Driving Economic Benefits for Value-Based Initiatives

November 9, 2022 | Written by: Phyllis Wojtusik, RN, EVP of Health System Solutions

In a value-based care (VBC) environment, Accountable Care Organizations (ACOs) are responsible for the entire patient journey. Therefore, their long-term success and financial viability are inherently tied to the performance of their network of post-acute care (PAC) providers.

As PAC costs continue to rise and CMS drives forward with value-based, risk bearing models of care, it is essential for providers to take proactive measures. By finding cost-effective, data-driven solutions, care facilities can meet the future demands of healthcare. Yet, disparate electronic health record (EHR) systems between acute and post-acute providers continue to pose challenges.

With approximately 50% of PAC costs for ACOs and CMS’ Bundled Payments for Care Improvement programs coming from skilled nursing facilities (SNFs), now is the time to act. By aligning acute and post-acute VBC initiatives, care providers can deliver better clinical and financial outcomes across the entire patient continuum. Which raises the question, how can ACOs and care providers get there?


Quality First, the Money will Follow

The path to generating economic benefits is to focus on quality. Care providers understand that quality comes first in patient care, and the money will follow suit. Quality is integral in patient outcomes, and when the right care is given, providers can reduce avoidable readmissions, minimize length of stay (LOS), and decrease unnecessary medical expenses.

Having the ability to measure quality via data is crucial to patient care. This data cannot include claims information as it is outdated, prohibiting care from being altered to improve outcomes. By utilizing live, quality metrics and data, providers know where they stand both at the patient and network level. Both equally critical to a provider’s success.


Acting in the Best Interest of the Patient

Care providers recognize that producing quality outcomes they must put the patient first, and to do so they must be able to access clinical data on the patient, no matter where patients are in the care continuum. Being able to identify issues and treat in place helps to prevent readmissions. Additionally, having data also allows for the ability to monitor real-time changes in clinical condition with post-acute partners, which is instrumental in achieving improved patient outcomes.

By accessing shared data, providers can work together to improve clinical pathways and standards of care. These can include identifying high-risk patients, recognizing changing clinical conditions, and maintaining communications with facilities to alter course of treatment. In setting these standards, monitoring the condition, and making changes in the plan of care – providers are working together in the best interest of the patient.


Funnel Volume to High Performing Providers

Having data on a patients’ care during the post-acute stay enables acute care providers to easily identify the top performers within their network. Whether its skilled nursing or home health, it is important to find the facilities who are delivering the best quality of care.

However, this needs to be done in unison with discharge planners when the patient is not in front of them. Ultimately, it comes down to patient choice and where they decide to receive further care. Patients cannot be funneled to where acute providers want them to go, rather they want to ensure their being provided with the data needed to help make informed decisions on care options. Care providers want to encourage patients to make the right choice based on outcomes, clinical data, and standards of care.  Drilling down further, it is imperative to communicate the outcomes and the care standards that are in place with partners so that together, they improve care outcomes.


Challenges in Managing Post-Acute Networks

Working together with PAC providers can prove to be challenging at times, especially with conflicting EHR platforms. Lack of data and/or data that lags providing little insight into what’s happening with a patient population in real-time, is a big challenge faced within the PAC network.

Another challenge providers face is the lack of sharing unblinded data throughout their network to see how all partners are performing. How can post-acute providers know how they’re doing in comparison to other facilities if they don’t have that insight? Additionally, without the right data or platform in place, it is not possible to determine if trends are developing or to accurately identify which patients are at higher risk.

Moreover, a lack of insight into network performances among care providers who are transitioning patients from acute care to post-acute is another challenge. They are not aware of this data and what’s being done throughout their network. Being able to keep the team informed of how certain facilities and the network are performing is critical to facilitating patient choice. How will care teams know what to communicate to patients who are determining their next care setting, if they don’t know themselves? This can be accomplished by educating internal staff, as well as external partners on what the standards are, reinforcing the significance of care standards, and eventually overcoming the fear of sharing data.


Drive Quality with Live Data and Interventional Analytics

To drive quality care providers must have data, no matter where their patient is in the care continuum. Oftentimes, the data from post-acute facilities is outdated and unusable in the “here and now”. The way to produce quality is by accessing live, actionable data from post-acute partners.

With Real Time Medical Systems (Real Time), providers can receive direct line of sight into the EHR of their PAC partners. By using Real Time’s Interventional Analytics solution, PAC partners can improve patient outcomes while reducing costs by seamlessly sharing live patient data, proactively preventing readmissions, and improving care transitions. Providers can also better manage their patients through their entire episode of care, whether its post-acute or home health.

Lasty, it is imperative to communicate with patients. Sharing the readmission rates of facilities (inside and outside of the network) so that patients can make an informed choice on their care is critical to patient success and outcomes. By having data for patients to present back, they in turn can make good choices regarding their healthcare. Therefore, in encouraging patients to make informed decisions, care providers must supply them with quality data, subsequently, driving volume to their preferred network.

By means of using live data to build and manage their network, care providers can do the right thing by the patient, which in turn solves the economic benefit.

To learn more, contact us today.

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