The importance of care coordination in a value-based world: Best practice approaches from Spectrum Health

Proper care coordination is more crucial than ever for healthcare providers as they take on more financial risk amid the shift toward value-based care, according to Ken Botsford, MD, CMO of naviHealth, a Cardinal Health company.

In 2014 — a year before CMS' introduction of alternative payment models and value-based payments — 20 percent of CMS' Medicare payments were traditional fee-for-service, 60 percent were fee-for-service linked to quality and another 20 percent were through alternative payment models, according to Dr. Botsford. By 2018, CMS expects alternative payment models to account for 50 percent of all payments, with quality-related fee-for-service payments decreasing to 40 percent and traditional fee-for-service payments dropping to 10 percent.

While the move toward value-based care is gaining momentum in the healthcare industry, many health systems are still in the early stages of implementing this model, said Dr. Botsford. Seventy-nine percent of health systems are in the process of evaluating value-based care processes, with only 8 percent having completed or nearly completed a full roll-out of the model, according to a 2016 survey conducted by HealthLeaders Media.

During a webinar hosted by Cardinal Health, Dr. Botsford joined Jay LaBine, MD, senior vice president and associate CMO of Grand Rapids, Mich.-based Spectrum Health, to discuss the importance of implementing efficient and thorough care coordination processes during the transition toward value-based care.

Why care coordination is more critical than ever

Dr. LaBine, MD, realized inadequate care coordination was a systemic issue in the healthcare industry after his dog, Dutch, got hit by car. He took Dutch to the local animal hospital and before the dog was released, the veterinarian sat down with Dr. LaBine for forty-five minutes to give in-depth instructions on how to care for Dutch at home. Later that day, Dr. LaBine went to his hospital to conduct rounds.

"I discharged seven people in 30 minutes," he said, discovering the unsettling reality that a veterinarian took more time to explain the care expectations for a recovering dog than a physician might spend with a human patient preparing for discharge.

Dr. Botsford notes poor care coordination creates negative consequences for both patients and healthcare providers. About one-third of patients have at least one medication discrepancy upon hospital discharge and 1 in 5 discharged patients experience an adverse event within three weeks of leaving the hospital. Post-acute care costs the healthcare industry more than $100 billion annually and readmissions cost $30 billion to $40 billion each year, according to Dr. Botsford.

The elements of successful care coordination

To attain proper care, physicians must ensure patients understand their physician's medication orders and address patient-centered discharge planning based on a patient's risk level, condition and ability to self manage, according to Dr. Botsford.

"I always assumed the higher intensity settings had to be the safest, but the best outcomes may be at a lower level of care," said Dr. Botsford. "On the flip side, a lower level of care is not always the cheapest. If you send someone to home health who should've gone to a skilled nursing facility, it may result in a readmission and that's more costly than it should have been."

Medication reconciliation is another key factor in efficient care transitions, along with more "warm" handoffs between the acute care staff and skilled nursing facility staff, according to Dr. Botsford. In warm handoffs, primary care providers meet face-to-face with a staff member from the post-acute care facility to talk about the care transition process and review all care orders for the patient, immediately making corrections and adjustments where necessary.

"I think the key is that the patient needs the right care," says Dr. Botsford. "Even if that's more expensive than alternatives, if that's the care they need, that's where they need to go. At the end of the day, they will have better outcomes and, therefore, better financial results."

Spectrum Health as model for best practice

Dr. Botsford said health systems looking to develop a proactive care transitions program should start with the following three steps: establish multi-disciplinary planning teams, use technology to support informed decisions and build high-quality, post-acute care networks.

To further highlight this change management process, Dr. LaBine shared Spectrum Health's journey in revamping its care transition program.

The health system saw huge variations in both care and medical spend for the skilled nursing facility network, but had no way of measuring the financial and clinical outcomes in the post-acute care setting, according to Dr. Labine.

"We wanted to be able to compare how skilled nursing facilities were doing and give the feedback to our discharge planners to show them how their patients did once they left the hospital," he said. "This could be very valuable information that leads to continuous performance improvement and gives clinicians the personal and professional satisfaction of knowing their patients are being cared for in a high-performing facility."

Spectrum Health developed a comprehensive RN care management transition program that went from a telephonic model to boots on the ground in the acute care facility and skilled nursing facilities. The health system also implemented naviHealth's LiveSafe data-driven tool (known today as nH Predict) to keep track of the financial and clinical outcomes at each post-acute care site.

"We're now able to see what facilities are hitting benchmark for discharge score, therapy hours, readmission rate and length of stay," said Dr. LaBine. "As a result, many of our acute-care facilities are competing against each other to do better."

Prior to implementing this program, the health system reported 966 skilled nursing facility days per 1,000. As of June 2016, Spectrum Health's skilled nursing facility days per 1,000 decreased to 640.

"We were able to reduce this rate significantly and at the same time proactively monitor how well patients' rehab was going to ensure they were discharged at the right time," said Dr. LaBine.

To view a recording of the webinar, click here.

To download a copy of the webinar, click here.

More articles on clinical quality:

Study: Care from non-physician clinicians equal to that of physicians in community health centers
Hospitals helping hospitals: Dr. Peter Pronovost on how peer-to-peer assessments can improve patient care
How the ACA affected access to primary care: 5 things to know


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