Historically, hospitals and health systems have largely focused on the services they’re providing, with little control or insight into what happens with patients who are discharged to skilled nursing facilities, home health agencies and other post-acute care settings.
As value-based payment models increasingly focus on costs and outcomes occurring inside and outside hospital walls, now is the time for health system leaders to rethink post-acute care strategies to drive value. Market changes — including bundled payment programs, ACOs and the Medicare Access and CHIP Reauthorization Act’s (MACRA) incentives for providers to join risk-bearing payment models — increase the need for health systems to better manage care across the continuum.
Care management as revenue generator
Many organizations have dabbled in care management by facilitating the next step in a patient’s journey in an effort to reduce readmissions and associated penalties. But they didn’t do much else to touch a patient once they left the hospital.
While rolling out a care management program may sound like a costly endeavor, it is a critical component for healthcare organizations as the industry transitions to patient-centered, value-based care models. A focus on supporting patient populations across the continuum of care with the right interventions at the right time has great revenue potential. An effective care management approach can help ensure patients receive optimal care when recovering from a procedure or in management of chronic conditions, all the while reducing unnecessary expenditures, complications, and readmissions.
Providing optimal, coordinated care across the patient’s journey is critical to maximizing reimbursement under new payment models. Couple this with the fact that CMS is now recognizing remote patient monitoring (RPM) in their reimbursement model for check-ins with patients, interprofessional internet consultations and other patient engagement opportunities. Clearly, there is revenue potential in supporting the infrastructure being built to help patients manage their health. Those providing best in class approaches have recognized the need to bring all the players into the equation: The patient, the care management organization and the providers throughout the continuum. When approached with the patient in mind and as a true new way of providing care, hospitals and health systems are now beginning to shift their mindset to consider what “care management” can truly mean for their organization.
Managing care beyond the inpatient stay
Today, nearly half of Medicare patients require post-acute care following a hospital stay. Therefore, closing the communication gap between the hospital, the patient and the care providers throughout the continuum is increasingly important for hospital leaders. Many hospitals have begun taking the steps to narrow their networks and forge collaborative relationships with high performing post-acute care providers to gain more control over quality and cost of post-acute care, which also enhances both the patient and the provider experience that ultimately leads to better outcomes.
To better communicate and coordinate activities between the index facility, the patient and care providers throughout the continuum, HealthLoop (now GetWell Loop) has launched an automated patient engagement solution that leverages the patient to provide daily, real-time feedback on his or her progress in the post-acute care setting. In addition, the platform closes the communication gap between hospitals and post-acute care centers by engaging the post-acute care provider to carefully monitor patient status, quality and utilization. No longer do the patient, the index facility and the providers throughout the continuum have to operate in silos that are inefficient and contribute to increased spend through poor outcomes and poor transitions of care.
Post-acute care engagement is a powerful tool to facilitate communication and transparency among all members of the care team. It also helps reduce care variation and spending that contributes to higher costs. Care team collaboration and mobile-based tools enable cross-continuum support of patient populations. Risk stratification and data reporting capabilities also enhance post-acute care performance.
Care management ROI
Several of our long-time customers utilized the solution to participate in the original BPCI initiative and are rolling it out again for BPCI Advanced, knowing full well the platform supports future reimbursement opportunities and the aforementioned care management initiatives. The initiative includes all post-acute care for patients undergoing elective hip, knee, and ankle replacements and non-elective hip fracture surgery.
One of those customers did a study and found that elective patients enrolled in the post-acute care program cost an average of 13.8% less and fracture patients cost an average of 1.4% less compared to baseline data. For elective patients where a partner skilled nursing facility was used, hospital readmissions dropped by 36% and the average length of stay dropped from 17.6 to 13.9 days. This was through reduction in unnecessary medical expenditures alone; they now couple this model with an empowered patient population that connects virtually with their care teams daily.
As hospitals continue to assume greater financial risk, an automated engagement platform is vital to support better collaboration and transparency between hospitals and post-acute care facilities. Organizations that adopt a care management solution see dramatic decreases in length of stay, hospital readmissions and complications. Those improvements translate into reduced readmission payment penalties, increased shared savings payments, improved outcomes and a better patient and provider experience.
Preparing for success
There are great opportunities ahead for organizations moving to value-based contracts and taking on financial risk for outcomes and costs. Success will require significant care delivery reforms, such as developing provider networks that deliver the right level of care at the right time and place, as well as enhancing care management capabilities. Investing in an automated patient engagement platform can support your organization’s transformation efforts and position it for success.