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Thank you for attending VNAA's 34th Annual Meeting,
April 6-8, 2016, in Miami, Florida.

Please click the links below to access the slides from the educational sessions.

General Sessions
Preconference Sessions
Operations/Financial Track
Payment Models Track
Leadership Strategies & Partnerships Track
Navigating Health Systems Track, Sponsored by Medtronic

General Sessions

Coordinating with Accountable Care: Partnership Opportunities for Coordinated Care Organizations and Home-Based Care Providers in New Payment Models
Donald Crane, CEO, CAPG - The Voice of Accountable Physician Groups
Home-based care providers have successfully engaged in pilot and small scale alternative payment models led by physician groups and health systems. Enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 repealed the flawed Medicare sustainable growth rate (SGR) formula for physician payments and estabished two new payment tracks for physician practices: the alternative payment model (APM) track and the Merit-Based Incentive Payment System (MIPS) track. Don Crane, CEO, CAPG, will describe the evolution of physician payment models and role of capitated risk, the impacts of physician payment tracks and the critical role of home-based care providers in partnerships to ensure success in these new payment models.
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Preconference Sessions

Home Health Value-Based Purchasing

Chris Attaya, MBA, FHFMA, VP, Business Intelligence, SHP
Bobby Lolley, RN, Executive Director, Home Care Association of Florida
Sue Payne, MBA, RN, CHCE, Senior Vice President of Clinical Services, Transpirus

Value-based purchasing (VBP) arrangements can improve coordination and health outcomes for the pupulations served by home-based care, and can drive quality and efficiency. Home health and hospice providers are in teh position to provide innovative and efficient solutions for payers and health systems that incorporate VBP. This session will provide an overview of value-based purchasing in practice, and the many ways it can be implemented; discuss the opportunities and risks for HHAs for participating in a VBP model; identify the best practices to demonstrate your value; hear from colleagues who have implemented VBP and have lessons to share; and preview VNAA's members-only Took Kit and other resources to help your agency succeed in VBP.
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Using Data to Understand and Improve Agency Performance and Quality

Tim Ashe, RN, MS, MBA, Partner and Director of Operational Consulting, Fazzi Associates
Jeanne Callahan-Lydon, RN, BSN, ND, SVP of Clinical Services, VNA Care Network
Teresa Lee, JD, MPH, Executive Director, The Alliance for Home Health Quality and Innovation
Jeanette May, MPH, PhD, Consultant
Robert J. Rosati, PhD, VP Data Analytics and Research, VNA Health Group

Home Health Compare, value-based purchasing, patient experience… so many measures, so little time. In this session we will examine quality from multiple perspectives. First, hear from VNAA and the alliance for Home Health Quality and innovation about trends in quality in the home health industry. How are we doing on quality measures? Then, we’ll drill down to quality at the agency level. We’ll hear from agency leaders about how they manage quality, including integrating OASIS measures, patient experience measures and claims based measures. Finally, participants will engage in a small group working session to learn how to review quality metrics in their own organization and tie data back into quality improvement strategies. Participants will come away with a better understanding of connections between measures, as well as information on how to access resources such as the VNAA Nonprofit Industry Research Database, the VNAA Blueprint for Excellence and other tools.

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Operations/Financial Track

Meeting the Needs of Caregivers: Building a Comprehensive and Sustainable Model of Support Services

Nicole Bruno, BSW, Community Educator, Transitions Life Care
Cooper Linton, MSHA, MBA, Vice President of Marketing and Business Development, Transitions Life Care
Family caregivers play an important role but typically are not fully supported by the healthcare system or community-based services. New models are urgently needed that meet their needs and also build the capacity of the professional workforce. This workshop presents an innovative, sustainable and replicable nonprofit service model that provides an integrated and comprehensive set of services, including: a Care Coordination and Support Service that helps family caregivers develop and implement individualized care plans; training in effective care for individuals with dementia; a life management program for individuals with dementia; hands-on caregiver skill training; and professional training, including enhanced Nurse Assistant (NA1) training that emphasizes eldercare. Community outreach complements direct services through weekly radio shows, an annual caregivers conference, lending library and a host of educational resources. 
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Facilitating Transitions and Reducing Hospitalizations

