Because of their high involvement with Medicare beneficiaries and their critical role within the care continuum, post-acute care (PAC) providers are an ideal partner for Accountable Care Organizations (ACOs) seeking to achieve the triple aim of improved quality, decreased costs and better patient satisfaction, according to a recent report.
In a healthcare eco-system that incessantly demands providers to improve quality of care at lower costs—or suffer the penalties—collaboration is key, says the white paper “The Right Care for the Right Cost: Post-Acute Care and the Triple Aim,” a collaborative effort between Managed Health Care Associates, Inc. (MHA) ACO Network and Leavitt Partners, a health care intelligence business.
“The value of post-acute providers cannot be understated and is only projected to become a more critical component under health care reform and the ACA,” said Michael Sicilian, president of MHA, in a written statement.
In 2012, Medicare spending for post-acute care services exceeded $62 billion, comprising nearly 11% of Medicare outlays and representing the largest per episode expense per beneficiary, according to data published in Health Affairs and February 2013 Medicare Baseline data from the Congressional Budget Office.
As the the percentage of the population aged 65 years and older continues to rise, this spending is expected to continue growing.
Preventing hospital readmissions, which has been another hot pressed issue for acute care providers, creates a realm of possibility to collaborate with PACs more than ever as both seek to benefit from collaborative ACO partnerships.
Preventable readmissions, in addition to costing the federal government $26 billion per year for Medicare beneficiaries alone, also inevitably disrupt patient recovery, according to the February 2013 report “The Revolving Door: A Report on U.S. Hospital Readmissions” by the Robert Wood Johnson Foundation.
Since the start of fiscal year 2013, hospitals have been penalized for having an excess population of Medicare readmissions. While the current penalty has been up to a 2% reduction of their Medicare reimbursement, the penalty will increase to 3% by 2015 and will also include more diagnoses, including hip and knee replacements, as well as chronic obstructive pulmonary disease.
“Collaboration with post-acute care settings can help non-PAC providers not only avery financial penalties, such as those associated with avoidable hospital readmissions, but also improve overall health spending and care quality,” write the white paper’s authors.
Although coordinating with post-acute care providers is not a formal ACO requirement, these organizations’ collaboration with PAC providers have the potential to impact overall quality of care and spending to help drive clinical and financial outcomes.
A case study provided in the report spotlights New York’s North Shore-Long Island Jewish Health System ACO, which developed an informal continuing care network of independent post-acute care providers, comprising 19 skilled nursing facilities.
Thus far, the collaboration has resulted in standardized treatment and assessment protocols for patients with severe conditions in both ACO and PAC settings, used by all the participating providers, as well as the creation of a universal transfer form that standardizes patient information that is transferred when with the individual moves between acute and post-acute providers.
This conditional collaboration with the SNFs has led the ACO to reduce its all-cause readmission rate by 5.5% and hear failure re-hospitalizations by 4% between 2010 and 2012.
By recognizing the role PAC providers can play in a patient’s recovery, as well as their potential to improve care and lower costs, ACOs can begin to form partnerships with these companies as they strive to build out a full spectrum of care.
“To achieve these aims, providers invoked in emerging care models must educate themselves on post-acute care and consider the benefits of ACO-PAC engagement,” write the authors of the white paper. “By creating more efficient care processes, ACO-PAC integration gives the various areas of the health care continuum the ability to work together to affect total cost of care and improve patient outcomes.”
Written by Jason Oliva