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How ‘Pre-Acute’ Care Is Giving One Provider An Edge

Many senior living providers are growing their post-acute rehabilitation services, but one innovative nonprofit is going big on what it calls “pre-acute”—and believes that success in this realm could give it a dramatic competitive edge.

“We want to allow seniors to stay home for life, not have to escalate to a higher level of care,” National Church Residences President and CEO Mark Ricketts tells Senior Housing News.

It’s this philosophy that is the foundation of what the Columbus, Ohio-based provider has termed its “pre-acute” approach, and in particular its Care Guide program.

National Church Residences began the program with the population in its affordable senior housing apartments, and this is no small contingent. With about 20,000 of these residents in buildings it owns, NCS is the largest affordable senior housing provider in the nation. Now, National Church Residences is rolling out the Care Guide program to residents its four continuing care retirement communities (CCRCs) and other health care properties, including assisted living centers.

Ricketts recently spoke with SHN about the nuts and bolts of the program and how the pre-acute focus already is making National Church Residences stand out to hospitals, health insurers and other crucial referral sources.

Going Proactive

National Church Residences has long touted the fact that it has a social worker embedded in each of its independent living apartment facilities, who would help coordinate services for the residents. However, changes that have swept the U.S. health care system since the 2010 passage of the Affordable Care Act prompted National Church Residences to reevaluate how the social workers were functioning and what their full potential could be.

Specifically, the ACA incentivized population health management. That boils down to Medicare and Medicaid providers such as hospitals and health systems seeing their payments tied to how well they can manage the health of the seniors they see, being rewarded financially by helping patients avoiding costly events such as hospitalizations. Senior care organizations have emerged as important players in this effort.

“We’re trying to activate our seniors in self-care, asking how can we work with seniors to let them know what contributes to better health, so they don’t have unnecessary trips to the emergency room and have expensive health care interventions,” says Ricketts. “If I can help you get access to physical therapy, manage diabetes, etc., we’ll have an overall lower cost of care.”

Helping seniors access these types of services has been a focus for National Church Residences for years, Ricketts adds. But now health insurers—such as managed care organizations that are actively trying to lower costs while improving outcomes—are much more interested in working with the company on this effort.

When thinking about how to take its population health management to the next level, National Church Residences realized that enabling social workers to be more proactive would make a huge difference.

“We asked social workers, ‘Who are you helping?’ And they said, ‘Anyone who walks down to our office,’” Ricketts says. “We wanted to change that.”

Specifically, Ricketts and other National Church Residences leaders wanted to arm their social workers with data about residents, so that the social workers could reach out to those people at greatest risk of a hospitalization or other adverse health event.

Enter: Care Guide

The objective that National Church Residences settled on was ambitious: assessing every one of the residents at its affordable housing buildings. To accomplish this, it implemented Care Guide, a tool that encompasses various types of evaluations, such as the Mini Mental Status Exam and Geriatric Depression Scale.

The online system launched in pilot phase at 15 locations in May 2013 and rolled out company-wide in the following months. Now, Care Guide is being used with 30,082 residents in National Church Residences-owned buildings and those it staffs.

The results stratify residents into three categories. Between 60% and 70% of respondents were categorized as healthy and living well, but 7% of seniors were identified as at high risk of having a hospitalization within 12 months.

With the goal of keeping these high-risk seniors out of the hospital, National Church Residences’ social workers are intervening on many fronts, including checking in on their medication adherence, checking on whether family members have been in touch, assessing their apartments for fall risks, and determining whether they’ve had a flu shot.

“That 7% of the population is getting an incredible amount of social work,” Ricketts says.

Because the success of the program hinges on the social worker, National Church Residences is holding these workers to a high standard, he adds. One of the social workers’ duties is connecting seniors with the community resources they need, such as home health. National Church Residences owns and operates its own home health organizations in Ohio and Florida, and works with outside providers in other markets.

Partly because of the Care Guide push, National Church Residences now is building up relationships with top home health and home care companies around the country, to make them preferred providers and help facilitate the process of connecting seniors with services. It should help ease the process for social workers, who are working hard to act on the Care Guide data.

“The social worker is held responsible for getting the care that is needed for the senior at risk,” Ricketts emphasizes. “They can’t give up because their first call was a dud.”

‘More Metrics Than Brains’

Not surprisingly, the assessments have given National Church Residences a huge amount of data.

“We’ve got more metrics than brains at this point,” Ricketts jokes.

Because 2014 was the first full year of the program, results will be used as a benchmark for measuring future success.

“We don’t know what to compare the data to yet,” Ricketts says. But already, there have been some standout numbers.

One in particular has been the number of high-risk residents—those with chronic conditions or classified as severely vulnerable—who have seen a physician in the last year. This has risen from 72% of residents at the beginning of the year to 82% now, Erica Drewry, vice president of Home and Community Services, tells SHN.

And then there’s the impressive raw number of documented interventions. There have been 159,032 instances in which service coordinators have assisted residents with their needs, Drewry says.

Still, there is some important information that National Church Residences does not have its fingertips just yet. Namely, claims data that resides at the hospital or insurer level. It’s this data that will show whether Care Guide is helping reduce utilization of costlier services in acute settings, and this is really the “secret juice” that will elevate National Church Residences above other senior care providers when hospital systems or managed care organizations are determining which providers to work with, Ricketts says.

“We don’t have access to that data easily,” Ricketts says. “We’re looking for an insurer or hospital that can give us access, and hope that 12 months from now, we’ll have claims data.”

Among other next steps will be the complete rollout of Care Guide to CCRCs and assisted living centers, and perhaps even to seniors living in private residences. It may be harder to engage social workers to help that group, but it’s not impossible, Ricketts says.

Even though it’s early days in terms of seeing Care Guide results, hospitals, insurers, accountable care organizations and other entities already are excited about the pre-acute capabilities of National Church Residences, Ricketts says.

“Hospital systems, primary care practices and insurers are looking at us uniquely and saying, if we partner with you, you’ll allow us to do somethign we can’t do: Get in people’s homes,” Ricketts says. “The prevention side of what we’re doing is really exciting.”

Written by Tim Mullaney

Pictured at top: First Community Village in Upper Arlington, Ohio, a National Church Residences CCRC