Judy Adamcsik, MSN, RN, Vice President of Operations, VNA of Somerset Hills
Interventions focusing on transitioning patients between settings have shown reductions in the number of patients re-hospitalized. Clinicians received formal education on care transitions based on the HHQI Best Practice Intervention Package, Cross Settings 1. Hospitalizations in a one month period were compared pre and post education. The number of re-hospitalizations decreased from 14.3 percent in June 2014 to 0 percent in June 2015.
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Prescription for Agency Health in Today’s “Under the Microscope” Environment

Karen Bommelje, RN, BSN, HCS-D, CHC, Senior Manager, Simione Healthcare Consultants, LLC
Beth Slepian, PT, President and CEO, Concord Regional VNA
In today’s health care environment there is an ever increasing amount of scrutiny and government oversight of home health and hospice providers. It may not be a question of “if” you are ever under investigation, but “when” your agency is under the microscope. It is becoming increasingly necessary to ensure your Risk and Compliance Programs meet the Federal Sentencing Guidelines (FSG). In this session we will look at specific CIAs and how closely mirrored they are to the FSG. A robust, effective and ethical Compliance Program that is more than a binder on the shelf will be a key to keeping the
“Medicine” away!
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Home Health Care Fraud Enforcement in 2016 and Beyond: It’s Not Just about Money

Daniel Bernstein, Assistant United States Attorney, Office of the United States Attorney for the Southern District of Florida
George B. Breen, Esquire, Shareholder Epstein Becker and Green, P.C.
The headlines are replete with enforcement actions focused on home health care providers. Medicare home health expenditures totaled $16.6 billion in 2013, and between 2010 and 2014, nearly $1 billion in improper Medicare payments and fraud had reportedly been identified relating to the home health benefit, according to HHS’ Office of Inspector General (“OIG”). Earlier this year, CMS announced it was developing a pilot program to determine how many Medicare fraud cases are taking place in home health agencies; its initial pilot focuses on South Florida which accounted for $2.1 billion of total Medicare home health spending in 2013.
While large dollar settlements are noteworthy, examples of the government’s increasing focus on individual accountability are becoming more common. This means that providers need to be concerned about the potential for exposure to both civil and criminal enforcement.
Led by the criminal health care fraud coordinator in the U.S. Attorney’s Office for the Southern District of Florida and an experienced defense counsel, this session will address the civil and criminal enforcement risks home health providers face in 2016 and beyond. We’ll address the laws you need to be most concerned about and offer tips on how providers, who are trying to do the right thing, can protect their business and defend themselves from the enforcement onslaught.
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Patient-Experience Surveys in Home Health and Hospice: The What, Why and How

Danielle Pierotti, RN, PhD, CENP, AOCN, CHPN, VP of Quality and Performance Improvement, VNAA
This session will provide background information on patient experience surveys; why and how they fit in the national quality agenda. As well as outline the current status of the home care and hospice surveys- public reporting, comparative data and benchmarks; comparisons of the surveys. Provide operational strategies for improvement, potentially including tips for interpreting the data and discussing it with various stakeholders (domains vs. items; percentage vs. percentile). As well as delve into the future of surveys in relationship to daily operations, public use and fiscal implications.
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Revenue Cycle Redesign

Donna DeBlois, RN, BSW, MSB, MBa, aHCa, President and CEO, HomeHealth Visiting Nurses of Southern Maine
Michael Freytag, Managing Director, Blacktree Consulting
With the challenging times currently faced by home health and hospice agencies throughout the country, even minimal interruptions can have a significant negative impact on operations. Home Health Visiting Nurses experienced significant changes in their operations after completing a change to their EMR system, transition of their President and CEO and turnover in key clinical management positions within the agency over a two year period. The results impacted the agency’s financial stability and created a need to redesign all aspects of the revenue cycle. This program will present the details of a case study containing the evaluation and redesign of Home Health Visiting Nurses’ revenue cycle. The following five areas of the revenue cycle will be included in this case study: intake, insurance Verification/authorization, Orders/Face to Face Management, Scheduling and Clinical Management. Details discussed during the presentation will include: obstacles faced, prior processes utilized by the agency, steps taken to redesign the process, and current success being achieved by the agency in each area stated above. The purpose of the program is to provide agency management with different avenues and ideas that they can pursue to perform an internal assessment of agency operations to identify areas in which they can operate more efficiently.
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Payment Models Track

