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Choosing the right post-acute provider for a risk-bearing partnership: A closer look at opportunities available to hospitals

As reimbursement models become more closely linked to patient outcomes and quality of care, hospitals and health systems are increasingly assuming risk for patients' health — even beyond hospital walls. Healthcare executives are meticulously crafting strategies to support high-quality, cost-effective care inside the hospital, but those efforts are futile if care administered at a post-acute care facility isn't managed with the same level of precision.

A lack of care coordination between hospitals and post-acute care providers further down the value chain increases the likelihood for substantial variance in treatment and outcomes, which can threaten hospitals' value-based reimbursement. Hospitals that forego partnerships with strong, large-scale post-acute care providers stand at a disadvantage to competitors who control their risk through highly-integrated post-acute care networks.

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As a result, it's critical hospitals establish formal relationships with trusted, national post-acute care organizations to address a variety of patient needs, such as home infusion therapy. Forming a partnership, like an equity-based joint venture, with a sizeable home health infusion provider is an effective and innovative way to increase patients' access to specialized care while ensuring a hospital's outcome- and financial-driven goals are supported throughout the care episode.

The post-acute care setting is ripe with risk — if not selected carefully

Hospital leaders that have identified the need to improve patient outcomes and reduce costs are increasingly steering their attention to post-acute infusion care. After discharge, patients may require post-acute infusion care for a variety of conditions, including congestive heart failure, cancer and nutritional or hematological disorders. In such cases, hospitals have a choice to discharge patients to a post-acute care facility for infusion or enlist providers who specialize in administering infusion in the patient's home.

In general, hospitals that refer patients to post-acute care facilities more frequently tend to have higher readmission rates, according to research from a 2016 UCLA study. While the study did not identify an association between how often hospitals used post-acute care and the number of postoperative deaths or complications, it uncovered an association between the use of post-acute care and indirect indicators of hospital quality, including readmissions.

Specifically, hospitals that referred patients to inpatient facilities more frequently were most likely to readmit patients within 30 days (24.1 percent) compared with those that referred patients to those facilities less frequently (21.2 percent).

Readmission rates for certain patients who receive outpatient infusion treatment post-discharge are also high. The 30-day readmission rate for patients receiving outpatient parenteral antibiotic therapy through infusion at an outpatient facility or in the home is approximately 26 percent, according to a 2014 study published in the journal Clinical Infectious Diseases.

Option Care Enterprises, a provider of home and alternate treatment site infusion services, has recorded readmission rates for patients receiving anti-infective treatments far below the national average. In particular, the national readmission rate for patients receiving infusion for pneumonia was more than 16 percent, while Option Care's readmission rate was approximately 4 percent. This resulted in a cost avoidance of $1,623 per pharmacist intervention.

"A substantial amount of outcomes associated with infusion administered in the post-acute setting can affect a hospital's reimbursement, such as line infections, unanticipated hospitalization and adverse reaction to medication," says Paul Mastrapa, CEO of Option Care.

These risks highlight the need for improved collaboration when hospitals transition patients from the inpatient to post-acute care setting. Hospitals without a line of connection or financial stake in a reputable post-acute infusion provider miss out on the opportunity to control quality indicators like readmissions, which can adversely affect reimbursements.

Ensure high-quality infusion care outside of your hospital

Discharging patients to a post-acute provider with deep clinical capabilities, robust infrastructure and expertise in home infusion treatment is a major determinant of hospitals' success under value-based payment models. 

Home infusion providers with a large, nationwide footprint and precise intervention techniques ensure patients receive continuous specialized care post-discharge, says Mark Flexsenhar, vice president of payer and health systems at Option Care. The company matches patients with more than 1,800 nurses and pharmacists well-versed in therapeutic services like antibiotics, parenteral nutrition and heart failure infusion. Comparatively, generalist nurses who provide infusion treatment don't have the same scope of specialized experience.

