What Health Plan Leaders Need From Post-Acute Networks to Drive Quality and Care – A Discussion

October 7, 2021 | Written by: Steven Stein, MD, Chief Medical Officer

Real Time Medical Systems works with almost a thousand skilled nursing facilities (SNFs) and health systems across the country, helping them use live point-of-care data to better manage their patients. Sitting on top of the SNFs’ electronic health records (EHRs), our platform extracts data every hour utilizing algorithms to identify opportunities to intervene before a vulnerable patient progresses to an acuity level that requires hospital readmission. Real Time’s interventional analytics solution enables these facilities to significantly reduce both their readmission rate and their average length of stay (ALOS).

But what about health plans, the payers literally taking on risk on these post-acute facilities every day? Couldn’t they find value in this same patient data, too?

We recently sat down with ten highly experienced executives representing health plans across the country. We wanted to learn more about their post-acute networks, how they collaborate with SNFs, and what information about their members treated in those SNFs would help drive both better quality and value. Here are the highlights of this eye-opening discussion.

Understanding Short and Long-Term Goals

A common challenge health plans face when interacting with their SNF partners is misaligned incentives.  One health plan executive noted that SNFs are traditionally focused on the short term, both economically and clinically, where payers must take a longer-term view. While SNFs are working to lower readmissions from the SNF back to the hospital, they tend to be less focused on discharge planning–explaining relatively high readmission rates in the days following SNF discharge. Because SNFs are generally paid on a per diem basis, reducing ALOS is not a top priority. However, that mindset has started to change as SNFs adopt value-based care strategies to garner increased market share of an ever-dwindling number of referrals to SNFs in general.


With the goal of providing wholistic, patient-centered care, health plans require more insight and influence on care delivery and discharge planning.


With the goal of providing wholistic, patient-centered care, health plans require more insight and influence on care delivery and discharge planning. This way, they can ensure available member benefits and services are managed in a cost-effective manner during the entire episode of care. They can also better support a safe transition back to the community.

All focus group participants agreed that health plans need greater access to relevant, timely, and concise patient data once members are admitted to post-acute care as well as comparable, real-time performance metrics to improve patient outcomes and make both the plan and the SNFs more successful in their mutual goals.

Contracting with Cost and Risk in Mind

Obviously, health plans are all about driving quality outcomes and achieving cost efficiencies. Sharing risk is also part of that equation. One focus group participant pointed out that in a perfect world, the health plan would evaluate medical, pharmacy, and behavioral health costs as part of any shared risk agreement with the SNF. The executive also admitted that it’s been difficult to consider offering upside and/or downside risk with an entity when there is such limited visibility into how care is actually being delivered in the SNF setting.

His peers agreed with another executive who said that getting access to real-time SNF data is key to knowing what measurable quality and utilization metrics can be effectively managed by the SNF and health plan as part of such a value-based contractual agreement.


Access to real-time SNF data is key to knowing what measurable quality and utilization metrics can be effectively managed by the SNF and health plan.


Two participants described a network strategy that is focused on lower readmission rates and lower ALOS in exchange for higher referral volumes. They both concurred that access to real-time data would enable them to better prepare for quarterly meetings with their SNF network instead of solely relying on anecdotal explanations for an uptick in readmissions or ALOS by the facility. Having access to the same set of SNF-level data enables health plans and facilities to have a much more insightful and productive dialogue…whether those discussions get down to the patient level or not.

Influencing PAC Network Performance with Onsite Clinicians

We learned that health plans engage with medical professionals in many ways. Some plans have relationships with SNFists – primary care physicians, nurse practitioners, and physician assistants who practice inside the facilities. Given their ability to influence care decisions and help coordinate successful transitions, one executive suggested that getting real-time patient data to SNFists may be the best way to impact both readmission rates and length of stay. Several participants agreed that developing value-based contracts with SNFists was on their radar as a way of reducing ALOS and readmissions while the patient is in the SNF as well as impacting the transitional period post-SNF discharge, which tends to also be a high-risk period.

One executive from a health system owned plan shared that the plan employs its own physicians to serve members in its high volume SNFs. Another plan works with its nurse practitioners to monitor patients in the facility, and, outside of the typical outcomes, also measures its post-acute partners on how often the floor nurse bypasses the plan’s nurse practitioner and instead calls a PCP to request a hospitalization that could have been prevented. That plan lowered readmissions by making the nurse practitioner the contact person for the nursing staff when there’s a subtle or not so subtle change in patient conditions.

Driving Better Relationships and Outcomes with Data Analysis

A consistent theme that emerged from our discussion was an ongoing need for more timely information about the status of health plan members in the SNFs – mirroring many of the same reasons that hospitals and ACOs subscribe to a platform such as Real Time. Health plans also want to access facility level data to measure performance and review specific metrics, identifying facilities that continue to warrant preferred network status.

Real Time’s interventional analytics platform allows health plans – as well as ACOs, health systems, and individual hospitals – to access live patient data directly from the EHRs in skilled nursing facilities. They can see relevant structured data including vital signs, oxygen saturation, and demographics, as well as unstructured data such as keywords in progress notes, without having to navigate the fragmented, unwieldy “rabbit hole” of each facility vendor’s EHR. The clinical alerts we send to SNF providers include actionable recommendations that can be customized to align with a health plan’s clinical pathways. There’s no better time than real-time to get the information you need to support your members’ health and well-being during their SNF stay while continuously improving the delivery of care in your preferred network.

 

Dr. Steven Stein is a fellowship-trained geriatrician and the Chief Medical Officer of Real Time Medical Systems.

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