Navigating the Medicare Advantage Payment World

Pamela Hall, RN, MBA, Executive Director, Athens Regional Home Health
Most Medicare Advantage (MA) plans provide a wide range of benefits at a lower out-of-pocket cost than traditional fee-for-service Medicare. MA enrollment has continued to increase following implementation of the Affordable Care Act (ACA) despite predictions to the contrary. While experts disagree on the rate of continued growth beyond 2015, the influx of baby boomers with better health and more accustomed to a managed care environment will likely drive continued growth in MA plan enrollment. The transition to fee-for-service rates under the ACA for MA plans has reduced payments to MA plans, however plan profitability remains strong and quality has improved. Home health agencies with the ability to provide a superior patient experience and high quality outcomes at a lower cost are strongly positioned to capitalize on the opportunities in this market sector. This presentation will discuss the strategies used by one home health agency to achieve this end while remaining profitable serving this population.

Hospice Payment Reform: Assessing Impact to Date

Patrick Brown, MBA, MS, Chief Financial Officer, Penn Home Care and Hospice Services
M. Aaron Little, CPA, Partner, BKD, LLP
This session will review the new Hospice payment reforms and discuss how to measure the financial impact of the changes to Hospice payment rates. They will discuss operational areas to focus on to ensure your agency continues to achieve financial success.
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The Inevitable Changes in Reimbursement for Health Care at Home and What You Need to become a Leader in this New Environment

Tim Ashe, RN, MS, MBA, Partner and Director of Operational Consulting, Fazzi Associates, Inc.
Marki Flannery, Executive Vice President and Chief of Provider Operations, Visiting Nurse Service of New York
There is a world-wide change in how health care will be delivered. It is affecting every continent and every country. It is driven by the same factors and is leading to the same structural conclusions. It is inevitable. So too is a growing shift to services in the home as the first choice, the default in newly emerging health systems. For home care and hospice providers, change creates opportunities for those who aggressively move in the right strategic directions and creates threats for those who want to retain the status quo.
With this change so too comes a shift in payment and reimbursement structure – we will explore the fundamentals of the movement towards Bundled Payments and discuss the essential keys to being successful in this and other risk contracting structures. Marki Flannery will present the advanced work that VNSNY has been conducting in their Bundled Payment programs as a great case study on how to succeed. Tim Ashe will discuss what is occurring nationally and how all agency leadership teams should be positioning their agencies for success.
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Unlock the Keys to Value-Based Care & Alternative Payments: Clinical Targets for Care Programming

Arnie Cisneros, PT, President and CEO Home Health Strategic Management
Cathy Sorenson, RN, BSN, MBA, President and CEO, Home Healthcare Hospice and Community Services
As new care and payment models arrive in the forms of CCJR and VBP reforms, home health has great opportunities to reinvent programming. Home health excels in flexibility, affordability and patient preference; how can they refine their care model to achieve the goals of the ACA Alternative Payment care models? Clinical and fiscal breakdowns of home care programs identify areas of opportunity for rewiring home care episodes in terms of value rather than volume. Nursing assessments and programming, rehab protocols for value and safety, modifying care using clinical indicators, patient-centered care for clinical outcomes; all can be rewired for focus and efficiency to address the new care landscape. This progressive presentation outlines providers who have successfully navigated care redesign, including case studies and clinical and fiscal outcomes while preparing for the ACA care demands of CCJR and VBP models.
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Making the Transition to Value-Based Home Health: Counting Patients vs. Visits

Christopher Lee, BS, CEO, Colorado VNA Hospice & Palliative Care
Colorado VNA (CVNA) and Kaiser Permanente Colorado have been partners for over 30 years. Over this time the relationship has evolved from a transitional FFS contract to one that is still FFS but has key performance metrics tied to rate increases. Some of performance targets and metrics include decreasing visits per episode, decreasing readmissions, cases opened in 48 hours or less and patient satisfaction. The contract has been successful in pushing CVNA to improve care and decrease cost for Kaiser which has made CVNA a better agency. This session will describe the details of the contract and how CVNA has been able to both decrease visits and increase revenue within a FFS contract.
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Getting Past the Overhead Myth

