According to many of our grandparents, most everything was better in the old days – lemonade tasted sweeter, the livin’ was easier, and in general it was a simpler time. But, when you think about the post-acute care (PAC) our grandmas may have had – where they spent several weeks at a skilled nursing facility (SNF) after surgery, slowly practicing walking, and being at high risk for complications that could cause readmission – the “good ole’ days” may leave something to be desired. And grandma would probably agree.
Today, PAC is beginning to look a lot different. It can involve patients being discharged directly home after surgery where they are up and moving, and physical therapists visit multiple times a week. In addition to frequent follow-up home visits, patients can also communicate with physicians through apps, skype-like interfaces, and remote monitoring. Analysis of the patient’s vital signs and physical progress can help identify risk factors or improve clinical intervention and treatment recommendations.
We are moving forward, but it has not been an easy journey. With 22 percent of all hospital discharges referred to PAC and accounting for 12 percent of Medicare’s budget, one could expect this care sector to be under scrutiny. But PAC often remains an insular and poorly understood component of the health care continuum, with large variation in treatment approach and quality. Many health care organizations are beginning to look at post-acute care in a new light and develop strategies to drive value. Many are building partnerships with post-acute care providers, where they historically have limited knowledge and relationships. In a recent study, the Deloitte Center for Health Solutions explored how organizations are making this work.
What should health systems consider when working with post-acute care providers? We learned that partnerships can be key and a few simple steps around communication, data, staffing, and technology can go a long way.
When health systems first engage with post-acute care providers, they tend to cast a wide net, partnering with any willing provider. Some zero in on high-volume providers, especially those where the health system refers many patients and facilities that readmit many patients back to the hospital. A typical first step is to engage in regular conversations to understand each other’s challenges. Over time, these meetings may evolve into a forum for clinicians and administrators to review data and discuss outlier cases.
These discussions likely cannot happen without data. Many providers have at least some data to build a foundation for their post-acute care improvement efforts. For instance, hospitals commonly track readmissions, and from there they can isolate cases coming from specific post-acute care providers, reasons for readmissions, and even by treating physician. Many post-acute care providers track length of stay for billing and staffing. Reviewing this data can point to issues, such as premature discharge from the hospital, or insufficient clinical documentation.
Often the next stage in a relationship between a health system and a post-acute care provider is to formalize the approach to quality improvement. Organizations can achieve this by identifying and understanding variances in performance. Below are some of the typical problems health systems face and how they approach them.
Once the partners have experience with each other, they can be ready for a more mature stage. At this point, relationships are often more formal, performance metrics more specific and granular, and post-acute care provider participation becomes contingent on meeting certain expectations. For their part, health systems can require that a significant majority of patients (e.g., 80 percent) be referred to participating post-acute care providers.
Many health systems that have partnered with post-acute care providers see promising results, such as reducing post-acute care length of stay, lower readmissions, decreased SNF utilization, and good patient experience scores. Health systems and post-acute care companies we interviewed are committed to working together, since a robust post-acute strategy is likely vital to their success in value-based care and population health. Together, they can change post-acute care into something that will be good for future generations of grandmas.