Transcript Slide 1

The Evercare Model:
Using Nurse Practitioners to
Achieve Positive Outcomes
Pat Kappas-Larson, MPH APRN-BC
Professional Relations/Development
April 24, 2008
A Care Model Becomes the Foundation for a Company
 The Problem:
• For many people living in nursing homes, care is fragmented and
uncoordinated.
• This results in transfers to physician offices, hospitals and emergency
departments at great physical and emotional cost to them, their
families, and increased financial cost to the health care system.
 The Answer:
• In 1987, a company known as Evercare engages nurse practitioners
as partners and places them at the center of an integrated team
delivering personalized and responsive primary care.
• Evercare would ultimately become a successful Medicare
demonstration project, helping to pave the way for the creation of
Special Needs Plans in the Medicare Modernization Act.
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Evercare: Founded in 1987 by Nurse Practitioners
The Evercare Premise:
 Enhance primary care services to reduce avoidable acute care
hospitalizations so as to improve quality of care for permanent nursing
home residents.
 Align financial and clinical incentives so that nursing facilities and
physicians collaborate to achieve the highest level of health and wellbeing for the resident.
 Comprehensive and continuous advanced care planning and family
communication are essential in the care of this population.
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The Mission
To optimize the health and well-being of
people who have long-term or advanced
illness, are older or have disabilities.
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The Nurse Practitioner: The Clinical Model
 Nurse Practitioners serve as collaborator, clinician,
coordinator, coach, and counselor.
 Nurse Practitioners are the center of a multi-disciplinary
team that collaborates on the appropriate and proactive
interventions, communicates the required changes in the
plan of care to all parties, and rigorously monitors the
responses.
 Nurse Practitioners closely monitor changes in health and
focus on early identification of any movement away from
baseline functioning.
 Nurse Practitioners constantly focus on reducing
fragmentation of care, ensuring individualization of the
care, and delivering care reflective of the values, wishes,
and beliefs of the individual and their families.
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Vital Engagements: The Clinical Model
 Families: Who are engaged and involved in the care
decisions and are available for more constant and consistent
communication.
 Nursing home staff: Who understand the goals of care for
each resident and are intimately involved in the monitoring
of the individual.
 Other key professionals: Physical therapists, nutritionists
and others who are available in the facility and are willing
to function as part of the broader care team.
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Evercare Evolution
1987
2 NPs Invent
Evercare
Nursing Home
product
in MN
1995
Evercare Medicare
Demo begins
in 6 cities
outside of MN
1987
2001
Evercare buys
LTC Medicaid
company
(Lifemark)
1995
2001
2003
MMA
creates
SNPs
2003
2005
Evercare
ESRD &
Erickson
CMS
demos
begin
2005 2006
Product (Membership)
1987
NH (100)
2002 Year End
NH (24,000)
LTC Medicaid (35,000)
2008
Evercare
Alzheimer’s
2006
SNP begins.
Evercare
Evercare
Hospice
Texas ICM
begins
begins.
2007 Yearend
NH I SNP (30,000)
LTC Medicaid (70,000)
Dual SNP (81,000)
CI SNP (28,000)
ESRD & Erickson Demos (2,500)
Hospice ADC (645)
2008
Who We Serve In Our Products
 5+ chronic conditions= 2/3 of all
Medicare costs
 50% of people die in hospital
outside of Hospice
 Greatest suffering = ineffective
resource utilization
 Poor palliation services
 Single condition but very
high impact, e.g.
quadriplegia, advanced
Alzheimer’s Disease
 May be functioning well, but
sudden event is catastrophic
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Clinical Model Effectiveness: What is Attainable Today?
Effect of Evercare on Hospital Use
with No Difference in Mortality
80
 Enrollee satisfaction: 97%
70
60
Admits
per 1000
Enrollees
 Physician satisfaction: 90%
50
40
30
20
10
0
Evercare
Evercare
Control 1 Control 2
Hospital Admissions
Control 1 Control 2
Emergency Room Visits
 Arizona: saved $111 million
compared to FFS LTC Medicaid
Arizona Long Term Care Setting
Nursing Home Eligible Population
100
Percentage of
nursing home
eligible
population
living in a
nursing home
vs. in the
community
 ER and hospital utilization for
dual eligible community-based
population: reduced 30%
Nursing Home
 Texas: saved $70 million in one
county
80
60
40
20
0
Community-based living
'89 '90 '91 '92 '93 '94 '95 '96 '97' '98 '99 '00 '01 '02 '03
Year
Unmatched clinical results…
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 Florida: reduced nursing home
placement by 70%
Barriers Encountered Along the Way
 A health care system focused on care in acute care settings,
not on treating multiple chronic illnesses with an integrated
care model responsible for the full spectrum of acute and
long-term care services needed by the individual.
 A dearth of staff and expertise in long-term condition
management, geriatrics, and end-of-life palliation.
 Lack of experience and understanding about coordination
across providers and care settings.
 System fragmentation and inadequate communication tools.
 Resistance to working and engaging differently, accepting
the need to change.
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Policy Recommendations
 Support initiatives that move toward innovative care
models focused on coordinating high quality care across a
variety of providers and settings.
 Reauthorize and enhance Special Needs Plans, which focus
on the needs of the chronically ill.
 Transform the delivery of long-term care in all settings to
support the key role of the nurse practitioner as the center
of a multi-disciplinary team.
 Ensure training and education for health professionals in
geriatrics and chronic disease management, and support
and expand existing academic programs focused on
building a work force for the aging population.
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