McKnight's Long-Term Care News, December 2018, Feature 2
For many acute providers, the big questions around data come down to reimbursement, experts warn. When a skilled nursing facility can show how it prevents readmissions, coordinates care and manages conditions, it is more attractive as a post-acute care partner. Collaborations can benefit everyone, but the stakes remain high.

The skilled nursing side of the post-acute care industry has worked hard in recent years to shed its outlier image among other sectors of healthcare. Under the evolving landscape of reform, it’s beginning to be recognized as a necessary partner in collaborative efforts to improve patient care.

But earning those stripes hasn’t been easy.

Many dynamics have led to building relationships. The Affordable Care Act elevated discussions around the continuum of care, prompting skilled nursing leaders to seek their rightful place at the collaboration table.

Common objectives in many of these partnerships are raising quality and lowering rehospitalizations.

For nursing homes, the stakes are high.

“Lowering rehospitalization rates has been key for market share,” says Cheryl Field, chief product officer for Prime Care Technologies. “Post-acute care providers want to be in these collaboratives and networks because they like being on that preferred provider referral list.”

Maria Arellano, RN, American HealthTech clinical product manager, says the objectives of these partnerships center around sharing and transparency. And each party needs to benefit for them to be successful.

Other motivators are at play.

“While quality is the obvious goal, the underlying driver that gets overlooked is cost,” says Jason Jones, chief technology officer for SimpleLTC. “Cost and quality go hand in hand, and carefully choosing and nurturing partnerships is critical to both. The question providers should ask is: ‘What’s the highest amount of quality we can deliver for each dollar spent?’”

Nursing homes and hospitals both understand they need to deliver better outcomes.

“Under the new [Patient-Driven Payment Model], key and timely information about the patient’s clinical characteristics will be vital to the SNF’s success,” adds Arellano.

Payers also need to see a good return on their reimbursement dollars.

“While items like rehospitalization penalties played a role in establishing initial partnerships, the future is geared toward value-based care, including total episodic costs, quality and patient experience,” says Steve Herron, senior director and solution executive for post-acute care at Cerner Corp. “This will require a massive shift within our industry to start considering patient care across the continuum and not episodically within our silo.”

Data at the core

The biggest motivator of all may be data. Lots of it. And it’s quickly becoming the most important currency of all.

“Essentially, hospitals have begun narrowing their network of referral partners, and as a result, they choose partners based on more scrutinized criteria — and data is at the heart of those choices,” says BJ Boyle, vice president, general manager of post-acute insights for PointClickCare. “The sharing of data, for many healthcare providers, has become a non-negotiable prerequisite.

“LTPAC providers need to go on the offensive by arming themselves with data, making strategic decisions to put them in the best position, and aligning themselves with the innovative partners and vendors that can help them thrive, not just survive, in this world,” Boyle says.

“Preventing readmissions, coordinating care for recovering patients and managing those with serious chronic conditions are all key objectives for both accountable care organization [ACOs] and long-term care providers,” observes David Carter, licensed nursing home administrator and vice president, advisory services, and LTPAC business and clinical operations analyst for Stratus Interoperable. “But neither of them is likely to survive the transition to value without the ability to exchange vast amounts of information electronically.

“What’s in play now is developing ways to work more closely together with the right technology to make that happen,” notes Carter.

Adds Dawn Iddings, senior vice president/general manager, homecare, for Netsmart: “Having access to real-time clinical information at the time of discharge to prevent rehospitalization is vital, but just as important is the availability of that information to conduct medication reconciliation and ensure data integration during the most vulnerable transition of care: between the hospital and post-acute care.”

Partners everywhere

Information technology linkages are as varied as ever, depending heavily on the sophistication of the nursing home’s infrastructure, as well as its appetite for expense and sharing data, say observers.

The acute side long ago invested heavily, and it shows.

“Referral sources, ACOs and integrated care networks have built technology frameworks and will partner with providers who have the technology to share critical resident data with the end goal of reducing rehospitalizations and improving care,” says Matt Mello, director of sales for CareWorx.

Nursing homes often are still playing catch-up.

Says Carter: “Some providers find themselves building out costly internal data operations and are still confused as to how to make it all work. Often, there is lack of the right incentives to make investments in data-sharing agreements and the interoperable interfaces necessary for success.”

Many find it necessary to outsource the task of data presentation and migration to predictive analytics services and other partial solutions to bridge the information sharing gap, he adds.

PharMerica has engaged with many post-acute providers in recent years in efforts to improve transitions of care. The transfer from hospital to SNF is a particularly thorny one that is still plagued by data quality issues, says Suresh Vishnubhatla, executive vice president of long-term care operations for PharMerica.

“In our experience exploring the care transitions from one care setting to another, we found the information was not completely reliable,” he says. “It’s like having a really expensive flat panel TV and great cable service, but nothing works because the cable signal is always down.”

Meanwhile, the goalposts keep moving.

While nursing homes are having to deal with more and more clinically complex residents, hospitals and other entities are calling upon them to engage in shared risk arrangements where payments will be based on minimizing expenses in a network with other venues of care, says Herron.

“These networks are not built from handshakes and gift baskets, but from analysis of hard data around cost, quality and experience,” he adds. “Proving that your organization is interoperable is not enough. You need to be able to demonstrate how you are taking advantage of interoperability to provide more accurate, timely, error-free care to residents.” 

Providers should understand that “now more than ever they are competing for hospital referrals based on quality,” says Thomas Martin, director of post-acute data analytics, CarePort Health.

“How that quality is being measured is shifting from measures that capture patients in your care setting to those that occur after the patient leaves your care setting,” Martin says.

Best practices

Most experts would agree that the long-term care industry is ready to bring significant value to these kinds of collaborations. They’ve invested heavily to ensure the quality of their data is as good as the care they provide.

Jones says one of SimpleLTC’s large skilled nursing customers uses risk stratification starting on the day of admission.

“They use predictive quality data and resident frailty indexing to maximize quality, which helps them attract and keep the best partners,” Jones says. “This helps them deliver top quality and control costs throughout the care process.”

One indisputable tool every nursing home needs is an electronic health records system, experts agree.

“Implementing a market-leading EHR with integrated analytics, decision support and care coordination tools are the key to driving enhanced outcomes,” says John Damgaard, president and CEO of MatrixCare. “This helps them deliver quality care efficiently by providing the data they need to identify and drive out any cost efficiencies or care practices that aren’t contributing to a successful outcome.”

He adds that these tools can give acute providers a window into the personal health record of their patient to track the senior’s recovery progress “even after they are discharged to post-acute care facility or home care.”

Post-acute care providers that look to acute care as a source for referrals can leverage this technology to examine the types of referrals that do best within their facility, Damgaard says. Nursing homes that are only now investing in EHR technology are finding they bear little resemblance to first-generation systems.

“EHRs that just modify outdated, paper-based workflows won’t cut it,” Damgaard adds. “You can’t implement decision support based on decades-old, paper-based workflows and expect to compete with those leveraging decision support that draws on machine-learning and other new technologies. You just won’t be able to get your cost and your outcomes where they need to be. You’ll be left in the last century.”