Nationally Recognized Transitional Rehabilitation Program’s Strategies
Disability is one of the most important public health issues in the U.S.; approximately 15 percent of U.S. citizens have disabilities.1 Allina Health believes that people with disabilities and other special needs deserve comprehensive care at every point of the care continuum—including key transition points. Fulfilling that vision is exactly what Allina Health’s Courage Kenny Rehabilitation Institute (CKRI) Transitional Rehabilitation Program (TRP) was designed to do.
Courage Kenny’s TRP can serve as a bridge between acute care and home or community living setting, providing service coordination, skilled rehabilitative care provided by physicians, nurses, and therapists, counseling, life-skills training, vocational training, and social activities. TRP residents have unique needs compared to average nursing home residents; 64 percent have recently experienced a traumatic injury, (such as spinal cord injury, or traumatic brain injury)—90 percent have multiple high acuity comorbidities.
Courage Kenny’s TRP is one of the leading SNF based rehabilitation programs in the country, with Centers of Excellence in spinal cord injury, traumatic brain injury, and stroke rehabilitation. It received a Five-Star Quality Rating for skilled nursing facilities (SNF) in 2015.
“The TRP fills an important niche in the care of patients with disabilities,” says Brian LeLoup, MPT and CKRI TRP Director of Sub-Acute Rehabilitation.
DIFFICULTIES PROVING VALUE WITHOUT QUALITY DATA AND REIMBURSEMENT LEGISLATION
The Minnesota Department of Human Services recognized that CKRI’s TRP required above-the-norm reimbursement for nursing facilities. In 1999, TRP received financial support when legislation passed that allowed a reimbursement adjustment. This legislation was repealed in 2012 by the state as a deficit reduction measure, resulting in an unsustainable financial loss for CKRI’s TRP ($110+ per resident, per day deficit and $1.4 million annual deficit in 2013).
Allina’s TRP needed to become better stewards of resources and prove that it helped people with disabilities achieve their maximum cognitive and physical functionality. It also needed to get new legislation passed that would provide critical reimbursement adjustments. Accomplishing these goals would require a deliberate focus on data and actionable analysis.
ANALYTICS PLATFORM AND DASHBOARD LEAD TO OUTCOMES IMPROVEMENT AND COST SAVINGS
CKRI’s TRP implemented an analytics platform from Health Catalyst that monitored the cost of care, tracked patient outcomes, and identified TRP candidates. It created a dashboard that tracked and reported costs,and allowed for useful cost comparisons. The dashboard tracked and reported outcomes in meaningful ways:
- Patient Reported Outcomes Measurement Information System (PROMIS) on physical independence, mobility, social integration and occupation, and overall mental and physical health score.
- Health outcomes reported according to nationally recognized clinical evaluation assessments. For brain injury, it used the Mayo-Portland Adaptability Inventory (MPAI) that assists in the clinical evaluation of patients during the post-acute period following a brain injury. For spinal injury, it used the Spinal Cord Independence Measure (SCIM) to measure items related to daily living, coordination, eating, functional mobility, and incontinence.
Using the analytics platform and dashboard, Allina’s TRP proved value to the community. By continuously reviewing patient data, it served those with the biggest need to maximize cost savings.
Reinstated Legislation for Adjusted Reimbursement and Closed Funding Gap
The analytics platform enabled Allina’s TRP to track and report costs and outcomes, demonstrate the value of their services, and generate savings for the health system and community. The TRP successfully lobbied the state of Minnesota to reinstate language specific to TRP to the Medical Assistance Rate Reimbursement policy.
Saved health systems and community $3.2 million over a one-year period: saved $35,364 per person, per year by improving transition-to-home numbers and reducing healthcare facility utilization.
20 percent greater success than traditional SNFs in discharging people to home and community: 83 percent of TRP residents return to their homes/communities (compared to 63 percent of impairment matched individuals who went to traditional SNFs).
20 percent overall improvement in impairment in individuals with brain injury (MPAI-4): 73 percent of identified TRP patients reached the threshold for significant improvement.
84 percent overall improvement in spinal cord independence measure (SCIM): 88 percent of identified TRP patients met threshold for significant change.
14 percent improvement on patient reported (PROMIS 10) physical health
13 percent improvement on patient reported (PROMIS 10) mental health
WHAT’S NEXT: CONTINUING IMPROVEMENTS WITH HIGH QUALITY DATA
CKRI’s TRP will continue using high-quality data to effectively manage services for individuals across the continuum of care and improve outcomes by expanding the TRP care model to include more people with disabilities. Courage Kenny is also working to integrate select program specific practices within the full continuum of its services (including the TRP) to ensure that the person served receives the right care in the right location.
- Center for Disease Control and Prevention. (2009). How many people have disabilities? Retrieved from: http://www.cdc.gov/ncbddd/disabilityandhealth/documents/disability-tipsheet_phpa_1.pdf
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