The Los Angeles Jewish Home introduces… CONNECTIONS TO CARE

1. The Los Angeles Jewish Home introduces… CONNECTIONS TO CARE A Rationale and Development of a Post Acute & Chronic Care System for a New Age • PEAK LEADERSHIP SUMMIT • Innovative Models for the Future: Integrated Systems & Payment Models Symposium • Molly Forrest, CEO & President, LA Jewish Home

2. Does this Sound Like Our World? “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going to Heaven, we were all going direct the other way.” Charles Dickens, Tale of Two Cities

3. “20% to 30% of health spending is waste that yields no benefit to patients… much is done that does not help patients at all, and many physicians know it” -Don Berwick, New York Times, December 3, 2011

4. OUR FUTURE : Lower Cost, Better Outcomes & Improved Health

5. Press the Individual into the Silo that seems to “fit” Fragmented System in ‘Silos’ of Care

6. Lack of Transparency out-&-inside! Limited/missing Research on Effective Care Services

7. Misalignment of Financial Incentives

8. In 1996, LA Jewish Home was A Fragmented System in ‘Silos’ of Care 1996-98 Data: 700 residents/year Average age – 90; 90% female Average length of stay – 7.9years Hospital utilization – 10,000 days/year

9. The Big Picture – Who says an Elephant Can’t Dance? What are the goals? • Modernizing the Home • Data, data, data • Identification • Accumulation • Development • Benchmarking • Exchanging with many! Partners, participants & payers • Integrating services with others • Sharing Costs of Care • Sharing Revenues from Care

10. Paradigm Shift in Individual Interactions From … • Telling patients what to do • Transfer of Information • Compliance To … • Listen, problem solve, collaborate • Developing confidence and skills • Building capability Outcomes … • Engagement in healthy behaviors • Better care experiences • Less likely to be hospitalized, readmitted, use emergency department or skilled nursing • Overall lower costs

11. Change CommunicationCritical in Changing Relationships

12. Introducing the Los Angeles Jewish Home’s CONNECTIONS TO CARE ONE CALL DOES IT ALL Mutually-Supporting Services Providing a Continuum of Senior Care “In Your Home or Ours” • Senior Housing and Residential Care • In-Home And Community-Based Senior Care Services • Jewish Home Non-for-Profit Parent Organization Programs

13. The Los Angeles Jewish Home’s Connections to Care Housing & Residential Services Home- and Community-Based Services JHA Non-Profit Parent Organization Programs • •  HOSPICE • PALLIATIVE MANAGEMENT FOR PAIN • AND CHRONIC CONDITIONS • GERIATRIC COMMUNITY CLINICS • •  PRIMARY & SPECIAL MEDICAL CARE • MEMORY CARE SUPPORT GROUPS • PACE / Brandman Centers for Senior Care • (A Program of All-inclusive Care for the Elderly) • •  PACE ‘Lite’—Self-Select PACE Services • CMS CARE TRANSITIONS • •  BRIDGE PROGRAM • •  HOME HEALTH AGENCY • •  PERSONAL CARE SERVICES • •  GERIATRIC CASE MANAGEMENT • Medical Management • TRANSPORTATION • •  CAREGIVER SUPPORT GROUPS • INDEPENDENT SENIOR HOUSING Fountainview at Eisenberg Village Fountainview at Gonda Westside Neighborhood Homes • RESIDENTIAL CARE • MEALS • SKILLED NURSING General Skilled Nursing Memory Care • SHORT TERM REHAB • ACUTE GERIATRIC PSYCHIATRIC CARE • INPATIENT HOSPICE • PHILANTHROPY BUILDING SKILLS FOR TOMORROW’S SENIORS • ANNENBERG SCHOOL OF NURSING Licensed Vocational Nurse (LVN) Personal Care Worker Home Health Aide Certified Nursing Assistant CNA) CSUN RN Program – Clinical Site Partnership • EMPLOYMENT AGENCY 855-227-3745

14. “The difference is that of attitude… Ideas, like people, flourish when they are welcomed and embraced.”— Barbara J. Winter • Leadership – commit prioritization of efforts & resources • Culture – change from “solo silo” to new care delivery • Communication – leaders , partners and local providers • Implementation – beware ! A quest for data perfection limits operational performance; begin at the beginning • Patient Engagement – develop mechanisms to reach out to patients and care-givers ; avoid the “opt outs” • Data Analytics – capable of processing data • Leadership and follow-thru on actionable reports

15. As a Non-Profit What Asset is Available? • $72 Million – Keeping the Promise • Goldenberg-Ziman Memory Care • Joyce Eisenberg Keefer Medical Center • Skirball Hospice • Jewish Home Center for Palliative Care • Brandman Centers for Senior Care (PACE) • CMS Innovation Awards • Care Transitions • Hirsch Family Campus • $215 Million – Keeping the Vision • Gonda WS Healthy Aging Campus • Polak Family Assisted & Memory Care • Towers Independent & Assisted Living • Goldstein Chapel • Jewish Home Care Services • Bride = connections to care” Philanthropy & Community Support

