Changes to provider payment—such as readmission penalties, quality mandates, and risk-based contracts—are increasing hospitals and health systems' responsibility for the full care continuum.
It’s not surprising that population health managers are looking for innovative ways to partner with post-acute care (PAC) providers to avoid unnecessary utilization of services and improve patient outcomes.
PAC networks undergoing closer evaluation
The average health system works with around 60 PAC partners, but many PAC referral networks are over double that size. Given the complexity in managing that many partnerships, the Population Health Advisor team works with providers to create performance scorecards that evaluate PAC performance on clinical quality, operational, and strategic alignment indicators.
Organizations can use these scorecards to create a smaller network of PAC providers and focus their collaboration efforts with these preferred partners.
Navigating preferred networks and patient choice
As providers establish preferred PAC networks, organizations must balance promoting high-performing partners and upholding patient choice.
According to CMS's Conditions of Participation, hospitals are bound to preserve and respect a patient’s choice of post-acute facility, regardless of the hospital’s relationship with that facility or others in the area.
Providers have traditionally been required to provide patients with a list of Medicare-certified PACs in the geographic area the patient has chosen. Last year, CMS revised its hospital discharge planning regulations, adding additional nuances to the rules regarding patient choice.
Translating policy into practice
Patients traditionally select PAC facilities based on factors like geographic proximity to home, word-of-mouth recommendations from friends or family, and/or perceived comfort with the facility and the staff. Many are unaware that quality information is publicly available.
There are two ways to bridge the information gap and promote high-performing PAC partners while maintaining patient choice:
- Choose simple promotion techniques, such as noting the affiliation on the list of available providers.
- Include publically-available post-acute provider quality information in the list of facility options or a patient’s discharge materials. While providers are not compelled to direct patients toward this information, it can make a positive impact on the overall cost and quality of care over time.
Patients are often receptive to such quality information and are likely to include that information in their decision-making process. Additionally, if providers have been working closely with affiliated PACs to elevate quality, more patients may express a preference for those PACs.
While patient choice will always remain paramount, providers can still promote informed decision making and form close ties with the PACs that are particularly well-suited to improving population health.
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