.jpg)
The U.S. healthcare system has struggled with rising costs and unequal quality.
In 2010 the Patient Protection and Affordable Care Act (PPACA) became law, bringing major changes clinically and financially to drive better health outcomes, lower costs, and improve the distribution and accessibility of healthcare.
Changes were made to fee for service reimbursement. The industry has seen a shift away from fee for service compensation to paying for performance. Fee for service; reimbursement is not linked to outcomes. Providers are paid on volume. The provider is paid whether or not patients’ health improves.
On the other hand, value-based care reimbursement model pays on improving quality. The focus is on appropriate levels of care to produce effective and satisfactory outcomes. Collaboration among stake holders and an integrated approach is integral.
An integrated care continuum is a key strategy for achieving better quality, better service, and lower costs per unit; which is promoted as the Triple Aim – a frame work developed by the Institute of Healthcare Improvement.
The increase in the number of baby boomers and aging population are factors; that require change to a more integrated care approach in care delivery.
In the drive toward value-based care reimbursement models, acute and post-acute care providers are increasingly accountable for the quality of care delivered to their patients at all points along the care continuum. They are interdependently and collectively responsible for delivering safe, reliable, consistent and quality care in their communities.
A deeper level of hospital-PAC facility engagement has become necessary to deliver care to patients in the community.
Creating formal relationships and building a network of PAC providers (skilled nursing facilities, home health agencies) that agree to meet quality standards, share data, interface electronically, and work with hospitals and other providers to reduce avoidable hospitalizations is highly recommended. These providers will become known as “preferred practice partners”.
Clinical Care coordinators should collaborate with social workers and case managers in decision making; in referring to these PAC facilities or home healthcare agencies.
While it’s essential to offer patients a choice about their care after discharge, recommending a specific PAC facility may be justified because of medical necessity and evidence-based care.
A thorough evaluation of these providers need to be done to ensure that there is adequate capacity, staffing resources, high quality of care, adequate geographic coverage.
A site visit is recommended to meet the senior administrative team and medical staff from your hospital and the facilities. The meeting should discuss your length of stay objectives for patients discharged to the SNF, quality measures, reporting on patients’ progress, and in turn, attain a solid understanding of the PAC’s business model.
Encourage quarterly meetings with PAC providers to give feedback.
Develop a score card for practice partners; assign specific weights to quality measures, to encourage healthy competition within the network.
Care Coordination is an effective strategy in post- acute care follow up to facilitate collaboration among all stakeholders and ensure that the treatment plans and care pathways are maintained. Clinical care coordinators ensure that there is accountability to quality, to patient experience and patient outcomes.
