As providers wade through the vast uncertainties of the evolving health care market, one thing is clear: hospitals and post-acute providers need to collaborate more.
As providers wade through the vast uncertainties of the evolving health care market, one thing is clear: hospitals and post-acute providers need to collaborate more. Understanding what hospitals are focusing on, how they have begun to explore options for reaching out to post-acute providers in their communities, and finally, what new roles post-acute providers can play, provide us a glimpse of the opportunities for collaboration.
Readmission rates
When hospitals initially embraced the movement toward accountable care organizations, many first looked at their internal structures. As health reform moves forward, they continue to focus on their physician alignment strategies, enhancing their quality outcomes, and defining their future as either independent community hospitals or as part of larger, multi-facility organizations.
The next step is to look outward and gain a better understanding of their patient base. This has increased attention on the clinical profile of patients and on readmissions. Some hospitals are using data to identify zip codes with higher readmission rates. Recently, a presenter at a health care conference mentioned that one hospital has created a “readmission prevention manager” position in the emergency room.
The manager’s job is to help direct non-emergency patients to more appropriate care settings. The organization also posted detailed descriptions of the services provided at local skilled nursing facilities to help educate its physicians and possibly guide them to make different decisions about readmissions.
Care coordination
Hospitals are also actively exploring how they can better coordinate care. Some are developing “care navigators” to engage individuals in managing their care by providing them with information and educational resources. Ideally, this will encourage informed decisions and more effective transitions from one health care setting to another.
Reform is forcing the industry to collaborate. Care navigator positions can help an individual decide on care after discharge and facilitate appropriate treatment with another care provider. These positions have also been successful in physician practices and skilled nursing facilities. Communication and follow up are proving to be powerful tools in improving outcomes.
Post-acute providers are naturally trying to understand their new roles. Should they be developing navigator positions too, or just figure out how to work closely with them as hospitals and health systems use them more? And how do they adjust their own care protocols to provide care that is more consistent with organizations they want to partner with? There are no simple answers, but the general direction is undoubtedly towards greater collaboration at all levels.
Cooperation
In certain markets, post-acute provider campuses are looked at as an opportunity to reach patients that were served by different elements of the health care community. While most of the conversation to date has been focused on the collaboration between hospitals and skilled nursing facilities or home health agencies, some health systems see value in keeping individuals from being admitted in the first place and are becoming interested in the long-stay nursing facility population and in both independent and assisted living facilities.
For instance, some are looking to host clinic practices on senior campuses and sending liaisons into independent living communities. Some are even embedding advance practice registered nurses in nursing facilities. One health system in the Midwest is exploring the opportunity to combine urgent care centers with post-acute providers.
Opportunities for post-acute providers
Hospitals and health systems are actively seeking out a preferred network of post-acute providers. When asked how they are choosing preferred providers, health systems respond that their first criteria is whether a post-acute provider is located in an area important to the health system’s discharge patterns.
The second requirement appears to be a collaborative mindset. Health systems are looking for providers who are easy to work with and open to changing care protocols. One provider commented that their organization will work with a “three star” nursing facility as a preferred provider if it was willing to work collaboratively to improve the total cost of care.
This does not underplay the value of quality, it simply acknowledges that health systems recognize there are opportunities to improve, but they need a provider with a willingness to change. Health systems are also looking to understand the clinical capabilities of post-acute providers and inquiring about their ability to provide bariatric, wound care, tracheotomies, and other more medically complex services. Again, the ability to adapt to the needs of partner organizations positions an organization well for future opportunities.
Successful collaborations
Hospitals, health systems, and post acute organizations are starting to collaborate successfully. All parties are looking to reduce the total cost of care. In this reform oriented environment, you are either a collaborator, or you risk not being included in a preferred network.
While there is still uncertainty about how our health care system will develop, it is clear that providers are beginning to better understand that collaboration can produce opportunities. However, collaboration happens intentionally and is driven by providers who approach change with a different mindset and are willing to invest in relationships with others to drive true reform in our health care system.