4 Ways to Use Postacute Data Strategically

With the increase in risk-based contracting, hospitals and health systems depend on leaders to develop measurements that will help keep patients out of high-cost care settings.

Leaders at hospitals and health systems with risk-based payer contracts are taking a crash course on postacute care.

Learning how to keep patients out of the hospital, where the highest-cost care happens, is critical to success under risk.

Here are four ways healthcare leaders are using data to help keep patients stable and out of the highest-cost care settings.

1.To Enable Course Correction

In helping to develop HM Home and Community Services, a division of Pittsburgh healthcare conglomerate Highmark Health, Brian Holzer, MD, saw his job in simple terms: Close gaps in postacute care.

The former president of the organization (he left in late May to become president of Kindred Healthcare's Kindred Innovations unit) says the best way to do that is through measurement of key metrics and collaboration with postacute care providers that allow course correction in the patient care journey at the earliest possible point. 

HMHCS manages the interactions between those postacute companies and acute care facilities with the aim of holding postacute providers accountable for their performance in quality and cost control.

Its team closely monitors metrics such as SNF and home health readmission rates and SNF lengths of stay. 

"Generically speaking, these are examples of the unit measures of quality, so we're looking at those trends, but as important on a weekly basis is how well the model is working for our ACO and health plan customers," says Holzer.

2.To Shorten the Data Lag

Holzer hungers for more data that is applicable to realtime scenarios. 

"Healthcare, particularly postacute healthcare, suffers from lack of actionable data," he says, adding that, nationally, approximately 40% of patients admitted to the hospital recover in some sort of postacute care setting.

"The ability to keep tabs on that patient to see whether medical recommendations are taking place, or when patients are picked up by other healthcare pros would be very helpful in helping the postacute side make commitments to hospitals and insurers on gains in quality and efficiency," he says. 

That would mean insights from realtime data that doesn't really exist yet.

"We need to have insights from data as they flow," he says. "We're not the only entity touching patients. We need earlier info on who's going home and will need services, so that hospitals can better educate the patient on options, build detailed care plans, and measure how those plans work out."

On that point, he'll get no disagreement with Daniel Varga, MD, chief clinical officer at Texas Health Resources based in Arlington, TX. He's basically accountable for all clinical operations in the health system, serving in a dyad management model with the chief operating officer.

3.To Take Out Costs

The first place to attack inefficiency is the inpatient side, Varga says, but Texas Health Resources wants to broaden its reach into the postacute experience, which requires different measures to help improve care coordination and efficiency and prevent gaps in care. 

"We know we have to take a significant amount of cost out of our system while not sacrificing quality, reliability, safety, and the patient experience," he says.

"That requires an obsessive approach to outcomes, an elegant approach to process redesign, and compliance with that process."

Compliance with process redesign is especially important in both inpatient and outpatient environments. The system has built hospital operations improvement dashboard measures, in close to real time, that allow observation of hospital operational metrics such as labor requirements based on patient load, productivity, and cost center analysis. 

"Those dashboards allow us to drill into process redesign compliance on a daily basis," he says.

"Another piece we look at is something brand-new for us: labor cost per adjusted patient day, discharge and productivity metrics, but essential to our daily analytics is reliable care blueprinting, which is our approach to high reliability in bedside operations."

The redesign of bedside care, which features process-level leading outcome indicators that populate in real time, helps evaluate compliance in time to make course corrections, Varga says.

Blueprinting helps him gauge compliance in, for example, fall risk, documentation, or assessments.

There are 20 leading process indicators to make sure the care redesign parameters are being followed, but more important, where there's compliance and where there isn't. Varga and his team can drill deeply into compliance—even by job title. 

"We've tried to create a metrics stack that's valuable to the specific user," Varga says. "For example, if we're looking at the reliable care blueprint for sepsis, observed versus expected mortality is really not valuable to a frontline technician. But we know a key process metric is early identification, and in order to slip the alert, a certain set of vital signs needs to be obtained. Everyone has a stack that applies to them."

4.To Enable More Risk Taking

Those tools and others like them will be important on the outpatient side as well, as Texas Health Resources takes more revenue risk, such as with the rollout of its NextGen ACO.

With approximately 80,000 beneficiaries, the ACO will be on the hook for plus-or-minus 15% of about $1.1 billion in annual premiums, depending on how it does in improving outcomes for Medicare beneficiaries.

Coupled with its existing Medicare Advantage offerings, the health system will experience about $1.5 billion in premiums either in total risk or partial risk in 2017, says Varga.  

With more healthcare services gravitating away from acute care, Varga says to unlock the value the health system creates by managing an entire episode of care, it must take more risk.

"The only way we unlock the value we create is to take more risk."