About RAVEN

Phase I - Clinical Interventions

UPMC entered into the CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents in 2012. This four year initiative (Phase 1) addressed the prevention of avoidable hospitalizations through the implementation of various clinical quality models.

The UPMC Community Provider Services ECCP (Enhanced Care and Coordination Provider), led by the Aging Institute of UPMC Senior Services, University of Pittsburgh and the Jewish Healthcare Foundation, implemented five clinical interventions within 18 partner long-term care nursing facilities (LTCs) throughout Western Pennsylvania.

These LTCs were located throughout rural, urban and suburban areas, and with varying status and ownership classifications including profit, not-for-profit, county, corporate, and locally owned.

 
 Raven Clinical Interventions
  • Facility-based Enhanced Care Staff

  • Evidenced-based assessment and clinical documentation tools

  • Innovative education

  • Enhanced medication management

  • Telemedicine
 

Our ECCP implemented the clinical quality interventions to accomplish these five main objectives across Pennsylvania:

  1. Reduce the frequency of avoidable hospital admissions and readmissions among nursing facility residents
  2. Improve nursing facility resident health outcomes
  3. Reduce overall health care spending without restricting access to care or choice of providers
  4. Reduce overall health care spending without restricting access to care or choice of providers
  5. Facilitate knowledge transfer and culture change within partner nursing facilities to sustain these best practices over the long-term

A 2015 RTI Evaluation showed our ECCP's positive impact on potentially avoidable hospitalization (PAHs), all-cause hospitalization and ED visits.

While this clinical quality model did show success, Phase 1 of the initiative did not address the existing payment policies that may be leading to avoidable hospitalizations. The Medicare Payment Advisory Commission (MedPAC) reported in their June 2010 Report to Congress of the financial advantages of LTCs to transfer residents to a hospital.

Phase II - Payment Reform

CMS has launched a Phase II of this demonstration to test the effects of providing payment to skilled nursing facilities and practitioners for the treatment of specific conditions. Phase II has been designed to run until September 2020.

The three key components of Phase II include:

  1. Payments to a long-term care facility under Medicare Part B for the treatment of qualifying conditions

  2. Increased practitioner payments under Medicare Part B for the diagnosis and treatment of qualifying conditions onsite at the facility
  3.     The Six Qualifying Conditions:
    • Pneumonia
    • Congestive Heart Failure
    • COPD/Asthma
    • Skin Ulcers/Cellulitis
    • Fluid or Electrolyte
    • Disorder or Dehydration
    • Urinary Tract Infection

  4. Practitioner payments under Medicare Part B for care coordination and caregiver engagement for beneficiaries in a nursing facility

Fifteen of our partner facilities from Phase I will continue to receive the same clinical interventions received in Phase I PLUS participate in the Phase 2 payment model.

In addition, our EECP has partnered with another twenty (20) facilities across Pennsylvania to implement the payment model only.