Value-Based Care: What’s Next for PAC Management
I started 2021 with a new job and a new perspective to add my variety of experiences in the population-health community as I joined Olio as the Vice President of Sales. For those not familiar with Olio, it is a software solution that makes it simple for hospital systems, physicians and payers to actively engage with post-acute providers about patient care. The primary reason I’m at Olio is due to conversations I’ve been having with value-based care leaders over the past several years; learning what efforts have been made to improve value-based care, what plans are being made for the future and deficiencies that still need to be addressed.
I came to Olio from naviHealth, where I spent time discussing with health system and ACO leaders how to address one of the most challenging and costly areas of value-based care - the post-acute space. My experiences have allowed me to see how people across the country are thinking about population health and value-based care. I’ve identified common themes of what organizations are struggling with and have seen the variety of ways they are trying to solve their problems.
If expanding into more risk agreements, figuring out how to deliver care outside the four walls of a hospital and addressing readmissions weren’t already major points of emphasis for every health system prior to COVID-19, they certainly are now. The COVID-19 pandemic changed so many things in healthcare. It fueled an increase in Telehealth out of necessity and expedited the shift away from fee-for-service for many. The scary thing for many organizations is the fact that once a patient leaves the acute setting they often lose the ability to impact care or have any real insight on where the patient is on their care journey. Post-acute care (PAC) management has become a critical area of focus because it directly impacts the success or failure of so many initiatives healthcare leaders are focused on.
Where PAC Management is Today
Since the launch of ACO’s in the early 2010’s, quickly followed by bundled payment models, there has been a very similar path taken for addressing post-acute care (PAC) spend and over-utilization. While I’ve seen a great deal of innovation from one region to the next, several consistent themes were always present:
1. Building PAC scorecards to rank the quality and adherence of care plans by PAC providers.
2. The formation of “narrow” or preferred networks as an effort to drive more patients to a smaller number of high-performing post-acute providers.
3. Developing care coordinator or patient navigator strategies that involve going out into the community and rounding on patients with the PAC space.
However, we are still faced with the reality that once patients leave a hospital and go into a skilled nursing facility (SNF) or home health, there’s often a lack of insight into where the patient is getting care, how their healthcare is progressing (or declining), and how long the patients have been there.
Calls, emails and fax are still the main means of communication between care managers and coordinators at health systems, physician groups, ACOs and payers with post-acute care providers. Real-time engagement is non-existent, leading to delayed response times, longer post-acute stays, and patients being readmitted back to the hospital.
While each phase of this journey has driven some level of improvement, it hasn’t completely addressed the issue at hand. Additionally, as we move further down the path it sheds more light on two flaws in the approach; scalability to a larger patient population and unbalanced “partnership” between acute and post-acute providers.
What’s the Next Phase of PAC Management?
For PAC management to truly become effective, the strategy needs to benefit both the acute and post-acute providers. Outside of the occasional gold star for quality performance or a slap on the wrist for poor results (some of which aren’t related to patient outcomes,) post-acute providers receive little value from the current model.
Technology can be better leveraged, if it’s focused on the right objectives.
First, providers considering solutions for post-acute and value-based care problems should do their research. Technology that centers around mining PAC or claims data doesn’t have any value to post-acute care providers. A solution that improves real-time communication provides value to BOTH sides.
Secondly, technology should give visibility into current patient status and easily escalate issues, before they turn into readmissions. No more care coordinators showing up to a specific SNF just because it’s on the schedule for Tuesday. PAC providers need a way to virtually raise their hand and say, “I have an issue here!” so instant collaboration on medication adjustments or changes to a care plan can happen.
Lastly, it has to provide immediate updates on patient transitions so everyone, including the primary care provider, has insight into where the patient is on their care journey.
In my short time at Olio, I’ve seen firsthand how the above technology approach has increased PAC engagement, created better alignment with all providers and reduced readmission rates to single digits.