Clinical competencies crucial to managed care success, experts say

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Lisa Thomson
Lisa Thomson

Providers need to assess their clinical competencies and seek out strategic opportunities for referral partners in order to succeed in the “new” world of managed care, one industry expert advised on Tuesday.

Strategy is vital to surviving — yet alone thriving — in an industry that's moving steadily toward being entirely managed care-based, said Lisa Thomson, chief marketing and strategic officer for Pathway Health. Her observation came during her session, “The New World of Managed Care,” at the American College of Health Care Administrators Convocation and Exposition.

By analyzing and strengthening their own clinical competencies, providers can help themselves stand out to hospitals and physicians as a quality referral partner, Thomson explained. This is especially important, given the Centers for Medicare & Medicaid Services' aim to send more long-term care patients into home- and community-based settings.

“If they need stabilization, they go into a skilled nursing facility,” Thomson said. “We need to redesign what we do with those clinical capabilities.”

Among the conditions being considered are total knee and hip replacements, cardiac services, and care for patients with sepsis and other infections. Being able to provide quality services in those fields, especially for hospitals assuming risk under bundled payments, will drive more volume into skilled nursing facilities, and drive up rehab levels, Thomson said.

She also suggested providers visit to see how their costs for certain episodes of care compare to regional averages.

“Ultimately, look at data, look at outcomes, strengthen disease states, and seek out partners,” Thomson said. “It's our time to show people what we do, and what we do well.”

The ACHCA 50th Annual Convocation and Exposition concludes Wednesday in Philadelphia.