To Improve Post-Acute Care, Health Systems Need a New Playbook

Health systems are trying their best to get a handle on post-acute care (PAC). That’s because there’s wide variation in both spending and quality performance among PAC facilities. And with pressures on providers to deliver better outcomes with no extra dollars, health systems are increasingly being squeezed for greater efficiency.

For the last 30 years, providers strived to treat patients efficiently and effectively, but they haven’t had to worry as much about what happens after they leave the hospital. In part due to a fee-for-service payment model, hospitals often had informal referral relationships with post-acute care providers and standards to determine the best settings for post-hospital care weren’t as critical.

For example, skilled nursing facilities (SNFs) are paid via a per diem payment system with fairly limited controls, and until recently, the home health payment system allowed for coverage reauthorizations without significant review. Due to this disconnect, lack of standards and focus on volume rather than value, post-acute care utilization and spend has spiraled out of control.

But as healthcare moves toward a value-based payment model, the game is changing for both acute and PAC providers, and this change is critical.

For health systems to win in the future, they have to build a new playbook – especially around PAC engagement and coordination. Value-based payment models that drive providers to work together to improve outcomes and save money means hospitals and PAC providers must build more effective partnerships to achieve:

• Complex clinical management and treatment modalities;
• Evidence-based practices;
• Overall standardization of processes and measures; and
• Improved resource utilization management.

St. Luke’s University Health Network in Pennsylvania knows this. As an early leader in bundled payment, they had to develop trusted partnerships with PAC providers. They met with them quarterly to review performance data, discuss opportunities and engage in two-way progress report sharing. Through these meetings, they found they needed to restructure their care model alongside their PAC providers. St. Luke’s embedded physicians and nurse practitioners within PAC provider facilities, helping to drive interdisciplinary daily rounds, team meetings, development and implementation of new care pathways, and align treatment protocols. As a result, SNF length-of-stay for patients in the St. Luke’s bundled payment program was reduced by 22 percent, and SNF readmissions were reduced by 23 percent. Additionally, SNF length-of-stay for total joint replacement alone was reduced by more than 50 percent.

As St. Luke’s and a range of other early adopters have shown, hospitals and health systems shouldn’t expect PAC providers to make these kind of improvements on their own. If acute care organizations want to be successful with PAC, they must meet each other on the field, in the dirt and the muck, and stack hands on a new game plan.

The solution is engagement and alignment. And that takes time, effort and teamwork.

For more on how to work with PAC providers to improve health system performance, check out Inpatient & Beyond: The Post-Acute Care Conundrum.