Leverage Real-Time, Post-Acute Analytics to Build Relationships with Medicare Advantage Payers

February 16, 2022 | Written by: Diana "Di" Smalley, FACHE, Senior Advisor of Health Systems & ACOs

Value-based programs continue to evolve, prompting hospital and health systems to take proactive measures to close treatment gaps, deliver higher quality care, and improve patient outcomes, while controlling medical spend. Given that post-acute care (PAC) is one of the highest cost segments, hospitals and health systems are building preferred networks with skilled nursing facilities, home health agencies, and assisted living providers to advance clinical performance in the PAC setting and generate savings.

High performing post-acute providers that embrace a value-based care mindset to help their hospital partners improve outcomes and costs can earn more referrals and more dollars. In turn, hospitals and health systems can leverage these results to drive their own upstream referrals and boost revenue, particularly with Medicare Advantage (MA) plans.

In 2022, payers offered more than 3,800 MA plans, supporting a projected 9% increase in enrollment over the previous year. And most Medicare beneficiaries in Parts A and B are expected to join Advantage plans (Medicare Part C) in 2023. As MA plans grow, it becomes advantageous for hospitals and health systems to prove to their payer markets that they are efficiently and effectively managing patient outcomes through the continuum of care. And doing so is a win-win-win for all involved.


Demonstrate Value to Payer Partners by Improving Post-Acute Network Performance

Demonstrating value in the PAC setting starts with timely, meaningful data. Real Time’s Interventional Analytics platform provides just that – offering hospitals the data transparency and clinical line of sight into the post-acute electronic health record (EHR).

Interoperability and data transparency that enable real-time visibility into patient status, outcomes, and costs are key to managing and strengthening PAC networks. Armed with live data mined from post-acute EHRs, hospitals and health systems have better oversight of clinical and financial outcomes as well as operational performance indicators. For example, Real Time’s Readmission Risk Scoring Tool identifies patients at-risk for rehospitalization and pushes live alerts to care teams with specific clinical recommendations enabling hospitals and health systems to monitor PAC patients in the moment and intervene as necessary before costly and unnecessary readmissions occur.

Sharing live patient data also allows acute and post-acute providers to enhance clinical collaboration by managing care together. By establishing clinical pathways and defining treatment standards, they can improve transitions and coordination between care settings. Post-acute data analytics can also be used to stratify and prioritize patients based on clinical need or assess readiness for safe discharge to home health. This data also informs regular discussions between hospital systems and their preferred PAC providers to measure performance, conduct case reviews, identify improvement opportunities, and share best practices.


Leverage Live, Post-Acute Analytics to Gain Upstream Referrals

Health plans will promote providers that better manage their patient population throughout the continuum while controlling total healthcare costs. Just as PAC providers can leverage their performance metrics to gain hospital referrals, acute care providers can apply the same concept to cultivate relationships with Medicare Advantage payers, secure preferred status, and ultimately earn more referrals.

By tracking and analyzing key post-acute performance measures and utilization trends such as volume, case type, length of stay, and readmission rates, hospitals can demonstrate value at both the provider and network level. Including this data as part of their total capabilities profile, acute care providers can validate performance in negotiations with their upstream referral sources. In addition, hospitals and health systems that assess live patient data and performance metrics in areas such as home health and physician clinics could greatly enhance efficiencies among referring providers as patients transition among care settings.  Knowing Medicare Advantage enrollees place high value on access to their preferred primary and acute care providers, hospitals can support their Medicare Advantage plan partners in gaining and retaining members, expanding access, and even developing narrow networks of preferred, high-performing acute and post-acute providers.

With a strong and reliable post-acute network backed by Real Time’s unique ability to provide live patient data and interventional care, hospitals and health systems can attract new payer partners who want to stay competitive and solidify their reputation in local markets – improving all-important star ratings and value-based care initiatives.


About the Author

Rooted in her training as a nurse, Diana “Di” Smalley is dedicated to improving both the patient and provider experience. Balancing her deep understanding of patient-driven health and operational innovations, she advises Real Time on helping acute care systems achieve post-acute interoperability to improve the quality of care and enhance care coordination across the delivery system.

Smalley has more than 30 years of senior-level executive experience. As Regional President of Mercy Oklahoma, she oversaw 15 hospitals and more than 100 clinics. She also served in various leadership roles with Alegent Health where she co-founded Avantas, a nationally recognized company for proven best-practice work strategies for the healthcare industry.

She is an active fellow with the American College of Healthcare Executives (ACHE) where she served as chairman, chairman-elect, and immediate past chairman. Acknowledged for her contributions in advancing care delivery, Smalley received ACHE’s highest honor, the Gold Medal Award, which identifies ACHE fellows who exemplify leadership at the organizational, local, state, and national levels while improving healthcare services and community health beyond their organization.


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