Post-Acute Care Networks: The Key to Success in Accountable Care
Emerging accountable care organizations that are focusing extensively on primary care redesign may be overlooking a part of the care continuum that may yield the greatest benefit — post-acute care. With early payment reforms targeting hospital readmissions, success in the new world of population management will depend largely on what happens to the patient following discharge. This will demand a leading role for rehab facilities, skilled nursing and long-term acute-care hospitals. ACOs will need to affiliate with or build an organized system to provide the firepower to manage post-discharge patients, which renders the post-acute care network a key element of accountable care.
Many hospital systems already have PACN components in place. In many markets these services are provided by stand-alone, for-profit entities with historically low levels of functional integration with other members of the care continuum.The strategic question is who will take the lead in forming PACNs to drive effective population health management.
There are four major components of post-acute care:
1. Long-term acute-care hospitals. Think of LTACHs as extensions of the hospital ICU. Often ventilator dependent, LTACH patients average 20-30 days length of stay. The objective is to provide a bridge from hospital care until the patient can be released to a skilled nursing facility or home.
2. Rehabilitation (inpatient/outpatient). Rehab facilities may or may not be collocated with an LTACH. A less intensive level of care is provided with focused physical rehabilitation on an inpatient or outpatient basis.
3. Skilled nursing facility. Long-term inpatient care often includes rehabilitation. Since the SNF is a lower-cost option, payors are now encouraging more rehab to take place there.
4. Home care. The preferred option for post-acute care that has the lowest cost and greatest potential for innovation. In addition to in-home visits, this element of the PACN encompasses electronic monitoring and telehealth.
Until now, these entities seldom linked with hospitals in formal contracting relationships, counting on referral streams to attract patients. An organized PACN could effectively manage patients at the appropriate level of care after leaving the hospital, reducing length of stay and lowering readmission rates. Forward-thinking PAC providers are now looking to band together to form integrated systems that include all of the components described above.
Hospitals may be looking to build their own PACN, but with so much existing capacity in the market it may make more sense to link up with existing providers. This is a prime opportunity for rehab providers to establish a key leadership position in the era of accountable care.
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