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How 2 Systems Cut Postacute Care Costs and Raised Quality

Analysis  |  By Philip Betbeze  
   December 22, 2016

Health systems are creating preferred networks and monitoring provider services to cut length of stay, reduce readmissions, and improve outcomes.

Just a few years ago, most hospitals discharged their patients and didn’t check on them again unless they showed up in the ER or were readmitted. But now, as government and private payers alike seek to improve care coordination, post-discharge patient care can no longer be ignored.

Through accountable care organizations and clinically integrated networks, health systems have access to data that can help them identify variation among postacute providers. These health systems can also spark performance improvement among their postacute partners by having them compete against each other for discharge volume.

In a recent press call with healthcare performance improvement company Premier Inc., two early movers shared the tactics that helped them drive better outcomes and financial results.

Preferred Providers
St. Luke's University Health Network in Bethlehem, PA, began building a preferred postacute provider network in 2013, said Donna Sabol, RN, vice president and chief quality officer.

That year, leaders at the seven-hospital health system decided to fully participate in a voluntary Medicare bundling initiative that covered 84 procedures and the follow-up care associated with those procedures.

Developing a truly accountable postacute provider network was an urgent priority. “We saw it as a learning opportunity in preparation for mandatory bundles,” she said.

Nonacute Care: The New Frontier

To ensure early success, St. Luke’s evaluated its internal needs for staffing, technology, data analysis, care coordination and gainsharing with invited postacute care organizations, and invested in those capabilities.

Registered nurses and physical therapy providers from St. Luke's worked with postacute providers to develop care protocols. Using its EMR, the health system identified bundle patients upfront so the specialists coordinating their care could supervise patients’ care on admission to the hospital and follow them for 90-days post-discharge.

There was room for improvement—data showed patients with commercial managed care averaged half the postacute length of stay of traditional Medicare patients.

Postacute partners needed training, so St. Luke’s embedded physicians in those providers and began sharing quarterly performance data as well as blinded data from other providers in the region.

St. Luke’s made clear from the beginning that postacute providers would be competing for a spot on the health system’s “preferred” list based on performance. The initial list included 16 partners, but was winnowed to nine by April 2016.

Organizations can be added to or removed from the preferred list based on ongoing semi-annual performance reviews.

Getting the Value Out of Postacute Care

Since 2013, the health system’s average length of stay in skilled nursing facilities has dropped from 36-40 days to 14-19 days. Meanwhile, 90-day readmission rates have decreased from 34.4% to about 21%.

Acute care sites can’t insist patients choose one postacute provider over another, but they can heavily influence that choice by prominently featuring organizations that follow the same agreed-upon care parameters as the hospital or health system. Postacute providers will compete for that volume, said Sabol.

One Number to Call
Presbyterian Healthcare Services, an integrated delivery system in Albuquerque, NM, piloted an advanced illness management program in 2015 that focuses on the 5% of its Medicare Advantage patients with the most serious illnesses.

Since piloting the program in 2015, Presbyterian has enrolled 600 of the sickest MA patients, said Nancy Guinn, MD, medical director of Healthcare at Home, a unit of Presbyterian Healthcare Services. These patients represent about 50% of the total costs of the system’s Medicare Advantage plan.

Potential candidates for the program are identified by case managers or health assessments, and are given one phone number to call for all services. They can use the number to arrange for in-home case management, for example, or to connect with a practice devoted exclusively to house calls.

The program tracks outcomes such as ED visits, hospitalizations, falls, urgent home visits, and hospice. Since its inception, the program has provided 553 urgent home visits, 372 of which avoided ED visits and subsequent hospitalizations. Initial reports on total cost of care show savings of $700-plus per member per month, Guinn said.

No postacute partnership is the same. Both of these examples are snapshots of the types of interventions that can yield results, but they demonstrate the immense power of true accountability to improve outcomes and cut waste.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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