaceably to establish a form of government for their safety and happiness:”

Now, therefore, I do recommend and assign Thursday, the 26th day of November next, to be devoted by the people of these States to the service of that great and glorious Being who is the beneficent author of all the good that was, that is, or that will be; that we may then all unite in rendering unto Him our sincere and humble thanks for His kind care and protection of the people of this country previous to their becoming a nation; for the signal and manifold mercies and the favor, able interpositions of His providence in the course and conclusion of the late war; for the great degree of tranquillity, union, and plenty which we have since enjoyed; for the peaceable and rational manner in which we have been enabled to establish constitutions of government for our safety and happiness, and particularly the national one now lately instituted; for the civil and religious liberty with which we are blessed, and the means we have of acquiring and diffusing useful knowledge; and, in general, for all the great and various favors which He has been pleased to confer upon us.

And also that we may then unite in most humbly offering our prayers and supplications to the great Lord and Ruler of Nations, and beseech Him to pardon our national and other transgressions; to enable us all, whether in public or private stations, to perform our several and relative duties properly and punctually; to render our National Government a blessing to all the people by constantly being a Government of wise, just, and constitutional laws, discreetly and faithfully executed and obeyed; to protect and guide all sovereigns and nations (especially such as have shown kindness to us), and to bless them with good governments, peace, and concord; to promote the knowledge and practice of true religion and virtue, and the increase of science among them and us; and, generally, to grant unto all mankind such a degree of temporal prosperity as He alone knows to be best.

Given under my hand at the City of New York the third day of October in the year of our Lord 1789.

Go, Washington!

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Honoring Pharmacists and Looking Forward

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By Shane Reeves, CEO of TwelveStone Health Partners

October is American Pharmacists Month, so it’s only appropriate that we honor the health care professionals who help us wade through adapting to new medications, recommended relief from seasonal allergies, and—if we didn’t get a flu shot—kindly point us to the medications that provide help during cold and flu season.

But American Pharmacists Month also brings back memories of my own family’s involvement in the pharmacy business. My father, Richard Reeves opened Reeves-Powell Saveway Drug Store in 1980. Dad still comes into the office and is a source of wisdom for the company. And even he is amazed by the rapid changes in the retail pharmacy industry and the benefits offered by packed (multi-dose) medications, and the methods of leveraging technology to maintain that relationship that people have historically had with their local, hometown pharmacists.

He isn’t surprised, however, that pharmacists continue to enjoy a solid reputation as experienced, professional caregivers. In a 2014 survey conducted by Claus Research Group, 83 percent of those surveyed view the pharmacist as someone who does more than fill prescriptions, and 81 percent see pharmacists as part of their health care team. With more than 10,000 medications on the market today, pharmacists are the constant, helping patients make sense of their prescriptions.

As October leans into November and the start of the holiday season, I’m also reminded of one of my favorite—but perhaps not well known – film characters: Mr. Gower, the pharmacist in the classic movie, “It’s a Wonderful Life”.

In the pivotal scene, Gower, who’s just learned his son has died from influenza, is distraught and has taken to the bottle to console himself. But he’s about to make a fatal drug compounding error. When first confronted with the evidence by the movie’s hero, a young George Bailey, he gets angry and slaps the boy. Only when he realizes George has prevented him from making an irreversible mistake does he fall on his knees and express both regret and deep gratitude to the boy. Gower never forgets what an impact George had on his life, and goes on to return the favor several times over.

Gower and Bailey both send a powerful message about how one person can make all the difference in the world. This story also reminds us of the need to leverage technology for the greater good—to ensure compliant and safe medication therapy that heals and saves lives. That message of caring and concern is one that I think all pharmacists take to their jobs every day.

Beyond your parents, who has had the greatest impact on your life? Who have you influenced? We’d love to hear back from you.

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Rx4HIM

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By Shane Reeves, CEO of TwelveStone Health Partners

“I believe that one of the next great moves of God is going to be through believers in the workplace.”

— Dr. Billy Graham

It is amazing to me the number of business owners that I meet who are serious about generating profits and delivering value to stakeholders (in other words, to customers, staff, vendors, and investors) while simultaneously trying to balance the pursuit of a higher calling in an effort to leave the world better than they found it.