Caryn Hohnholt, CSW, CFRE, Vice President of Development, VNA of the Midlands
A dangerous myth prevails among funders and donors that nonprofits with lower overhead – the share of an organization’s administrative costs – channel more funding to programs and operate as leaner and more successful organizations. Essentially, their assumption is that low overhead can be used as a proxy for efficiency, when in fact research shows that under-investing in administrative overhead is often linked with poor nonprofit performance.
This session is aimed at VNA fundraising leaders, including CEOs, CFOs, CDOs and other development professionals who are interested in understanding and spreading awareness about the dangers of under-investing in overhead, who wish to invest in administration and who need strategies for communicating to funders the true costs of running their organization.
Adequate investment in administrative staffing and infrastructure – “overhead” – allows nonprofits to more effectively carry out their missions. In this session, attendees will learn: Why the nonprofit starvation cycle exists; How to properly measure their overhead utilizing updated OMB uniform guidance; How organizations that invest in administration can subsequently improve their programmatic work; and Strategies for explaining to funders and donors the importance of overhead costs for future success.

Leadership Strategies & Partnerships Track

Leverage Your Board to Meet Mission

Kerry Bartlett, CFRE, MBA, Vice President, Foundation, VNA of the Treasure Coast
Sue Tompkins, VNA and Hospice Foundation Board Member and VNA TC Vice Chairman
Instead of thinking of your Board of Directors as a necessary evil, they can bring significant resources to the table in many areas including fund development, strategic planning and organizational assessment. Their connections, skills, expertise and unique perspective can extend your organization’s reach as well as strengthen its capacity to meet mission. In this session, you’ll learn about the transformational outcomes one VNA Hospice has experienced by engaging its Board leadership in developing and implementing key priorities. It’s a win-win opportunity!
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Home Health Reimagined

Beth Hennessy, RN, BSN, MSN, Executive Director, Sutter Center for Integrated Care
Paula Suter, RN, BSN, MA, Clinical Director, Sutter Center for Integrated Care
This presentation will outline the organizational and clinical competencies needed to provide patientcentered, evidence-based, coordinated care in order to succeed in value-based care delivery models. The following topics will be covered: Discuss the urgency for healthcare leaders to re-imagine and transform care delivery; Make the case for person-centered care delivery in order to attain optimal star ratings and meet the revised CMS conditions of participation; Define what it means to be a competent clinician in value-driven models of care; Identify your organization’s readiness to participate in new models of care; and Examine the relationship between patient engagement, health literate care and shared decision-making practices.
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Impact of an In-Home Pharmacist Working in Conjunction with Nurses

Jason Grace, PharmD, Clinical Coordinator, Tria Health
Christy Mesik, Director of Marketing and Provider Relations, VNA of Kansas City
in 2014, an in-home Pharmacist grant was submitted with the objective to improve health outcomes by increasing medication education, lowering medication discrepancies and lowing re-hospitalization for Medicare patients with CHF, COPD, Diabetes and those patients taking 8 or more medications. A partnership was developed with UMKC School of Pharmacy to include the in-home Pharmacist program as an option in the community rotation for senior level students. Tria Health was contracted by VNA of Kansas City to provide preceptor and pharmacist supervision to the students.
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Navigating Health Systems Track, Sponsored by Medtronic

Value-Based Purchasing: What Is It and Are You Ready?

Chris Attaya, MBA, FHFMA, VP, Business Intelligence, SHP
Reynold Spadoni, President, Partners HealthCare at Home

Home health value based purchasing (HHVBP) has been finalized by CMS to begin starting January 2016. Agencies have 21 OASIS, HHCAHPS and Claims quality and process measures (plus three new measures) that will be used to evaluate whether a penalty or bonus will be awarded based on both individual agency performance as well as improvements over the base year. As one of the agencies in the demonstration states, Partners HealthCare at Home, along with SHP will present an overview of HHVBP and their findings in preparing for VBP. The presenters will first review the structure and calculations of VBP, and give some insights learned from the Hospital VBP, underway for over three years. They will also reflect the steps they took to engage their organizations to be in the best position to understand their current ratings and how they planned to improve and report on their performances and progress along the way. Specifically, analytical and organizational operational/workflow considerations will be reviewed.

