Physician leadership at nursing homes can substantially reduce costs and improve quality measures, but is a woefully underutilized resource.
A unique ACO partnership has reduced length of stay, readmissions, and costs for Medicare beneficiaries receiving post-acute care at skilled nursing facilities in New Jersey.
How it achieved such improvements relies largely on the influence of physician leadership.
When Poonam Alaigh, MD, was New Jersey's Health and Senior Services Commissioner in 2010, her mother-in-law was diagnosed with a serious illness. Alaigh was able to navigate the fractured healthcare system because of her unique experience as a physician and healthcare executive. But she says she knew other patients and families were unlikely to have someone like her that could steer medical care appropriately.
Poonam Alaigh, MD
That experience led to a sort of personal mission for Alaigh after she left her appointed post in 2011 and says that "taking care of elderly and making sure they have the autonomy and respect they want is my personal and professional mission."
Alaigh drew on her personal connection to her in-laws to help develop the Atlantic Accountable Care Organization, a joint venture developed in 2010 between Atlantic Valley Health System, a Morristown, NJ-based nonprofit health system, and Valley Health System, a 451-bed acute care, nonprofit hospital, based in Ridgewood NJ.
"I work in the nursing home at the VA on the weekends," Alaigh says. "My patients tell me, 'If only we had all those resources.' Those things have inspired me when looking at the post-acute care world."
Focusing on Post-acute Care
Atlantic ACO decided to focus on post-acute care last year with Optimus Healthcare Partners, a clinically integrated network with 500 primary care and specialty physicians.
Thomas Kloos, MD
"Our analysis of data showed a significant regional difference in the post-acute care costs for both our ACO's as compared to national averages," says Thomas Kloos, MD, executive director for Atlantic Management Services Organization, which provides management services to both the Atlantic ACO and Optimus Healthcare Partners.
Two approaches helped Atlantic ACO understand why its metrics were an outlier. The ACO formed a multidisciplinary group of physicians, social workers, nurses, and others to analyze the data. The ACO also worked with the American Health Care Association (AHCA), the organization that represents more than 11,000 nursing facilities, assisted living facilities, and sub-acute care providers in the United States. ACHA shared data on length of stay, readmission rates, and the percentage of patients discharged back to community.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.