Evolving Post-Acute Care Strategies: NAACOS Webinar Roundup
Healthcare organizations continually have had to pivot, not only with the pandemic, but also with changing policies from state and national regulatory agencies. In these busy times, ACOs are looking for ways to evolve their post-acute care strategies, and the reason we wanted to discuss the topic during the National Association of ACOs Fall 2020 Virtual Conference.
During the panel, I talked with Greg Baumer, Chief Growth Officer at NaviHealth and Troy Reiff, VP of Post-Acute Service Development & Managed Care at American Senior Communities. We discussed how ACOs and the broader market are evolving, the ongoing challenges we face, along with the best practices and advice for ACOs moving forward.
Watch the full conversation below or read the blog below for the highlights.
How Healthcare Organizations Are Continually Pivoting
Two years ago, American Senior Communities — which has 78 SNFs caring for over 7,000 patients a day — took a pivotal role as CMS put in a new payment model with PDPM, the first in over 20 years in the post-acute space, along with value-based purchasing.
“We took a lot of playbooks out of acute care to really understand the current data coming from health systems, their needs, and how we serve and manage those relationships to bring visibility into post-acute care,” Reiff says.
ASC also signed on with large claims companies to better understand their role in value-based care, improving outcomes and reducing readmissions back into the hospital. They also pivoted by leveraging new technology, particularly Olio, a software solution that helps to simplify and scale how they work with ACOs and hospitals to improve care.
“With Olio, hospitals can have a visual insight on how their patient is progressing in post-acute care and the barriers to discharge. We’re giving instant feedback to our hospitals, which has been important during the pandemic,” says Reiff, noting they work with about 14 different hospitals.
Baumer of naviHealth says three words really stood out to them when it came to how healthcare organizations have had to pivot in the face of the pandemic and constantly changing rules and regulations: grit, ingenuity and care.
“The SNFs work so hard during these trying times to care for their patients,” says Baumer. “We’ve been impressed with how creative SNF leadership and care teams have been in finding ways to engage with their patients and how they’re allowing patients to engage with their families in different ways when normal mechanisms for visiting aren't there.”
Baumer says one example includes a SNF who put up plastic walls with arm holes in them so patients could still hug their families. “The sacrifice and care that the SNF staff, care teams, administrative and leadership teams have offered to the most vulnerable patients during this time is extremely heartwarming and encouraging,” he says.
From our clients’ perspective at Olio, we’re hearing our ACO and health system clients say that they wish they would have been more aggressive in inking managed care arrangements to take more risk while investing in population health solutions.
Further, what we see is historically what was done on a Med-Surg floor is now done at a SNF, and what has historically been done at a SNF is now moving into home health care. Higher acuity patients are going into the home. Because of that, we’re focusing on our development of Olio to support that entire patient journey.
Ongoing Challenges Faced by Post-Acute Care and ACOs
None of us have solved the ideal post-acute strategy, but we’re learning as we move throughout this dynamic time. During the discussion, we wanted to bring the challenges we’re seeing to the forefront.
Baumer of NaviHealth says he believes SNFs will continue to have depressed volume in patients, but most SNFs currently aren’t structured to handle it. “Identifying ways that they can broaden the value they’re providing across the continuum for at-risk providers, such as ACOs and payers, will be critical,” he says.
Investing in technology to do remote monitoring and telehealth will be necessary as post-acute care providers move forward. “That has allowed SNFs to take some readmissions risk,” Baumer says. “It’s a great starting point. I do anticipate downward pressure on both volume and rate from payers.”
Providers in general are all chasing that Med-Surg nurse and trying to recruit and hire them, adds Reiff of ASC. Across the country, he says we need more non-skilled workers in healthcare. “We want to elevate and keep nurses working at the top of their license to minimize unnecessary tasks that a licensed nurse doesn’t have to do,” Reiff says. “We’re working on recruiting those types of roles and hopefully they can transition into clinical roles down the line.”
At-risk models are another challenge post-acute providers are facing. Reiff says ASC jumped into an upside/downside risk with a large payer in 2019 because they built an integrated care network. “We have nine integrated care managers that follow patients prior to discharge all the way to discharge past 30 days.”
Reiff says ASC continues to learn and will be working with another large payer in 2021 to take upside risk, but admits it’s not for everyone and not even all of their buildings.
“We’re facing challenges head on,” Reiff says. “We continue to work with our leaders. It’s new for them, it’s new for our organization, but they understand if we’re going to be in this game long term, we have to have to be a good community partner and we have to jump into that risk model they’re laying out in front of us going forward.”
Best Practices and Advice for Building a Post-Acute Strategy
Before, best practices for ACOs meant preferred post-acute networks, investment in data and claims lookbacks, monthly meetings to review data, read-only EMR access, and committed FTEs working across the continuum. What always has worked doesn’t always ring true as we move the needle forward on value-based care and developing a strong post-acute strategy and stronger partnership relationships.
Having visibility into all of their providers, acute care, PCPs and payers, as well as utilizing technology has really helped American Senior Communities move forward, Reiff says. “With Olio, we get that visibility back to our referral sources in real time,” he says. “We can also address process improvement in real time, versus looking in the rearview mirror — not weeks, months, quarters or a year later. The real-time analytics have been tremendous.”
Reiff says it’s important to know how the PCP business is working, and the payers as well, because they want acute-care hospitals to be successful. “It’s about knowing what their targets are, where they’re at on Medicare spend and what we can do to assess that. It’s about having those conversations and bringing it to the forefront.”
Baumer agreed with Reiff and says ACOs must engage with post-acute providers in order to move forward. Post-acute care providers, he says, can effectively impact episodic spend outside their four walls.
Certain post-acute providers do a better job than others at discharge planning, Baumer says, ensuring safe transition to home and making sure another ACO or health plan care management program has been referred or deployed in order to wrap around that number.
“If I’m a payer, whether a health plan or ACO, I’m thinking about how to identify those post-acute providers who can do that,” Baumer says. “The second piece is looking at post-acute providers who’ve been able to invest in capabilities to actually demonstrate they drive outcomes.”
Baumer also says that more ACOs should look at unique levers available in CMS’ new direct contracting program, especially around downstream contracting. “We’ve seen how more imaginative payers have constructed really unique payment models for SNFs that have driven differentiated outcomes. It provides substantially more freedom for ACOs to come up with creative ways to align incentives, to drive quality through the post-acute continuum.”