Four steps providers should take in a value-based marketplace
The key to success in today's value-driven environment is highly effective post-acute care services and programs that are well integrated into the care continuum. To be successful in bundled payments, the accountable care organization environment, and the new outcomes-driven reimbursement arrangements, payors and health systems must maximize the impact of the post-acute care continuum for the benefit of patients and their own financial health.
How can PAC providers position themselves to be attractive for these value-based relationships? What should PAC providers do now to ensure they can successfully thrive under the quality, cost, and outcome expectations? Here are four steps to take now.
1. Join and Succeed in Narrow Networks
Payors, including the Centers for Medicare & Medicaid Services, and providers are increasingly analyzing the cost and quality of care delivery in PAC settings through multiple types of programs such as bundles and risk arrangements. To help manage cost and forecast better outcomes, narrow networks are being created for PAC services to include providers that have demonstrated results through publicly available data such as Five-Star ratings.
Being selected as part of narrow networks is important for sustainability, but solely focusing on selection will not guarantee success in the long term. Networks will continue to evolve and participants will not be static — but will be held to higher standards in order to be considered. A proactive approach to understand the network's goals and how to be a partner versus a referral source (even if you are not selected initially) in accomplishing those goals will allow for differentiation within a fragmented environment.
2. Invest in Care Management and Transformation
Care management focuses on ensuring patients are kept healthy in the safest and most clinically appropriate site of service regardless of reimbursement; this is a significant paradigm shift for most organizations. Ensuring that a discharge plan is in place is critical, but stopping at discharge is not enough. A true care management plan needs to follow a patient for at least 90 days after an acute episode occurs.
Transforming care in conjunction with care management results in reduced readmissions and emergency department encounters. To truly transform care, understanding and incorporating into the care plan a patient's social determinants allows for a more comprehensive view of a patient's interaction with the health care system. By including social determinants into the care plan, a higher number of patients are able to stay at home and be supported through home- and community-based services.
3. Embrace Data
The structure of healthcare delivery and the slow uptick of true clinical integration has left the PAC provider community with a gap in determining where to get data and what to do with data. The first step is to ensure internal protocols have been established for consistent input in the electronic medical record so the data can be used to create meaningful reporting. A more free-form and customizable entry leads to difficulty in meaningful analytics.
Obtaining data from sources such as through narrow network participation or payor relationships to get an overall patient view compared to a site-specific view can improve patient outcomes as well as the creation of best practices within a PAC provider's span of control. The EMR is a starting point, but being able to analyze various data sets such as claims or HL-7 EMR standards in conjunction with the EMR will lead to more comprehensive insight.
4. View Payors as Partners
While there will continue to be differences in payment rules and reimbursement and administrative hurdles, understanding the payor's needs to create solutions provides added value. Payors continue to look for PAC providers that are innovative and willing to be accountable for outcomes both from a quality measure and financial perspective. Understanding that PAC spend is a relatively small percentage of the premium dollar in many cases makes getting a payor's attention difficult; however, that does not mean interest in something unique does not exist. When the opportunity presents itself, having a value proposition as well as a plan to address the needs of their population shows initiative and changes the tone of the traditional contract negotiation discussion.
PAC providers are key to successful outcomes and have a unique opportunity to contribute to and participate in the value they help to create. However, success requires a strategic pivot toward new partnerships, new capabilities, and an embrace of risk.
Brent Feorene is Vice President of Integrative Delivery Models at Health Dimensions Group.
Drew Sheinen is Vice President of Strategy and Network Development at Kindred Healthcare.