by Chris Watson
Spring 2015 – In what many are calling a historical announcement earlier this year by HHS Secretary Sylvia Burwell, the agency has put a stake in the ground – 30 percent of fee-for-service Medicare payments will move to value-based pricing, also known as outcomes-based reimbursement, by the end of 2016. Fifty percent will move by the end of 2018. The bulk of this movement comes under the umbrella of the Hospital Value Based Purchasing and Hospital Readmissions Reduction programs that are designed to hold hospitals and physicians more accountable for the patient’s condition once they leave the facility.
So how are hospitals going to make such dramatic shifts in their care delivery models to cost-effectively manage patients outside their four walls? What creative strategies can be put in place to keep a closer eye on patients, particularly the high-risk and chronic disease patients who cost the most? The purpose of this article is to help hospital administrators begin to understand and embrace the value post-acute care providers can bring to the table in the new world of accountability.
Many hospitals have already started this journey by implementing new technologies, such as telehealth and patient portals, to more cost-effectively track and manage patient activities once the patient has been discharged. But nothing can beat the human interaction between a caring clinician and a patient, particularly an aging Medicare patient. And when a home health clinical team is working in close coordination with the physician, providers can begin to see true progress toward the fundamental goals of healthcare reform – reducing the cost of care, improving the patient’s condition, and increasing patient satisfaction. Consider this:
• Reducing costs: The latest research reports indicate that the average daily cost of caring for a patient in the hospital has grown to $10,000/day. Post-care settings, such as nursing home facilities, fall in the $250/day range. Home care averages less than $100/day.
• Improving outcomes: Post-acute care providers, particularly home health agencies, have the unique opportunity to see what is really going on in the patient’s home and daily surroundings. They are able to get a more holistic picture of the patient and proactively identify risk factors, such as fall risks, before an incident arises and creates an unnecessary readmission. Often times, these care givers are also working closely with the patient’s family members and friends, so they can help ensure the patient has a stronger support system in place, which is proven to positively impact outcomes.
• Patient satisfaction: Thousands of baby boomers reach retirement age every day, and they are choosing to live more independently well into their late 70s and beyond – whether that be in their own home or in assisted living facilities and retirement communities. Healthcare systems must learn to adapt to patients’ preferred care settings and take advantage of the cost savings these settings afford.
For those organizations that get it right, building strong partnerships with post-acute care providers can be the key to surviving, and even thriving, in this new world of more accountable care. Here are five things you can do to ensure your post-acute strategy is successful:
- Research the post-acute care providers in your area. Great resources for finding home care agencies include the National Association for Home Care (NAHC) and Medicare’s online service called Home Health Compare, where home care agencies are scored based on certain criteria, including patient satisfaction.
- Document what criteria are important to your organization and use these quality measures when interviewing potential partners. For starters, focus on metrics associated with specific chronic diseases, such as diabetes, COPD or dementia, or on the conditions your highest readmission patients have. Many home health agencies have developed best practices around these diseases and can help patients and their families proactively care for these conditions.
- Ensure the partners you choose have modern systems in place that make it easy to share data electronically in near real-time between your organizations. Interoperability is critical to effectively support smooth transitions and avoid gaps in care that can result in unnecessary readmissions.
- Intentionally create opportunities for your discharge planners and care coordinators to get to know your post-acute care partners. You can host education sessions, lunch and learns, or other social-oriented meetings where team members get to share their challenges, concerns and unique needs. Having both sides truly understand each other’s needs will create more seamless care transitions and help the partnership realize its full potential.
- Monitor patient satisfaction and provider performance regularly. Your post-acute care partners are an extension of your brand, and it is important that you gather and share feedback continuously. This can also help all partners work more seamlessly together to uncover new cost efficiencies.
2015 is the year that post-acute care will begin to emerge as a critical service for hospitals and physicians in their quest to design new strategies in the value-based pricing models that are rapidly becoming a reality.
About the Author
As a founding partner of in90group, Chris Watson has spent 22 years defining and executing high-growth strategies for technology companies. She has nearly 10 years of experience in healthcare, working with both large, publicly traded and small, start-up companies to establish market dominance and operational excellence. For the past five years, Chris served as chief operating officer and chief marketing officer at Brightree, a cloud-based revenue cycle management software provider in the healthcare IT market. At Brightree, she architected and executed the company’s growth strategy from $27M to $100M in four years while successfully branding the organization as the leader in the post-acute care market, with deep domain expertise in the home health, hospice, pharmacy and home medical equipment sectors. Chris is an evangelist and activist on Capitol Hill where she supports the emerging role post-acute care providers will play in the new world of accountable care. She serves on several advisory boards, including the CommonWell Health Alliance and has been published in healthcare industry publications, including Healthcare IT News, Health Data Management, Homecare and HME Business.
In 2012, Chris was awarded CMO of the Year by the Technology Alliance of Georgia (TAG), for her career achievements in results-oriented marketing strategy and execution. In 2014, she was selected as a Women of the Year finalist by Women in Technology (WIT), which recognizes women leaders who have demonstrated success in both their professional careers and contributions to their communities.
After witnessing the unique challenges high-growth companies face when trying to transform their businesses while maintaining existing revenue streams and staying true to their entrepreneur roots, Chris decided to form in90group® to help companies push through barriers to achieve remarkable results. The goal of in90group is to help companies quickly and efficiently transform their businesses via the delivery of actionable, evidence-based blueprints within 90 days– whether it be go-to-market, business development, product management or content strategies. If you are looking to find creative, cost-effective ways to begin transforming your business in 90 days, you can reach Chris at firstname.lastname@example.org.