Achieving operational excellence in 2024 and beyond
The senior care sector faces a complex array of challenges as it navigates the imperative to innovate and adapt in the face of an aging population, substantial workforce shortages, and persistent financial constraints. Amidst these pressing concerns, the emergence of value-based care offers a promising pathway forward. James Yersh, chief financial officer and chief revenue officer, senior care at PointClickCare, says that as the momentum towards value-based care intensifies leading up to 2030, some providers and operators are already making the shift. "This evolution is about transforming operations to be proactive, collaborate well with other providers, and integrate technology effectively, ensuring that high-quality care goes hand in hand with financial viability,” he says.
In this conversation, Yersh examines critical hurdles faced by the senior care sector, outlining a strategic roadmap for the future. He explores how value-based care, coupled with technology advancements like AI and machine learning, can support senior care providers in achieving operational excellence through resilient care models that enhance coordination and patient outcomes.
Q: What challenges does the aging population pose to the senior care sector in providing quality care while maintaining fiscal responsibility? How “recovered” is the senior care sector post-COVID?
Yersh: As baby boomers approach 80, their increasing number of medical conditions and medications make care delivery more complex. This situation necessitates more personalized care plans, while transitions from hospitals to care facilities amplify the risks for medication-related errors. Meanwhile, there is a shortage of nurses who are being asked to do more with less, and when staff are available for hire, the costs are higher. Occupancy levels in skilled nursing facilities (SNF) still lag behind pre-COVID levels, resulting in less revenue. Collectively, these issues have created a tough operating environment.
Q: How do value-based care models advocate for a shift beyond routine practices in the senior care sector?
Yersh: Value-based care redefines compensation for senior-care providers, transitioning from a traditional fee-for-service model that pays for the volume of care delivered to one that rewards the quality of patient outcomes. This model incentivizes preventative care and early intervention, shifting the focus to wellness instead of sickness. Take, for instance, patients in a SNF; interventions can be introduced earlier to prevent hospital re-admissions or to reduce the severity of their condition. These models encourage senior care providers to take proactive and comprehensive care approaches, aiming to prevent conditions from worsening and avoid repeatable events. Ultimately, financial incentives align with achieving higher-quality results.
Q: How can senior care providers effectively implement and adapt to value-based care models?
Yersh: Collaboration across the continuum is crucial, especially with practice groups rather than individual doctors. It's vital to understand patient needs both within your building and in the broader healthcare landscape. For example, collaboration with a provider group can improve a SNF’s ability to quickly address overnight issues and reduce rehospitalizations.
With the shift toward value-based care, providers are taking on more responsibility for patient outcomes, working within models like institutional special needs plans (I-SNP), chronic special needs plans (C-SNP), dual eligible special needs plans (D-SNP), and accountable care organizations (ACO). Technology, particularly virtual health tools, plays a key role in managing care from a distance and preventing hospital readmissions. At PointClickCare, we support our clients in developing repeatable care plans tailored to specific acuities and designed to deliver the right outcomes.
Q: How do you see technology, particularly AI and machine learning, playing a pivotal role in achieving operational excellence in senior care?
Yersh: Technology acts as a foundation for numerous essential processes, including supporting standardized workflows for treating ailments within a facility. Standardization is fundamental to delivering consistent, high-quality care. For instance, using evidence-based protocols to document skin conditions or wounds can minimize complications and achieve better outcomes. Additionally, technology is vital for the seamless exchange of information during care transitions between hospitals and SNFs, bolstering efficiency and accuracy, and helping to minimize medication errors.
AI extends this foundational support, enhancing not only workflow efficiency but also predictive capabilities. AI algorithms can alert us when a patient’s vital signs suggest a potential risk for hospital readmission, enabling intervention. At PointClickCare, we’ve embedded a machine learning model, Predictive Return to Hospital (pRTH), in our skilled nursing analytics offering, which analyzes data to help nursing staff prioritize patient care.
Q: With the constant evolution of technology and care practices, how do you foresee the role of senior care providers transforming over the next decade?
Yersh: Senior care providers are poised to integrate AI and machine learning more deeply to reduce administrative tasks, increase quality of documentation, and flag high-risk patients — all crucial in a value-based care environment. Standardized applications will become increasingly prevalent in senior care settings. Predictive analytics will be central to enhancing billing and care pathways. Collaboration across the entire healthcare ecosystem will also grow, with accurate and prompt information exchange and care plan management being essential to avoiding penalties and unnecessary hospital trips.
Q: How can senior care leaders foster a culture of innovation within their organizations to embrace change and improve care outcomes sustainably?
Yersh: Education is fundamental as value-based care shapes future compensation. Many states have adopted the patient-driven payment model (PDPM), with CMS moving toward value-based care by 2030. Leaders need to understand these models deeply, not just keep abreast of changes but also learn the successful practices of their peers. Already, providers who've embraced value-based care are achieving notable outcomes, bridging the gap between recognizing what quality care looks like and implementing these models efficiently.