16. 2013 Data: • 4300 total seniors served; 75% governmental assistance • 65% of these aided by short-stay or at home • Average age in residence – 90; 90% female • Average length of stay – 7.0 years • Hospital utilization – 3300 days/year • Readmission to acute within 30 days of admit: 1996-98 Data: 700 residents/year; 10,000 days Average age – 90; 90% female 75% governmental assistance Average length of stay – 7.9years Hospital utilization – 10,000 days/year

17. Stratifying Patients / Not “Inpatient” &“Outpatient” • Hospice/Palliative Care • Care Management • Provides medical and palliative care management by specialized Physicians, Nurse, Care Managers, and Social workers for chronically frail seniors LOCATION FOR CARE DELIVERY IS ANYWHERE • Level 4 • Care Management • High Risk and Care Management • Intensive 1:1 physician, social worker & case management for the high risk, and/or post-discharge population. Patient is transferred to Level 2 when stable. Physicians and Care Managers are highly trained and closely integrated into community resources • Level 3 • High Risk • Complex Care and Disease Management • Provides medical and palliative care management by specialized Physicians, Nurse Care Managers, and Social workers for chronically frail seniors • Level 2 • Complex Care & Disease Management • Self Management, PCP • Provides self-management for people • with chronic disease • Level 1 • Self-Management & Health Education Programs

18. Geriatric Care Model: Patient Risk Stratification Tool Using Electronic Health records databases. The tool allows to identify members at risk of hospitalization, poor health outcomes, high costs • The model consists of five key factors: • Likelihood of Hospitalization • Hospital admissions or ED Visits • Behavioral Health diagnosis • CHF or COPD • >= 15 medications

19. Areas of Focus Today ….--Considerations in the Preparation for California “Duals” • Data Analytics for Connections to Care • Care Transitions • SNF Readmissions • Short Term Rehabilitation • PACE & PACE “Lite” • Home Health • Hospice • Palliative Care • Independent Physician Association IPA • HCC Adjusted Risk Scores/Revenue Sharing

20. The Los Angeles Jewish Home’s New CONNECTIONS TO CARE Providing Seniors With All the Services They Need Your Home or Ours --- ”One Call Does It All” Skilled Nursing Memory Care Residential Care Independent Senior Housing Acute Geriatric Psychiatric Short Term Rehab Memory Care Support Group Inpatient Hospice  PACE Brandman Centers for Senior Care PACE ‘Lite’ Alternative Care Settings Senior Centers Community Centers Community Clinics Primary & Special Medical Transportation CMS Care Transitions Bridge Program Home Health Agency Personal Care Services Geriatric Case Management Medical Management Hospice and Palliative Care Annenberg School of Nursing Licensed Vocational Nurse (LVN) Personal Care Worker Home Health Aide Certified Nursing Assistant Philanthropy Employment Agency Skilled Nursing Memory Care Residential Care Independent Senior Housing Acute Geriatric Psychiatric Short Term Rehab Memory Care Support Group Inpatient Hospice  PACE Brandman Centers for Senior Care PACE ‘Lite’ Alternative Care Settings Senior Centers Community Centers Community Clinics Primary & Special Medical Transportation CMS Care Transitions Bridge Program Home Health Agency Personal Care Services Geriatric Case Management Medical Management Hospice and Palliative Care Skilled Nursing Memory Care Residential Care Independent Senior Housing Acute Geriatric Psychiatric Short Term Rehab Memory Care Support Group Inpatient Hospice  PACE Brandman Centers for Senior Care PACE ‘Lite’ Alternative Care Settings Senior Centers Community Centers Community Clinics Primary & Special Medical Transportation CMS

21. Acute Psychiatric • Community Mental Health • Medication Management Skilled Nursing • Short Term Rehab • Chronic LTC • Memory Care Connections to Care Customer Relations Assisted Living • Memory Care • Home Care PACE or PACE-Lite • w/ MD • w/o MD Independent Living 2 5 3 4 1 Home Health Agency Clinic • MD/NP Services Personal Care/ Companion Hospice Palliative Care “Bridge” Care Transitions 7 11 12 10 6 8 9 Distance Care-giving Employment Agency IPA Transportation Caregiver Support 13 15 14 16 17 • Menu & Meal prep • Home-delivered meals Houeskeeping/ Laundry Tel-Assurance Shopping Handyman 18 22 19 20 21 HC Technology • Non-Invasive Surveillance • Invasive Surveillance • E-Access HC Pharmacy • Prescription • Intravenous • Infusion Durable Medical Equipment (DME) Medical Home Other? 26 27 25 24 23 Palliative Care

22. Questions?