As payment models and risk continue to shift, health systems are looking to post-acute providers to provide transparency and data to support referral relationships and reduce readmission rates. Do you have the right technology in place to support value-based care initiatives? Gene Huang, vice president of business development at Remedy Partners shares his thoughts.
Q. How do health systems view the delivery of value-based care?
A. The answer to that question depends on whom you ask. Hospital and health system executives are interested in many different models because they have differing views on the delivery of value-based care and different positions on investment and risk tolerance. Some organizations have become insurers, serving as their own health plan. Others are launching their own accountable care organizations (ACO).
Health systems also are participating in bundled payments for care improvement and other bundled payment initiatives, such as chronic care and commercial bundles. Hospitals also are supporting Medicare Access and CHIP Reauthorization Act of 2015 initiatives for physicians which drive them toward programs like bundled payments.
In some instances, it depends on how much control over patients and outcomes an organization is seeking. And this relates to contention over whose patient it is – the referring doctor, the surgeon or the primary care physician? By taking advantage of patient ownership, many hospital leaders feel they can more effectively control the clinical path during any episodes they manage.
In doing so, health system leaders clearly understand the need to control the patient path financially. They understand the revenue and margin opportunity and can reap the financial reward of providing quality patient care if they do a great job. If the patient does well or the care is provided efficiently, especially in a bundled payment situation, it’s to the advantage of hospital.
It is these efforts that are setting the tone for the need of even more robust and beneficial post-acute partnerships.
Q. Why are health systems looking to work more closely with post-acute partners?
A. Health systems are entering value-based programs and starting to take risks with regard to what happens to the patient during the episode of care. They feel the pressure to reduce potential penalties for issues such as re-admission. Post-acute providers can significantly reduce their risk in that area and others as well.
Health systems also recognize that there is a wide range of costs for different paths in the post-acute setting that have similar clinical outcomes. Reducing this variability by focusing on best practices can deliver significantly lower costs with the same clinical outcomes.
It’s difficult for hospitals to have a large number of referral organizations, and it’s even more difficult for these organizations to develop great relationships with providers they don’t work with regularly or have a high-volume relationship with. It’s like having 300 best friends. And while the Centers for Medicare and Medicaid Services (CMS) continue to launch new programs, private payers are holding health systems accountable, so the health systems really need to have good partners.
Q. What are the key attributes of the ideal post-acute partner?
A. Effective, responsive communication that is clear and open is a must. Calls that aren’t picked up or any unwillingness to cooperate as needed with the health system will result in the agency being dropped from the referral network very quickly. Post-acute organizations also must focus on continuous improvement in key areas, such as transitions of care and continuity of care. These are the areas where inattention to detail can negatively impact outcomes and increase the health system’s risk.
Finally, agencies must make insightful use of data and be willing and able to securely share any data collected with partners. Additional patient information allows those partners to do a better job and improve outcomes. As a result of the partnership, lengths of stay can be lowered and rehospitalization rates can be reduced, while providing excellent care and increasing patient satisfaction.
Q. Where does this leave post-acute providers?
A. Hospitals are examining everything that can help them minimize risk and seeing that post-acute providers are in a position of strength when keeping patients from being re-admitted. This is especially true as we move from fee-for-service models as organizations seek ways to improve care coordination in a value-based payment model.
In all frankness, being a preferred provider for your health system partner means you can offer some predictive patient outcomes. Those post-acute organizations that can provide such reliability and transparency will likely find themselves in exclusive or highly preferred partnerships with a health system.
Gene Huang leads the SNF Model 3 bundled payment business for Remedy Partners and has been with the company since July 2012. Prior to that, Gene was the president and chief development officer for a home visit physician practice and has held multiple leadership roles in major healthcare organizations.
Remedy Partners delivers software and services that enable payers, employers and at-risk providers to organize and finance healthcare delivery around a patient’s episode of care.