"Specialized nurses with enhanced skill sets are dedicated to assuring home infusion patients comply with their treatment plan and respond well to infusion," Mr. Flexsenhar says. In turn, partnering with a home infusion provider dedicated to this compliancy during post-acute treatment optimizes hospitals' quality metrics and reduces unnecessary medical spending. 

Find a partner with national scope and proven quality outcomes

Partnerships with post-acute infusion providers that have a national footprint position hospitals to have better patient outcomes while protecting their bottom line.

In particular, the rate of adverse events associated with home infusion therapy is substantially lower when hospitals formally partner with home care infusion providers. For example, Mr. Mastrapa says Option Care found a link between heart failure patients participating in its home inotropic infusion program and a lower number of hospital readmissions.

Under the program, Option Care partnered with a hospital to provide targeted and innovative medical support to roughly 240 heart failure patients moving to home infusion care. To ensure seamless care consistency, participating patients transitioned to prescribed infusion pumps and medications before leaving the hospital for home care.

Once the patients moved to home care, Option Care clinicians specifically trained to manage inotropic therapy patients oversaw frequent assessments and early detection of adverse treatment reactions, all the while maintaining a direct line of communication with the hospital.

The initiative led to a significant reduction in admission rates by 0.295 per patient annually. By focusing on the continuum of care in the post-acute infusion setting, the hospital saved $17,187 per patient, or $4.1 million for all patients in the program.

"That type of outcome measure requires a tighter collaboration between the health system and home infusion providers so [we] can track and score relative measures that are important to both parties, making sure to intervene with case management when required," Mr. Mastrapa says.

The best partnerships between hospitals and post-acute providers are built around a shared goal

A successful risk-sharing partnership between a hospital and a home infusion provider requires clarifying both parties' motivations and ensuring that each organization's goals cohere.

Those goals may include expanding services, creating brand recognition or establishing an integrated delivery system that increases the revenue stream. Hospitals may also want to optimize their patients' experience by coordinating care to a home health provider that offers convenience and best-in-class service.

The structure of the partnership can range depending on the organizations' shared goals.  For some hospitals, the most effective partnership is less formal, like a preferred provider network or a bed-day management relationship. Other hospitals or health systems seek equity-based relationships, such as joint ventures.

"Hospitals have substantial cost pressures and they're looking for high-value partners in post-acute care as part of the value chain within a health system or hospital," Mr. Mastrapa says. He says forming a strategic relationship with an infusion provider, such as a joint venture, "could allow the health system to proactively coordinate care for infusion patients and minimize the number of inpatient days, especially if the health system is at risk."

A joint venture with a home infusion provider positions the hospital to bear greater risk under value-based care models while improving patients' experience and outcomes. The joint venture may also prove to be a more fiscally responsible way to control hospital quality indicators compared to investing in an in-house infusion business, which requires internal resources, management and another administrative layer for logistics like payroll and staffing.

"We bring our full suite of therapeutic offerings to our joint venture partners as part of the value proposition that we offer when we enter into these relationships," Mr. Mastrapa says. Many hospitals find the joint venture structure allows their clinicians and executives to retain focus on their core capabilities in inpatient care while a specialized partner ensures patients receive timely, high-quality and efficient infusion services in the home.

Leveraging external partnerships in the era of value-based care

Under value-based reimbursement, hospitals are held accountable for patient outcomes and quality indicators. As a result, hospitals today cannot afford to discharge patients who require post-acute infusion treatment to any post-acute care facility. Instead, hospitals have the opportunity to gain more control over patient outcomes and ultimately, their bottom line, if they establish formal relationships with post-acute home care providers that specialize in infusion.

Organizations such as Option Care are staffed with high-performing clinicians with vast experience in administering infusion treatments for a variety of conditions. Unlike general post-acute care facilities or home-care providers, organizations that have one sole focus — such as infusion — can hone in exclusively on delivering the best infusion care possible.

Every hospital faces different challenges and has unique goals. Option Care's team of professionals works with their hospital partners to articulate objectives, create terms of agreement that benefit both parties and provide the best home infusion care possible.  

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