In large organizations such as Whole Foods, Starbucks, Waste Management and UPS, generating a profit is a strategy for supporting both the company and a significant social cause.

When TwelveStone Health Partners was launched in February 2016, we decided from the very beginning that our purpose statement was going to be about more than just making money, taking care of patients and developing a tremendous team. We also wanted to be a company that honored God in how we invest our time, influence and financial resources.

So how do we do that?

We have decided to take a percentage of our profits and invest in a newly formed nonprofit organization called Rx4HIM. This organization will fund the following four initiatives:

  • Internally: Offer pastoral services for employees.
  • Community: Support faith-based, nonprofit healthcare organizations.
  • Benevolence: Fund the care for truly marginalized patients in our service area.
  • Mission: Provide funds for medical missions to Third World countries.

Although we have just gotten Rx4HIM off the ground, we recently were able to support a patient through our mission initiative.

A five-year-old child recently placed at the City of Children orphanage in Ensenada, Mexico, is unable to walk due to severe health issues and neglect experienced early in life. Diagnosed with hypoglycemia and a seizure disorder, this child also has mental disabilities. This young man requires a specialized diet and has visited several local physicians who eventually prescribed diazoxide to address and stabilize his conditions.

This expensive medication is not available in Mexico, but through a communication by a recent TwelveStone intern, Rx4HIM was able to provide assistance. Through Rx4HIM, a shipment of diazoxide was immediately shipped to Ensenada. The orphanage’s director, Tom Begin, shared a praise report for the Rx4HIM response and has high hopes that the new medication will improve this boy’s life.

I encourage business owners and executives to vigorously pursue their companies’ missions and to generate unprecedented profits and then use some of those profits to serve, lead and help leave our world better than you found it.

 

The Transformation of Post-Acute Care

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By Shane Reeves, CEO of TwelveStone Health Partners

In a recent article put together for the Nashville Business Journal I summarized my thoughts about where I see our industry heading in terms of the transformation of post-acute care.

Regulatory transformations and demographic shifts have quietly lined up to create a “perfect storm” for providers in the U.S. Acute and post-acute care providers are now responsible for patients’ health outcomes for a longer period of time. The top eight trends that support the need for transformation include the following.

  1. Management of aging Baby Boomer population with multiple chronic conditions.
  2. Technological advancements come with a cost.
  3. Increased medication usage.
  4. Readmissions under the microscope.
  5. Accountable Care Organization (ACO) and value-based payments.
  6. The patient as consumer.
  7. Skilled Nursing Facilities (SNFs) preparing for greater acuity in patient populations.
  8. More specialized care and the risk of fragmented delivery.

So what are the keys to navigating this transformation for both acute and post-acute providers? In my opinion, it can be broken down into there core concepts.

  • Collaboration
  • Innovation; and,
  • Nimbleness

The focus needs to be on leveraging technology to create a patient-centric delivery model where partners work together to ensure compliance. Instead of thinking about managing care, we need to be managing health outcomes, with a consistent “owner” of the patient’s health from point A to point Z. Successful collaboration between acute and post-acute care organizations includes an emphasis on patient education to support a seamless post-discharge experience, ensuring medication compliance by simplifying prescription delivery and deploying case managers and clinicians to follow the patient along the way.

Aligning the services that patients require into an easy to access bundle, together with support between facilities and home-based care, will be critical to ensuring adequate reimbursement, patient satisfaction and managing costs.

Shane is available to speak on this topic and others. To reach out fill out the form at the bottom of our home page.

 

Lessons Learned at Leadercast

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By Shane Reeves, CEO of TwelveStone Health Partners

At the Leadercast Event last week, some incredible speakers shared highly relevant content with more than 100,000 people nationwide. As sponsors of a site in Murfreesboro, many of the leaders in my company and our community were able to hear from a group of really motivating presenters including Pastor Andy Stanley, Branding Specialist Kat Cole, Sportscaster James Brown, Coach Nick Sabin and several others.

Andy Stanley led the event with a tremendous message —clarity results in influence, which is the essence of leadership. We follow those who are clear, we value that even over integrity. This axiom holds true in politics and in business, as well. At TwelveStone, our goal is build a company with both integrity and clarity.

