Long considered an “add on” to the healthcare system, post acute care facilities (PACs) have gained new importance as the healthcare industry shifts to a value-based care model.
Yet PACs may not have the tools that will provide real-time visibility into patient episodes and metrics capable of fueling integrated and profitable patient-centric healthcare.
The Centers for Medicare and Medicaid Services (CMS) have a stated goal of converting 50 percent of fee-for-service Medicare payments to value-based-payment models by the end of 2018. These bundled payments models levy penalties if patients are readmitted into the hospital within 30 days of discharge. In order to ensure that patients are healthy and ready to go home without a chance of readmission, PACs need live updates on patient progress, along with insight into provider involvement, billing and other information.
Cloud-based Healthcare Relationship Management (HRM) solutions can play a pivotal role in a PAC organization’s ability to deliver on the promise of personalized care while meeting the broader demands of initiatives such as bundled payments.
HRM platforms harness the bounty of clinical and business data residing in various systems throughout the organization, including Electronic Medical Records (EMR), Laboratory Information Systems (LIS), Rehabilitation Systems, billing, and other data. This information is consolidated and organized as customer profiles in the HRM system, where a comprehensive view of each patient and provider is available, along with actionable workflows.
The ability to leverage live analytics and data-backed insights will benefit PACs as they move to a bundled payments model in several ways:
Deliver outstanding patient care. Because PACs play the final role in the patient care continuum, they are the last opportunity to provide a great patient experience. In addition, PAC organizations are uniquely positioned to rein in growing healthcare costs while meeting value-based payment initiatives because they are responsible for impacting the metrics used to measure the success of these initiatives. These metrics include patient readmissions, patient length of stay, test utilization and patient safety.
Gathering this data manually is difficult because it often is housed in different systems. Time used to manually compile reports takes time and effort away from the patient while placing an enormous burden on PAC staff. With an HRM solution in place, PAC facilities can automatically track and report on critical patient metrics in real-time.
The ability to track and measure the quality and efficiency of care keeps all involved in the healthcare process—physicians, caregivers, home health nurses and other—on the same page regarding post acute services and care. This is important as patients often are shuffled from one acute or post acute setting to the next where they may be subject to redundant questions and duplicative tests.
HRM solutions also help reduce costs for large Accountable Care Organizations (ACOs) or networks, especially when it comes to value-based payments. HRM platforms track and record all relationships (patient/provider and patient/network) to provide coordinated care. This visibility ensures that patients are not sent home before they’re ready, which reduces readmission rates.
Translate data into action. With real-time metrics at their fingertips, caregivers can spot trends, improve decision making and keep patients safe. Physicians and nurses are instantly aware of patient backgrounds, biometrics, and prescription history, without consulting a paper chart. Real-time alerts and workflows help managers at PAC facilities identify where to focus critical resources and time.
Access to data also helps post acute networks personnel manage quality metrics on an individual facility level as well as across an entire organization in order to pinpoint exactly where improvements are necessary. Individual facilities can hone in on one patient’s metrics or sentiment, while networks can visualize compliance metrics and ensure standardized processes are being implemented consistently.
While patient satisfaction is the foundation of quality care, reducing healthcare costs is at the root of bundled payments. HRM platforms provide the data, trends and analysis to enter into mutually beneficial relationships with referring partners and payers to maximize reimbursements.
Boost referrals. Competition is fierce in the post acute market, and with more organizations focusing on value-based care it’s critical for patients and providers to objectively understand what separates a given PAC organization from its competitors. HRM platforms deliver the data and analytics to achieve high quality and continuously measure and report on superior quality levels, resulting in more referrals.
PAC organizations can now present clear, data-backed reports and metrics to referring health systems to prove they’re the best choice for post acute services. Tracking quality care metrics and costs alongside referral rates and denials, provides internal visibility to decision makers on how to increase patient referrals.
One of the largest PAC facilities in the Midwest began using an HRM system to track and manage patient quality and incoming patient referrals in early 2017. They were able to eliminate duplicative paperwork for incoming patients, delivering a seamless referral experience to both patients and referring physicians. The data repository and workflow built into the HRM system ensures that all team members can coordinate the admission process efficiently regardless of who is facilitating the process at any given time. Real-time reports provide insight into why patients and providers choose the facility, why denials occur, and what issues impact the timeliness of the process.
Value-base care is here to stay
The time for implementing a quality-focused, patient-centric, value-based care strategy has arrived. While government regulations and mandates may evolve, the shift from fee-for-service to value-based care is the new reality of healthcare. Post acute care organizations, along with other healthcare providers across the care continuum, must make long-term investments that enable success moving forward.
Access to effective healthcare relationship management, including advanced analytics and actionable workflows in an intuitive healthcare CRM environment, will play a key role in helping PACs drive quality care while meeting the mandates of bundled payments and other value-based care models.
About the author:
Brad Bostic is CEO and chairman of hc1.com.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.