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Post-Acute Care Has a Quality Management Problem

By HealthLeaders Media News  
   July 26, 2016

Less than half of health plans and health systems have identified solutions to assess the quality of their post-acute networks, survey data shows.

A survey of some 20 Medicare Advantage health plans operated by both health insurance companies and health systems shows that only 31% of them have identified solutions to help them assess the quality of their post-acute provider network.

More specifically, and perhaps more troubling: most plans and health systems are developing post-acute networks one provider type at a time. Rather than finding ways to integrate care management and accountability across settings, skilled nursing facilities are the most common area for initial focus.


Related: Strategies for Managing the Post-Acute Environment


The survey and interviews were conducted by Washington, D.C.-based consulting firm Avalere Health in cooperation with post-acute provider Kindred Healthcare. Post-acute providers include long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies.

"Providers that can integrate data across the care continuum can drive better outcomes for patients and be better partners to Medicare," said Josh Seidman, a senior vice president in Avalere's Center for Payment and Delivery Innovation, in a media release.

Some of the findings suggest a reliance on interim measures, such as robust post-discharge follow-up by a variety of methods, to help encourage, if not ensure, good outcomes.

Clearly, better analytical and decision-assisting tools are needed, and organizations would probably benefit by constructing their post-acute networks more systematically rather than in an ad-hoc manner.

Avalere reached three broad conclusions about the survey data:

1.Reliable data are critical to advancing value-based post-acute contracts.

Unreliable provider quality data was a cited as a common challenge in some of the interviews conducted with health plan and health system representatives.

Payers also were skeptical about the capability of post-acute providers to enter into risk-based contracts with health plans directly. Health systems also cited a lack of data infrastructure to systematically channel patients to high-quality post-acute providers.

2.Incentives to redefine post-acute management could be most prominent in arrangements where health systems are bearing financial risk.

All health systems placed a high priority on developing high-quality post-acute networks, and more than half were interested in discharging patients to lower-cost post-acute settings such as home health.

Interviewees indicated that entering into bundled payment or accountable care organization contracts, under which providers bear financial risk for the total cost of care, were important catalysts for this prioritization.

3.Reducing readmissions is an area of focus, but the role of post-acute in improving readmission rates is still evolving.

All interviewees reported investments to reduce hospital readmissions. Many are just beginning to think about how post-acute provider quality and accountability can contribute to those efforts.

Health systems are ramping up their focus on post-discharge follow-up, including exploring new uses for remote care technology.


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