Anne Tumlinson

If new payment reform initiatives sowed the seeds of small disruptions in 2013 — narrowing referral networks and prompting clinical integration, those seeds will start sprouting bigger disruption across multiple markets in 2014. This year ACOs will proliferate and will include SNFs in a real way. Bundled payment experiments will be beginning all over the country. 

This new wave of reform initiatives will do two things: 

1.     Intensify the focus and dispersion of post-acute network development among hospitals and health plans.

2.     Create more pressure on hospitals to move beyond clinical integration to genuine risk management. 

Hospitals, health systems, and payers are taking a hard look at post-acute care providers’ (PAC) clinical capabilities and cost effectiveness. We know that hospitals increasingly realize that managing dozens of relationships with different PACs just isn’t tenable. We know they will slim down the number of those relationships as much as legally possible. True, they can’t limit where patients go, but there are creative ways they can guide them.

To clinically integrate with PAC companies, hospitals and health systems will target the absolute best—those PAC companies that are the most engaged and highest performing. And what was lacking before—a focused, uniform calculation of metrics—is now available through the Vantage Care Positioning System (CPS) ™ Post-Acute Care Scorecard (PAC Scorecard). The Scorecard is the most comprehensive Medicare fee-for-serve data set available for it includes all the providers in every U.S. market. For each PAC provider, all the metrics are brought together in a single report, and can be easily compared to other providers. Since each organization may consider some performance elements more than others, Vantage allows users to weight the individual metrics to reflect those priorities.    

There are a lot of metrics that can be used to determine a PAC provider’s score, but for this Scorecard, Avalere conducted a literature review and examined research that specifically focused on scorecards or initiatives that promote partnerships between providers. Coupled with interviews with hospital executives and other experts, Avalere identified a subset of metrics that are the most relevant, and then developed a method to present them to simplify access and understanding. In short, a best-in-class solution.

Streamlining these metrics into the independently developed Scorecard allows hospital executives to easily evaluate the data they need to evaluate a relationship with a PAC provider and to compare them against each other. The right PAC partner yields many benefits for a hospital or health system: higher quality care, greater clinical sophistication, better communication. Other stakeholders also benefit from a strong link between a hospital and PAC provider.  

For example, clinically appropriate and improved care transitions may reduce the number of readmissions, which not only improves patient care but saves money for bundled payment holders, Accountable Care Organizations, Medicare Advantage Plans, and the Medicare program.

For PAC providers, the Scorecard is an opportunity to be an active participant in the evaluation process and show hospitals and health systems that you are part of the solution and willing to play an active and helpful role in their network development. Having access to these metrics gives PAC providers the chance to focus on what they’ve done right, and what could be better. It’s a marketing tool that touts your achievements, and it’s a diagnostic tool to determine areas for improvement. From both sides of the coin, understanding your own performance is essential to reaffirming your relationship with hospitals and health systems.

Having the right data at the right time can accelerate new partnerships, and fortify existing ones. It’s a new year, ripe for change, and that change is now at our fingertips.

It really is that simple.

Anne Tumlinson is the senior vice president at Avalere Health. She spoke at “Using Standar Scorecards to Demonstrate Value and Increase Referrals,” a Feb. 6 McKnight’s webinar. You can click here to listen.