Therapy Management & Consulting Services Blog

Get Your Seat At The Table Today!

Get Your Seat At The Table Today!

The Time is Now to Execute on Initiatives to Optimize Patient Care & Demonstrate Positive Outcomes


Accountable Care Organization (ACO) networks and bundled payment programs continue to gain momentum across the nation. As such, these influential networks (inclusive of physician groups, hospital systems, managed care, etc.) are becoming more influential and even more refined.

Every post-acute care (PAC) provider must be considering strategies to link elbows with referral sources, ACO/bundled payment networks, managed care networks and regional conveners. After all, the climate has changed quickly and dramatically; consider the startling statistics:
  • Currently, one in ten Medicare beneficiaries are attributed to an ACO
  • 50% of all payments this year will be via a value-based program
  • 90% of FFS MCA dollars are linked to quality or value

The impact of these health care reform mandates speak volumes! They suggest that this shift will continue to gain momentum. For example, several studies demonstrate the percentage of bundled payment patients discharged from the hospital setting directly to a skilled nursing facility has dropped as much as 30% - 50% for orthopedic and cardiac valve replacement surgeries.

High Expectations!
Becoming part of a preferred network or bundled payment program is critical to PAC providers’ survival, but it comes with a price: high expectations!

Healthcare organizations and networks are seeking only strategic partnerships that will help them to remain financially viable. As such, it is imperative for PAC operators to not only understand these expectations, but to also execute on processes, programs and plans in support of these important strategic changes as soon as possible. The following discussion encourages swift and smart execution on three critical drivers: quality patient care, monitored performance metrics and tactical operational changes.

Patient Care is Paramount
CMS’s focus on the “Triple Aim” initiative dictates whether many PAC facilities will survive the healthcare reform transition. There is a universal sense of urgency related to adopting internal care designs to improve quality patient care and satisfaction; improve the health of populations; and to reduce the per capita cost of health care. Additionally, the “Six Aims for Improvement” defines “ideal healthcare delivery,” and PAC providers must also be prepared to demonstrate their efforts to align with each of the six quality indicators, which state that care should always be:

  • Timely
  • Efficient Equitable
  • Safe
  • Effective
  • Patient-Centered
Moreover, “in-network” providers are expected to embrace INTERACT, or a similar program to track, manage and report out on a comprehensive admission, discharge planning and communication processes related to care transitions. Often times, although a PAC operator understands the value of INTERACT, implementation is a challenge. Execution on developing care paths, advanced care planning tools, patient/caregiver education, quality review and QAPI processes continue to be intimidating but worth the investment.

The Power of Performance Data
The key to unlocking strategic partnerships is the ability to demonstrate positive performance data. In fact, ACO networks and those who own bundled payment programs will require preferred PAC providers to report out on bi-weekly/monthly/quarterly reports on performance metrics and key outcome measures to designated Clinical Care Coordinators. At the minimum, a PAC operator should have systems in place to swiftly and easily demonstrate:
  • Functional outcome measures
  • Care coordination measures
  • Patient engagement measures
  • Organizational capability measures
  • Composite measures
  • Efficiency measures
  • Disparity measures
  • Performance Measures
Moreover, each provider ideally should also implement the use of internal scorecards to capture the following:
  • Re-hospitalization rates by diagnosis;
  • Percent of patients discharged home/ with home care / with out-patient referrals
  • Average length of stay by diagnosis for both SNF & HH partner
  • Quality Measures- sepsis/UTI, falls, cognition, etc.
  • 5-Star Ratings
  • Therapy intensity (minutes/week)
  • Functional Status Changes/LOS
  • Control group/peer benchmarking/ hospital & national standards
  • Cost/episode by diagnostic group

PAC providers can also leverage the power of performance data related to marketplace intelligence and data analytics specific to their referral sources. For example, it’s important to understand how a referring hospital’s reimbursement and their cost is associated with readmissions, VBP adjustments and/or Avoidable Hospital Days. Consider the value of a savvy PAC operator who is able to identify and strategically execute on interventions that contribute to the mitigation of unnecessary costs for their referral source; a “Win-Win” result in this scenario would surely hard-wire an important network partnership.


Operational Accountability
Providers across the post-acute care continuum are being held accountable for having programs, tools and resources in place that objectively demonstrate a shift from quantity to quality. Networks will continue to demand evidence of such sophisticated key quality indicators as:

  • Plans for seamless transitional care (as with the Project RED philosophy);
  • Care pathways which support population health-oriented niche programs;
  • Whether clinical programming /interventions align accurately with patients’ needs, acuity and complexity;
  • Appropriate patient/caregiver education;
  • Specific internal and external communication protocols;
  • Consistent compliance programming/training/auditing ;
  • Staff selection, training based on a foundation of culture which supports health care reform initiatives;
  • Ability to form strategic plan based on objective performance data (e.g.: Quality Measures, PEPPER, Casper, CMS 5 Star and Quality Measures).
  • Concurrent outcomes and cost analysis;
  • Ability to make good risk management decisions;
  • A clean claims process.

This transition away from the industry’s traditional focus on driving utilization is as much an operational change as it is a cultural change. This may present a challenge for some facilities, while other PAC operators embrace the opportunity and leverage their ability to execute as a competitive advantage.

Prepared to take your seat?
To summarize, consider whether your community is well-prepared to build and sustain meaningful, long-lasting partnerships with valuable networks by evaluating the industry’s top ten “Value-Based Initiatives Across the Continuum of Care.” Has your PAC community executed on the following:

  1. Discharge planning that is integrated across the continuum of care
  2. An integrated technology hub is in place.
  3. Data & data analytics which support communication with upstream/downstream providers
  4. Model that can support an integrated Post-Acute Continuing Care Network
  5. Population Health Management capabilities for chronic care 
  6. Integrated cost reduction initiatives
  7. Truly community-based programs
  8. Network of case management/care collaboration
  9. Clinical and financial partnerships
  10. Payment models that share risk
Eventually, every PAC provider will be required to embrace this shift from volume to value and integration with upstream and downstream partners will be a necessity.

The biggest challenge then becomes executing on the many initiatives, programs and operational tactics. Because many PAC facilities do not have the necessary resources, they may engage help from healthcare reform consultants, such as HealthPRO®/Heritage. Some consulting firms like HealthPRO®/Heritage have been executing on innovative healthcare reform strategies since the onset of ACO networks almost four years ago. Once thought of as only a therapy management team, HealthPRO®/Heritage is a unique example of where PAC providers can find highly qualified, specialized team of experienced leaders who can support your interdisciplinary teams in making necessary changes.

Whether PAC providers choose to forge ahead on a strategic path independently, or will enlist the support from industry experts, the next generation of health systems and networks will feature those PAC communities that offer integrated, evidence-based, innovative and integrated systems that can consistently demonstrate the highest quality of care and the ability to collaborate with the full continuum of care delivery.

Tags: Heritage Healthcare, HealthPro, post acute care provider, PAC provider, Advisor Newsletter, Advisor