When we hire someone, we hire their hands and part of their brain but we also strive to engage their heart. Our vision and mission isn’t something we say, it’s something we do every day. We live it and reward it so that our culture reflects our commitment to simplify the complexity of healthcare while delivering exceptional service.

We have a purpose that every employee is encouraged to memorize and repeat often.

TwelveStone Health Partners is an organization that

  • Honors God
  • Cares for Patients
  • Develops our Team; and
  • Generates a profit

It really is that simple…

The Transformation of Post-Acute Care

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By Shane Reeves, CEO of TwelveStone Health Partners

In a recent article put together for the Nashville Business Journal I summarized my thoughts about where I see our industry heading in terms of the transformation of post-acute care.

Regulatory transformations and demographic shifts have quietly lined up to create a “perfect storm” for providers in the U.S. Acute and post-acute care providers are now responsible for patients’ health outcomes for a longer period of time. The top eight trends that support the need for transformation include the following.

  1. Management of aging Baby Boomer population with multiple chronic conditions.
    Technological advancements come with a cost.
  2. Increased medication usage.
  3. Readmissions under the microscope.
  4. Accountable Care Organization (ACO) and value-based payments.
  5. The patient as consumer.
  6. Skilled Nursing Facilities (SNFs) preparing for greater acuity in patient populations.
  7. More specialized care and the risk of fragmented delivery.

So what are the keys to navigating this transformation for both acute and post-acute providers? In my opinion, it can be broken down into there core concepts.

  • Collaboration
  • Innovation and
  • Nimbleness

The focus needs to be on leveraging technology to create a patient-centric delivery model where partners work together to ensure compliance. Instead of thinking about managing care, we need to be managing health outcomes, with a consistent “owner” of the patient’s health from point A to point Z. Successful collaboration between acute and post-acute care organizations includes an emphasis on patient education to support a seamless post-discharge experience, ensuring medication compliance by simplifying prescription delivery and deploying case managers and clinicians to follow the patient along the way.

Aligning the services that patients require into an easy to access bundle, together with support between facilities and home-based care, will be critical to ensuring adequate reimbursement, patient satisfaction and managing costs.

Shane is available to speak on this topic and others. To reach out fill out the form at the bottom of our home page.

What’s Next in Healthcare—It’s All About the Patient

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I think one of the most profound changes I’ve witnessed in the healthcare industry over the past 25 years is actually a philosophical challenge. Previously, executives and leadership had more of an inward focus—how many beds are filled this month? How many providers do we need for staffing? What is our market share in the communities we serve?

At TwelveStone (previously Reeves-Sain) we’ve maintained a belief over the years that the patient is actually at the epicenter of healthcare.

This simple truth is one of the reasons why I believe that TwelveStone is well positioned to help acute and post acute care organizations to make the leap to new, more patient-centered model of care. At TwelveStone we are what I like to call “environment impartial,” meaning that we totally focus on the patient, regardless of whether we’re supporting them in a post-acute care setting or helping them make the transition from the hospital to recuperate in their home or a long-term care facility.

Factors Driving Change

In the rapidly fading fee-for-service world, providers had a much narrower view of their role. Now, providers have increased responsibilities, even post-discharge. Given the introduction of bundled-payments, healthcare organizations are now much more involved in driving key quality, cost and patient satisfaction issues like medication compliance and reducing the risk of readmissions. For example, Medicare penalizes hospitals with relatively higher rates of Medicare readmissions, by withholding up to 3% of the payment. To thrive, healthcare organizations must find creative ways to address these added pressures.

The Future of Patient-Centric Care

As the CEO of TwelveStone, I frequently meet with executives of hospitals, health systems, hospice organizations, long term care facilities etc. and all of the conversations usually have a common thread. I frequently hear that they’re concerned about being asked to take on more responsibilities and improve health outcomes using the same amount of resources. And, more importantly, they’re concerned that this trend is going to continue and expand.

We’ve designed the TwelveStone product and service offerings to continue to play a larger role, to do more of the heavy lifting. We’re able to offer clients the right kind of flexibility and clinical expertise with a clear line of sight to the patient as they move through the healing process between facilities. By wrapping everything a patient requires into a single source and maintaining contact to ensure that any issues are dealt with and questions answered we are an extension of our partners, driving down discharge timing and minimizing issues throughout the healing process.