|Without question, the new face of American medicine has begun to take shape and will continue to transform relationships among healthcare providers across the continuum. Those that will thrive in this new environment will have proactively forged new, meaningful relationships based on delivering value, defined as better patient outcomes on lower overall costs.
Implementation of the Affordable Care Act (ACA) is in full swing, along with a multitude of concurrent initiatives to support the CMS Triple Aim goals: improve care, reduce overall costs and better manage a population of patients. While different providers and markets are experiencing varying levels of intensity of change, all hospitals are facing growing incentives to better coordinate care with all post-acute providers, and in particular, skilled nursing facilities (SNFs).
SNFs have the highest rates of hospital readmissions across all post-acute care provider types. Not surprisingly, the attention of hospitals is focused on partnering with SNFs to improve care transitions and reduce unnecessary readmissions. However, other key provisions impacting hospitals in 2013, including the onset of hundreds of accountable care organizations (ACOs) and bundled payment arrangements throughout the country, have expanded the focus to creating closer partnerships with post-acute providers in order for hospitals to achieve the Triple Aim goals (improving health, improving healthcare and lowering costs by transforming the finance and delivery of healthcare) and navigate into a risk-bearing future successfully. This provides a unique opportunity for SNFs to proactively reposition themselves from a vendor and referral destination for hospitals to a partner and value-driven solution to address some of the challenges being faced by hospitals.
Determining Which Hospital Would Be a Good Partner
The answer to these questions will tell you the reliance of your potential hospital partner on unaffiliated post-acute entities and the degree of risk they are facing as they move from fee-for-service toward population-based models of care. For example, if a potential hospital partner is considering the development of an ACO, then their interest in aligning with SNFs is even greater.
To further narrow your focus to a target hospital or hospitals, you should understand their unique needs and where your organization can directly align your value proposition and strategic roadmap to address those needs. This will involve conducting research and data analysis from publicly available and no-cost sources such as Hospital Compare, as well as pursuing other data sources to obtain hospital discharge data such as average lengths of stay and volumes in key diagnosis-related groups (DRGs). Hospital discharge data is available and can be requested in some states from the state healthcare agency responsible for data collection, or if not available in your state, can be purchased from third-party vendors.
From the data, ask these questions:
In our work, we have found that some hospitals continue to be challenged by long average lengths of stay for clinical conditions where SNFs can offer a solution by creating smoother patient transitions and defined clinical care pathways with the hospital. Packaging a defined program around these clinical conditions to approach the hospital has clear and tangible value to them. From the review thus far, you should narrow the potential hospital partners in your market based on their fit with you as a partner and begin to formulate your partnership strategy. This strategy should be focused on those areas where you’ve identified a need or challenge and where you can directly provide a clearly tangible solution to the hospital.
Developing a Value-Based Partnership Strategy
For the target hospital(s), based on this research and knowledge about a hospital’s interest in risk-based payment, ask these questions:
For example, we are seeing hospitals increasingly need more medically complex care to be delivered in SNFs which can be met with highly specialized clinical program development around the specific needs of a particular clinical condition. The ability to care for these medically complex patients with the clinical skills to prevent readmissions, achieve good quality and functional outcomes and ultimately discharge patients to home will differentiate those SNF providers that are best in class from those that are not.
Once you determine where your facility can meet specific hospital needs, take a proactive approach to reaching out to the target hospital and request a meeting with key leaders. But before initiating this meeting, prepare by putting together a presentation that clearly articulates who your organization is and what programs and services you offer, shares data on your patients (volume by diagnosis group, 30-day readmissions rates, quality outcomes, average length of stay, etc.), and defines your current areas of focus and future priorities. Finally, relate all of this back to the information you gathered and interpreted about the hospital and ask them to validate what you have learned and clarify outstanding questions you have.
The meeting goals should partially be about educating hospital leaders and articulating your value as a healthcare provider in your market as well as launching the beginning of an ongoing dialogue with the hospital about their needs and challenges and where you directly can partner together to develop solutions.
The Future Is Now
These networks create referral pathways for the hospital’s patients and are chosen based on providers’ ability to demonstrate quality outcomes, manage complex patient populations through evidence-based protocols, and manage overall costs of care.
Brian Fuller has extensive experience as a senior executive for an integrated post-acute healthcare organization and was responsible for positioning the system for future healthcare delivery environments. He has been actively involved in the Center for Medicare and Medicaid Innovation’s Bundled Payments for Care Improvement (BPCI) initiative, both authoring applications and serving as an expert panel reviewer for CMMI to review round one BPCI applications. He is currently senior consultant for Health Dimensions Group.