The combination of carrot and stick incentives that CMS has unleashed on health systems has forced most to assess their existing post-acute programs, services and relationships.
Historically, the cost, quality and outcomes (the "value") of post-acute care was not a significant issue for health systems due to wide provider availability and the absence of significant downsides to providing avoidable or inefficient care. In today’s landscape, the increased prevalence of value-based payment arrangements and penalties make this approach no longer viable.
Today, providers across the nation are looking to maximize the value of post-acute care. Many health systems have responded by developing preferred post-acute networks. While not a new concept, PPNs are certainly not widely mature. Few PPNs have existed more than five years – meaning that many systems still haven't determined their best practices, which emerge predominantly out of a costly cycle of trial and error. In Health Dimensions Group’s consulting practice assisting health systems in the post-acute space, we craft health system post-acute strategic plans that integrate the client’s previous efforts at PPN development, and also assist clients working to create new PPNs as a key aspect of their overall post-acute strategy.
Through creating PPNs and working with existing ones, we have learned a few "To Do's" – and more importantly a few "Not To Do's" – to ensure PPNs provide meaningful contributions to the overall health system post-acute strategy. Here are eight key success factors for making a successful post-acute care network:
1. Intentional selection of PAC partners – The health system must first understand the specific strategic needs the PPN will address. It may be Medicare Spending Per Beneficiary, bundles or throughput, among others. No matter the issue, it’s important for health systems to know what specific problems need to be addressed. Next, turn to partner selection with a disciplined, quantitative approach that incorporates factors important to your strategic needs that are defensible to internal and external constituencies. Quality is of course a foundational criterion, however, don’t forget qualitative factors that are at the core of any sustainable relationship including culture and willingness to work toward common goals.
2. Dedicate appropriate resources to PAC relationships – Establishing your PPN is only a first step. Investing in the relationships is necessary to achieve desired outcomes for the PPN. Interoperable communication technologies, access to education and clinical resources, dedicated network management and a willingness to change the health system status quo are all required to build a thriving post-acute network.
3. Establish PAC provider accountability – The individual PAC providers must also invest in the relationship and share accountability for success. Data-driven dashboards with process and outcomes measures, monthly meetings and continuous quality improvement are among the necessary commitments from PAC providers.
4. Understand and address PAC placement decision-drivers – Market norms and pressures (internal and external) for PAC placement and selection are a challenge to a PPN. During the first year, many PPNs have compliance of less than 40 percent. Defensible PPN selection criteria, evidence-based placement decision-making to determine appropriate PAC level of services needed and a willingness to directly address conflicts of interest are necessary health system activities. Support the PPN by providing patients and their families with educational materials on their options so they make an informed choice. Hold inpatient care managers accountable for referral choices and ensure “exceptions” require approval.
5. Take a continuum view of care management – Managing the patient across the continuum is difficult but required. The process begins internally through coordinating among existing health system care management programs to promote awareness and collaboration. Managing the patient then extends through to integrating with – and likely investing health system resources in – PAC provider care management by educating on best practices and problem-solving around impediments.
6. Identify and track high need/cost patients throughout the care continuum – Enhance your ability to identify high need/cost patients regardless of point of entry into health system for appropriate management through the continuum. Identify, track and risk stratify for appropriate resource and service deployment.
7. Address social determinants of health as equal challenges to physical needs – Social determinants of health are often of more importance to value than medical care. Therefore, you must ensure these social determinants are evaluated and addressed as part of the overall discharge process to support target "discharge to community" and re-admission reduction goals. Partner with and support community housing and social service infrastructures (including addiction and behavioral health) to address current and future (pre-acute) patient needs.
8. Develop a SNFist practice – More mature PPNs have implemented an attending model of healthcare professionals (MDs and NPs) in skilled nursing facilities as crucial to managing increasingly complex patients and achieving outcomes such as reducing length of stay, readmissions, Emergency Department usage, discharge to community, and a competitive cost profile.
In this climate and in the foreseeable future, PPNs are a key component of an overall health system PAC strategy. Not simply referral networks to build and forget, PPNs are a framework for building a mutually beneficial relationship that requires investment from all members. Only then will the problem-solving and care transformation necessary to provide value-based care occur.
About Brent Feorene
VP of Integrative Delivery Models at Health Dimensions Group
Mr. Feorene, with over 25 years of experience in health care consulting, has nationally recognized expertise in identifying and addressing the strategic and management issues in physician-led, post-acute, and community-based services and programs. His clients have included health systems and accountable care organizations (ACOs), managed care organizations, medical practices, home care agencies, and community-based providers and service agencies. Among his engagements, Mr. Feorene has worked collaboratively with these clients to create integrated delivery models that bridge location and level of care to ensure timely access to appropriate services and high-value care delivery. Mr. Feorene offers clients exceptionally strong strategic and business planning skills seasoned through multiple program implementation engagements.
About Health Dimensions Group
For more than 25 years, HDG has designed integrated and customized solutions for hospitals, health systems, long-term and post-acute care clients across the country. HDG offers industry-leading expertise in post-acute and senior care management and consulting services.
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