Being held accountable for the entire care episode is one of the greatest challenges providers face under value-based care. Even though many acute care providers don't own the full continuum of care, they're often held accountable for care decisions made outside of their control. Instead, providers must influence downstream behavior through strong partnerships with post-acute (PAC) providers.
In the dynamic value-based landscape, PAC performance increasingly impacts hospital financial success. That, coupled with the significant variability in post-acute quality and cost, has driven hospitals to form narrow networks with the highest-quality PAC providers. But we know maximizing them is easier said than done. We frequently get questions about the "how to's" of collaborating effectively with their PAC partners and influencing patient choice toward in-network PAC providers.
To understand how providers can overcome these challenges and better position their organization to succeed under risk, we sat down with Advisory Board's post-acute care expert Monica Westhead.
Monica Westhead: Progressive health systems' success under value-based care depends on how effectively post-acute providers are able to improve quality and reduce costs—even though most post-acute providers still operate under fee-for-service. To ensure both providers' needs are met, acute and post-acute providers must collaborate to ensure PACs have support for the operational changes that will help health systems meet their population health goals.
Westhead: Hospitals form preferred networks of high-performing post-acute partners to improve PAC performance related to patient outcomes, costs, and experience. Some advanced organizations have considered further integration by sharing financial accountability for quality and cost outcomes through risk-based contracts.
However, PAC networks fall short when patients do not use their care—impacting acute and post-acute providers involved. Out-of-network utilization minimizes potential benefits for hospitals, such as elevating patient outcomes, improving episodic efficiency, and streamlining cross-setting communication. It also impacts PAC providers' financial sustainability under fee-for-service. Since PACs often make upfront investments to join these networks (e.g., care management, length of stay reduction), their bottom line is dependent on promised volume increases. Thus, network success hinges on the hospital's ability to encourage patients to choose in-network PAC providers.
Westhead: Three ways we've seen providers promote in-network utilization:
Westhead: Patient choice laws are less restrictive than perceived. While providers may not explicitly recommend a facility or omit facilities from the list that fall within a patient's chosen geographic area, they can be transparent about high-quality options. For instance, it's permissible to include objective data on facility lists distributed at discharge, list providers with shared financial interests, and point out high-performers.
It's important to familiarize discharge planners about these laws given the prevailing culture of nervousness around them or all-too-often fear of violation. In particular, confirm that your organization's method to inform decisions about PAC providers does not violate patient choice laws.
Patient choice is critical in post-acute and long-term care. To learn what patients and their families want when making that choice, we conducted a national consumer survey measuring preferences on everything from care delivery to decor. Four major lessons stood out.
Get our infographic to find out if high-quality specialization matters more to consumers than general provider quality, why patients want one-stop convenience, and more.
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