Hospitals are more and more turning to value-based care initiatives to remodel care supply, decrease the entire value of care, and enhance affected person outcomes. In contrast to conventional fee-for-service (FFS) fashions that reimburse suppliers based mostly on quantity (i.e., the variety of affected person visits), suppliers are reimbursed based mostly on the standard of care delivered in value-based care. Finally, success below these reimbursement fashions hinges upon seamless coordination between all stakeholders throughout the continuum of care.
Leveraging expertise, suppliers extra successfully talk with different stakeholders to align on shared targets for the affected person, achieve enhanced visibility into essential affected person outcomes, and streamline care coordination. Listed here are 5 methods hospitals can use expertise to succeed below value-based care:
1. Enhance emergency division (ED) diversion
The Company for Healthcare Analysis and High quality’s Healthcare Value and Utilization Mission cites roughly 144.8 million visits to the ED every year within the U.S. The ED is an costly care setting that prices an estimated $76.3 billion in 2017 – a quantity that has solely risen for the reason that onset of COVID-19. Nonetheless, many of those visits are doubtlessly avoidable and by decreasing the variety of pointless admissions, the U.S. might doubtlessly save as much as $32 billion yearly. With the correct expertise, suppliers can monitor sufferers throughout the continuum, establish when sufferers current to the ED, intervene in a well timed method, and reroute sufferers to a less expensive degree of care. Care coordination expertise additionally loops in major care suppliers and post-acute suppliers concerning shared sufferers, powering cross-continuum visibility right into a affected person’s care.
2. Scale back hospital admissions
For each sufferers and suppliers, journeys to an ED, and even only a brief hospital keep, are expensive. Social determinants of well being (SDoH) – together with nonmedical components similar to social isolation, meals insecurity, or housing and transportation issues – are roadblocks to care which will additionally result in doubtlessly avoidable ED visits and acute admissions. In truth, homeless people have better than eight instances the incidence of ED visits than these which might be the identical age and intercourse however usually are not homeless.
To appropriately handle SDoH, hospitals require care coordination expertise to proactively take into account these roadblocks to care and join sufferers with native home- and community-based organizations to scale back sufferers’ reliance on hospitals and forestall avoidable visits and admissions. By proactively addressing sufferers’ social-risk components by means of expertise, hospitals take a complete and coordinated strategy to whole-person care, leading to higher outcomes, decrease prices, and sustainable care – all essential to success below value-based care fashions.
3. Establish the suitable subsequent website of care post-hospital discharge
In 2019 alone, and below the standard fee-for-service mannequin, Medicare spending on expert nursing amenities (SNFs) averaged $27.8 billion. With practically 90% of Medicare sufferers referred to SNFs or residence well being care when discharged to post-acute care – and an approximate 26 million child boomers getting older into Medicare by 2030 – this spending is positioned to extend. Moreover, hospital referral patterns range considerably; whereas some well being programs primarily discharge sufferers to residence well being, others largely discharge sufferers to SNFs – no matter whether or not these sufferers may very well be handled efficiently at residence.
It’s due to this fact essential that hospital suppliers maintain ongoing discussions – starting at hospital admission – to find out whether or not the affected person requires post-acute care. In that case, suppliers should then establish the suitable subsequent website of care post-discharge. To facilitate this dialog, suppliers leverage care coordination expertise to help degree of care decision-making by contemplating historic high quality and outcomes information of comparable sufferers. Outfitted with the correct instruments, suppliers could make the suitable post-acute care choice for his or her sufferers to mitigate readmission danger and cut back potential post-acute care spending.
4. Optimize expert nursing facility size of keep
As touched on above, post-acute care delivered within the SNF setting accounts for a good portion of Medicare fee-for-service prices. The variations in Medicare funds to care settings are additionally important. In truth, the common fee for sufferers which might be discharged to a house well being setting was $5,384 lower than these sufferers that have been discharged to SNFs. With that in thoughts, it’s crucial that suppliers leverage expertise to offer the real-time size of keep information and benchmarks to optimize the size of a affected person’s SNF keep. The best instruments assist suppliers cut back spending, guarantee sufferers solely keep within the SNF for so long as is medically vital, and obtain a profitable affected person discharge again into the neighborhood.
5. Mitigate avoidable hospital readmissions
As soon as sufferers transition again into the neighborhood, they’re nonetheless in danger for readmission. In truth, these transitions are among the most difficult. A examine revealed within the Journal of the American Medical Administrators Affiliation recorded 24.4% of SNF sufferers have been readmitted to the hospital inside 30 days. Hospital readmissions value Medicare $17 billion yearly – and plenty of of those are doubtlessly avoidable. Hospitals and well being programs face mounting stress to scale back pointless readmissions, significantly the Hospital Readmissions Discount Program – a Facilities for Medicare & Medicaid Companies (CMS) value-based initiative – which penalizes hospitals with comparatively greater charges of Medicare readmissions.
To keep away from missteps within the care transition course of which will finally end in readmissions, hospitals can make the most of expertise that unites stakeholders concerned in a affected person’s care on a singular platform. Suppliers can extra effectively refer sufferers to high-quality suppliers, monitor high-risk cohorts, achieve visibility into the beginning of a house well being care episode, get notified of any rehospitalizations and establish – early on – value-based sufferers to observe by means of the episode of care.
If hospitals are to achieve success below value-based care fashions, they should put money into options that enhance transparency and coordinate care throughout your complete affected person journey. Investing in the correct expertise breaks down siloes in affected person care by enabling steady communication and alignment with all stakeholders in a affected person’s care journey – guaranteeing that sufferers obtain the suitable degree of high-quality care.
Mike Ipekdjian, MBA-HM, BSN, RN, SANE, PHRN, NREMT, is the Head of Scientific & Answer at CarePort, powered by WellSky.