Spurred by the adoption of a bundled payment program, St. Luke's University Health Network used data analysis to radically improve its post-acute care services over a two-year period—cutting patients' average length of stay and readmission rates in half, Shelby Livingston writes for Modern Healthcare.
St. Luke's knew it needed to take a closer look at spending when it decided to participate in Medicare's voluntary bundled payment program for 84 services, said Chief Quality Officer Donna Sabol—and upon digging into the data, St. Luke's leaders discovered some startling facts. Sabol explained, "It was very evident that patients who were in managed-care products had half the length of stay in (skilled-nursing facilities) compared to those that were Medicare fee-for-service."
To improve patient outcomes and reduce costs under the bundled payment program, St. Luke's began collecting performance data from skilled nursing facilities (SNFs). It sought to spur competition, notifying the SNFs that they would be taken off St. Luke's "preferred" list if they did not meet certain performance standards.
In addition, the health system developed new care-transition protocols and embedded its own physicians into the SNFs to train them on protocols. St. Luke's also met quarterly with the facilities to assess progress. To help manage the changes, St. Luke's hired a program manager for bundled-payment programs, as well as transition-of-care specialists and other clinical staff to help train post-acute care providers.
St. Luke's also began following high-risk patients through discharge. The health system phoned SNFs when such patients were released from the hospital, and SNFs in turn would notify primary care physicians when the patients were discharged from their care. Further, St. Luke's opened up its EHR system so SNFs could easily access important patient medical records.
Between 2014 and the second quarter (Q2) of 2016, St. Luke's winnowed down its preferred post-acute care network from 16 providers to nine. And the improvements in post-acute care have been dramatic, Sabol said.
For instance, the health care system cut the average LOS for Medicare fee-for-service patients in the bundles from an average of 36 to 40 days in 2014 to between 14 and 19 days in Q2 of 2016. In addition, St. Luke's reduced the number of SNF patients readmitted to the hospital within 90 days of discharge: In 2014, it averaged between 34 to 45 percent of patients. In Q2 of 2016, it had declined to 21 percent (Livingston, Modern Healthcare, 12/31/16).
Key initiatives to target the most complex patients—and reduce costly, avoidable care
Hospitals continue to deliver care that is entirely avoidable and sometimes unfunded—often to the most complex, high-need patients in the hospital. Advisory Board has identified four high-impact strategies to properly and efficiently manage outlier cases that represent a staggering proportion of avoidable utilization and resource opportunity.
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