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Integrating Technology into Care Delivery: Examples of Several Innovations and How They Work in Practice

Robert J. Rosati, PhD, VP, Data Analytics and Research, VNA Health Group
Software and hardware companies are creating innovative solutions that have the potential to dramatically change how home providers deliver care and interact with patients and family caregivers care. The challenge with these innovations is determining those that are most effective, affordable and can easily be integrated into clinical workflows. This presentation will share lessons learned implementing a HIPAA compliant text message system with a group of young mothers in the Nurse Family Partnership, a tablet-based remote monitoring system that includes secure video and a smartphone application that can be used for wound management. In addition to learning about the products, feedback from staff will be shared, the impact on clinical outcomes and patient experience data. Finally, information will be provided on how to effectively partner with technology companies looking to explore new markets.
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Bundled Payments: Rigorous Focus on Quality and Patient Safety will Improve Patient Outcomes and Ensure Financial Success

Scott Rushanan, MS, OTR/L, MBa, Director of Rehab Services, Penn Home Care & Hospice Services
Cynthia Celi, MSW, Director of Business Development, Penn Home Care & Hospice Services
The Orthopedic Clinical Care Pathway was developed at Penn Medicine in response to the lower major joint bundle payment. This program has demonstrated that home care is a major factor in post-acute care. Home care can be utilized as a way to decrease cost and improve quality outcomes. Success can be achieved with program development by partnering with hospitals and physician practices. Communication, collaboration and sharing quality metrics are keys to patient outcomes and financial success.
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Survival Strategies for Non-Acute Providers in a Value-Based Contracting World

Karen Collishaw, MPP, CAE, President and CEO, CHAP
Denise Prince, MBA, MPH, System Vice President, Value-Based Care, Geisinger Health System
Representatives of the Geisinger Health System and the Community Health Accreditation Partner will discuss survival strategies in the ever-evolving health care delivery environment. How can home and community-based care providers remain relevant given changes in payment, delivery systems and regulatory requirements? What strategies can non-acute care providers employ to position themselves as an essential part of a broader continuum of care? What are some ways to adjust patient care approaches when working within a system taking on increased risk and expecting improved outcomes? Finally, what are large health entities looking for from providers when deciding who they want in their networks? 
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Care Management: The Emerging Role of Home Health

Patricia Upham, RN, Director of Care Transitions, FirstHealth of the Carolinas
The FirstHealth Care Management Model, a comprehensive model of care for patients with complex chronic conditions, was developed with the support of the health system as a critical component of the organization’s population health strategy.
FirstHealth Care Management includes The Center for Telehealth providing remote monitoring across care settings, Complex Care Management for patients with chronic disease who are not eligible for home health but who require ongoing support and education and Home Health.
The development and implementation of a multidisciplinary team based model that includes standardized evidence based practices for both nursing and therapy led to the redesign of the on boarding and on going competency program and a pay for performance model to align quality and compensation.
This course will describe how one agency created a clinical and financial model for high risk patients with chronic disease for the health care system.
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Essential Tools for Leaders in an Outcome-Based World

Joan Doyle, RN, MSN, MBA, Executive Director, Penn Home Care & Hospice Services
Margherita Labson, BSN, MSHSA, CCM, CPHQ, Executive Director, The Joint Commission
The movement towards outcome based reimbursement is yet another sign that healthcare has embarked on the journey towards high reliability. Leaders go to great lengths to arm their staff with tools and resources that help produce the best outcomes but what tools and resources does the leadership have to leverage your operational capability to produce sustainable performance and optimal outcomes? Join us as we share some essential tools that all leaders can use to obtain useful information from imperfect data. High reliability is a key concept in this new outcome based health care world, come learn about some hands on practical tools that can jump start your journey.
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