It’s a brave new world in healthcare – rife with promise but also replete with demands. Through such initiatives as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the federal government continues to signal its future direction with the industry: paying for value, not volume, of care. Increasingly, providers will be asked to navigate exacting incentive programs that tie payments directly to quality.
The rapid move toward a highly integrated, value-focused delivery system requires hospitals to collaborate seamlessly with post-acute care (PAC) partners in providing well-coordinated care. With ongoing pressure to deliver better clinical outcomes at lower costs, acute care providers will need to select their post-acute partners carefully and build them continuously into their overall care strategy.
“Collaborating closely with PAC partners helps get patients into the right setting after their hospital stay and raises the likelihood of their swift recovery,” says Henry Allen, MD, a Dallas-based internal medicine specialist named one of the “top docs” of the Dallas-Fort Worth area. “Working together, acute and post-acute providers can achieve an appropriate length of stay for each patient, reduce hospital readmissions, and improve care efficiencies.”
Delivering accountable care
According to Dr. Allen, today’s overarching imperative for healthcare providers is delivering accountable care. The two pillars of accountable care, he explains, are fiscal responsibility and quantitative quality.
“When I started practicing medicine in the early ‘90s, the healthcare community was not subject to metrics the way it is now. Although quality has always been an important goal for any individual or institutional provider, we didn’t until recently have an objective methodology for measuring and pursuing it. Today, we have metrics that can help us gauge quality, find variations in practice, and continuously improve our processes.”
The ultimate aim, he points out, is the best possible clinical outcome at the most affordable cost for every patient – while avoiding episodic care and moving toward disease prevention and health maintenance overall.
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Determining the role of post-acute partners
“The patient’s care experience doesn’t end when he or she is discharged from the hospital,” Dr. Allen says. “It continues as the patient transitions to the next care setting. Continuity is key to effective care because physicians see patients in the hospital and in the PAC setting. We need to know exactly what’s going on with each patient at every point in the care continuum.”
Throughout the patient care journey, hospitals need to collaborate with PAC providers to standardize processes so that patients are not subject to haphazard care and random results, he explains. “Delivering consistently good outcomes requires providers to have greater oversight in the post-acute ‘voyage to value,’ where much of the variability in care can emerge.”
Developing a PAC network
The most important criterion in selecting the right PAC partner is its track record in quality, Dr. Allen says. The Improving Medicare Post-Acute Care Transformation Act of 2014, known as the IMPACT Act, requires PAC providers to submit standardized data on quality measures to help facilitate coordinated care and better outcomes. Reports on these measures will be shared publicly across settings.
“It’s vital to look for partners who are proactive, not reactive, in implementing care metrics and using consistent standards for specific disease management.” One of the most common metrics for evaluating PAC providers is readmission rate, he explains – how many patients under their care end up back in the hospital. Other key measures are wide ranging, from incidence of major falls to medication reconciliation.
According to Dr. Allen, post-acute care facilities vary greatly in their ability to provide and gauge quality. He offers an example from his market of a PAC provider uniformly proactive in delivering and measuring accountable care: StoneGate Senior Living, with facilities in Texas, Colorado, and Oklahoma. StoneGate’s “secret sauce” for success? “They have in place the right mission, the right vision, and the right values. This foundation empowers the care team to practice evidence-based medicine, leading to optimum patient outcomes and return to function.”
Defining the future of care
Today’s trajectory toward value-based care is only the beginning of what the future holds for the healthcare industry, Dr. Allen predicts. In the years ahead, care will be more transparent, standardized, and accountable. Expectations will accelerate for seamless care delivery in every setting. Outcomes will be easier to measure than they are today. Payment for care will be vigorously responsible and vigilantly tied to quality. Together, acute care and PAC providers will maintain a laser focus on understanding, improving, and measuring the patient experience.
“The picture of tomorrow is one of profound transformation, taking providers to an even deeper dimension in fulfilling their missions. Ultimately, we are remodeling a “sick care” system into one that delivers true healthcare – highly collaborative, exceptionally efficient, and relentlessly patient-centered.”
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