How Data Can Help ACOs With Post-Acute Care Decisions

While many accountable care organizations are focused on the primary and acute care they provide to their patient populations, a large aspect of patient health may be being overlooked by many: post-acute care.

"The post-acute care world is just as significant a part of both the lives of a lot of our members and the cost related to the care we're in charge of managing," says Jason Dinger, CEO of MissionPoint Health Partners, a clinically integrated network and Medicare Shared Savings Program ACO based in Nashville, Tenn.

On the cost side, spending on post-acute care continues to grow. Between 2005 and 2010, Medicare spending on post-acute care grew 6.6 percent each year, compared to a growth of 2.5 percent annually on acute care, according to a National Health Policy Forum issue brief. In 2011, post-acute care cost Medicare $63.5 billion, or more than 11 percent of its total spend, according to the same report.

Along with being costly, post-acute care also affects patients' lives in a major way. Transitioning from a hospital to a skilled nursing facility or to home care is a difficult time in patients' lives, and it is easy for patients to stray from a care plan during those changes. "We find those transitions are highly important and have to be managed really well to drive good outcomes," Mr. Dinger says.

Using data

In order to facilitate optimal transitions and cut the cost of post-acute care and the total cost of care in the ACO, MissionPoint decided to take a data-driven approach and brought in a partner, naviHealth, a post-acute care continuum navigator, to help with the initiative.

Patient function. The core of the data-driven approach to high-quality post-acute care transitions hinges on assessing patients' functional status through screens of cognitive and physical function while the patient is still in the hospital. "We look to better understand the functional decline they experienced in their most recent healthcare event," explains Clay Richards, president of naviHealth.

"We find that is a much better determinate of where [a patient] should go," says Mr. Dinger of the functionality screen, compared to looking simply at a patient's lab test results, for example.

Once the screens are complete, the results are analyzed using a database of clinical outcomes and matched with other data from patients with similar experiences. That comparison is then used to determine the best setting for that patient's post-acute care, such as home healthcare as opposed to a skilled nursing facility.

"We can much more precisely recommend where the patient should go to get optimal recovery," says Mr. Richards. "We assess the patient, and the output of that is a patient-specific care protocol that we share with the patient, family and discharge planners." Using data as the main driver for developing post-acute care plans for patients can save ACOs money by placing patients in the optimal post-acute care site, limiting unnecessary utilization and extra care transitions for patients.

Quality providers. Beyond gathering patient data before the post-acute care transition, naviHealth also gathers risk-adjusted quality data on post-acute care providers. "The traditional way to look at a network of providers is to rank them on length of stay and readmissions only," says Carter Paine, senior vice president of business development for naviHealth. "We look at a number of risk-adjusted quality metrics including functional improvement of a patient during their stay, and make sure providers are not dinged for accepting more feeble or sicker patients," he explains. That way, hospital care navigators can make sure patients are not only transitioned to their best post-acute care setting, but also help patients and family members pick the higher quality skilled nursing facility based on extensive quality information.  

Giving data-backed suggestions of care sites helps facilitate informed conversations between care navigators and a patient and family members about where the patient should go for care. "Our nurse navigators…feel a lot more empowered to talk with patients when they have a set of data that informs that discussion," says Mr. Dinger.

"When you look at both the quality metrics as well as the total cost of care that ACOs are required to manage effectively, post-acute care is a huge opportunity," Mr. Richards says. When ACOs take a data-driven approach, they can better control the cost of post-acute care and help limit readmissions from the post-acute setting by ensuring patients get the right level of post-acute care from a high-quality provider.

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