Post-acute care providers should be considering creative joint ventures with hospitals to best take advantage of evolving healthcare delivery and payment systems, healthcare finance and legal experts said Wednesday in an Avalere Health webcast.

Healthcare reform has changed the way hospital systems are approaching post-acute care, said Wyatt Ritchie, a managing director at investment bank Cain Brothers. Medicare margins are better for post-acute care than acute care, so hospitals are increasingly seeking an “economic stake” in the post-acute system, Ritchie told the webcast audience. However, post-acute care run through a hospital system is typically starved for capital and has historically been difficult to administer. At the same time, readmission penalties are motivating hospitals to be choosier about referring discharges to post-acute facilities with lower rehospitalization rates.

“What we see here is the makings of why there should be joint ventures,” Ritchie said.

These joint ventures between acute and post-acute providers do not have to take the form of Accountable Care Organizations or similar systems being piloted by the government, said Chris Donovan, a partner in the healthcare practice group of law firm Foley & Lardner LLP.

Donovan said his firm is helping facilitate “bespoke joint ventures,” or partnerships that providers are embarking on independent of the government. These arrangements can position providers for the more integrated healthcare system of the future while giving them more short-term flexibility than an ACO. The partnerships can be phased in at a pace that meets the needs of the providers, and may have less intensive capital requirements than those associated with joining an ACO.

Challenges include navigating anti-kickback laws, determining the capital commitments of the partners, and deciding on how the joint venture will be governed — for example, if a nonprofit provider is partnering with a for-profit provider. Yet these challenges are not insurmountable, and most post-acute care providers will join a joint venture, Donovan said, because hospitals will no longer be outsourcing the entirety of their post-acute care as they have in the past.

Bill Pomeranz, also a managing director at Cain Brothers, identified a few things that post-acute providers can do to make themselves attractive candidates for joint ventures. They should seek to “raise their profile within the hospital system” and think about how they can contribute value to the whole system, not just the discharge planner. Technology investments also matter, and post-acute providers would be smart to choose computer systems that are interoperable with those of local hospitals, he advised.