Johns Hopkins Reveals Inner Workings of Its Preferred Skilled Nursing Network

One academic health system found that though the process can require considerable time and resources, establishing a preferred skilled nursing facility network could provide a leg up in improving care and in implementing value-based health strategies.

Johns Hopkins Medicine (JHM), an integrated care system that includes five hospitals in Maryland and the District of Columbia, laid out the details of how it established a preferred provider network and skilled nursing facility collaborative in an article published in the Journal of Hospital Medicine in March.

“We learned that partnership with SNFs is truly needed to change the way we deliver care for patients,” corresponding author Sarah Johnson Conway of Johns Hopkins School of Medicine said in comments e-mailed to Skilled Nursing News. “The post-acute care transition is such a critical time, and through partnership and engagement with SNFs, we can hopefully make big strides in improving patient care.”

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The academic health system established the JHM SNF Collaborative to improve the continuum of care for patients discharged to post-acute facilities. Initially the stakeholder group identified 36 local SNF partners that included a blend of freestanding facilities and large corporate chains. Partner selection was based on a combination of factors, including recommendations from each JHM hospital, publicly available quality metrics, and historic referral volumes.

“While we sought to align with high-performing SNFs, we also saw an opportunity to leverage collaboration to drive improvement in lower-performing facilities that continue to receive a high volume of referrals,” the authors wrote in the article.

In particular, they stressed the importance of physician leadership at all levels of the collaborative governing structure, with providers representing various hospitals able to speak about practice patterns.

Transitions between the SNF and the hospital are regarded as crucial to lowering 30-day readmission rates for patients, but obstacles abound. One study published in The American Journal of Managed Care found that providers struggled with care transitions even with tools for easing patient handoffs. In addition, even among providers with specific partners, hospital staffers don’t always know why certain SNFs are designated as preferred, according to a report from the United Hospital Fund.

The JHM collaborative chose transitions of care as its initial focus area; all the affiliated hospitals were working to deal with with these handoffs, and there were opportunities for developing an aligned approach that used hospital input, the authors said. But new priorities will likely surface over time, and the work group — which included representatives from medical and administrative hospital leadership, the home care group, and SNF medical leaders, among others — is likely to evolve in line with changing priorities, the authors noted.

Implementing the SNF collaborative raised some notable challenges and lessons for JHM. These included the need to balance overall coordination efforts with existing engagement initiatives at the hospital and SNF level; finding the right post-acute data sources to use when developing assessments and goals; and the need for support related to data sharing and HIPAA compliance, due to the complexity of the SNF legal structure.

“Larger preferred provider networks require considerable administrative support to facilitate communication with the entities, coordinate completion of network agreements, and manage the dissemination of SNF- and hospital-specific performance data,” the authors noted.

The greatest upfront investment was likely the time and effort of individuals who created the vision for the collaborative, Conway said in her remarks to SNN.

“The coordinating team had representation from population health, care management, hospital administration, health plan, and skilled nursing facility medical leadership,” she said. “Once the framework was in place, initial investments went toward administrative infrastructure with project management, data and analytics, and medical oversight. All of these were felt to be core to pushing the effort forward and maintaining alignment with the initial vision.”

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