Twenty percent of Medicare patients are discharged to a skilled nursing facility (SNF) following a hospital stay. Hospitals and health systems have found that closer management of the post-acute process not only keeps patients out of the hospital, but also strengthens care coordination and improves outcomes. An effective preferred network can pay powerful dividends to providers, patients, and payers alike.
Following are seven steps to building out a preferred network.
Step 1: Evaluate Your Capabilities
An important first step to building out a preferred network is to look internally to determine if you have the resources to support one. Building a list and managing your top post-acute providers takes time, as well as personnel. Commonly, the responsibility of building a preferred network lies in the hands of discharge planners, care coordinators or individuals in innovation roles. Many larger health systems and hospitals have formed roles specifically for managing post-acute partners. Additionally, leveraging and integrating technology into the process of running a preferred network will be an important piece.
Step 2: Obtain Buy-In
Organizations that successfully manage preferred networks consistently have internal buy-in. Spend time pulling numbers, demonstrating the benefits, creating roles, and building morale to make sure all parties are engaged.
Step 3: Issue RFPs
Even before establishing a preferred network, a sizable health system will work with hundreds of post-acute providers. A best practice approach is to start to review quality metrics to narrow down the list and determine from which facilities you want to solicit proposals.
Step 4: Evaluate the Facilities
Once you have received proposals and applications, it’s time to evaluate the potential facilities. A few key metrics to consider include mortality, census, readmissions, average length of stay, and geographic coverage. Additionally, in-person visits and interviews help to determine which post-acute providers will be the best partners. Seeing the facility, meeting providers, and hearing them talk about their services will give you a better sense of how patients will experience care in their facility.
Step 5: Finalize Selections
When making final decisions about which providers will be in your preferred network, take into account your entire patient population. You’ll want to present them with a variety of options. Some things to consider are specialty programs, activity offerings, and visitation rules. The number of post-acute facilities chosen will vary from system to system. Some health systems may choose 10 to 20, while others may choose 50 to 100.
Step 6: Create a Two-Way Partnership
Once you’ve finalized your preferred network, the next task is to establish a collaborative relationship. Preferred networks should be approached as partnerships. The goal is to work alongside the post-acute facilities to ensure continuity of care for your patient population. True care coordination is a two-way street.
Utilize bi-directional tools that allow communication and critical information to flow freely between acute and post-acute facilities. Critical information should be shared in real time between facilities–from ACOs to hospitals to home health agencies. When building out their PAC networks, some health systems make implementing this care coordination technology a requirement.
Step 7: Optimize Your Network
Ongoing program evaluation is necessary to maintain an optimized preferred network. Many health systems continue to refine their lists of post-acute providers after gaining more insight through their partnerships. Others will simply replace providers as other potential facilities’ performance metrics improve. Either way, your preferred network should be periodically evaluated and updated.
Building and managing a preferred post-acute network is no small feat. Getting on board with establishing a preferred network in the post-acute space will help you better prepare for the healthcare of tomorrow.
About the author
Brian Manning is VP, Head of Growth for PatientPing, a Boston-based care coordination platform that reduces the cost of healthcare by seamlessly connecting providers to coordinate patient care. The platform allows providers to collaborate on shared patients through ‘pings’ — real-time notifications when patients receive care – and ‘stories’ – important patient context at the point of care.
For more information, visit http://blog.patientping.com/topic/four-questions to learn how healthcare experts from across the continuum use technology to help solve care coordination challenges.
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