Some ACOs See Value in Closer Skilled Nursing Partnerships Post-Pandemic

The rise of value-based care has put a greater focus on costs and quality of all health care providers.

While accountable care organizations (ACOs) have gotten a bad rap in the skilled nursing industry in the past, joining forces with these groups, which consist of groups of doctors, hospitals and other health care providers, remains a path for SNFs to integrate themselves into the health care system.

With the pandemic having decimated occupancy, now may be a time for SNF providers to reconsider their models. Some see now as the time for SNFs to branch out from their traditional silos and work more closely with health systems, including by taking on financial risk.

The good news is, for some ACOs that are looking to drive down costs and improve their performance metrics, SNFs are a partner of choice.

ACOs looking for SNFs

“How does post-acute care play into an accountable organization?” MJ Tran, ACO executive director for HCA Healthcare, asked during the Synergy Summit on Wednesday, sponsored by Synergy HCA and SRX. “I will say regardless of a pandemic or not, post-acute partners are instrumental in the success of an ACO and hopefully you don’t hear anything different.”

The ACO affiliated with Nashville-based HCA — the largest hospital system in the United States — could not be successful without post-acute partners, she said.

“For us, post-acute care becomes the eyes and ears of our patients. When a patient falls … we can’t be a provider in all those spaces and so it makes sense for us to find true partners in the community,” she explained. “I think starting an ACO in the pandemic in a lot of ways allowed us to keep our conversations going and I don’t think they ended during the pandemic.”

She is not alone in seeing SNFs as high-quality partners.

When developing an integrated network of care, these groups are looking for facilities that always pick up the phone, show up for the meeting and are engaged with the health system as a whole.

“If a facility is willing to take risk as we continue on this arc from fee-for-service to value, if we can find partners on the post-acute side that want to take some risk with us or embed themselves in a different kind of relationship with us … that signals to us that facility’s overall alignment with what we’re trying to do,” Dr. Nihar R. Desai, medical director for value innovation at Yale-New Haven Health, said during the hospital executive perspective portion of the state of the industry panel at the Synergy Summit this week.

There are things that experienced skilled nursing operators can provide that no one else can.

“We have seen firsthand … there are unique skills and attributes and talents that you bring to the table that we do not,” he explained. “For now we are very much committed to [SNF partners] on the post-acute care side.”

Success depends on finding facilities that, based on a rigorous evaluation process, put the patient in the best position to have the best outcome for themselves or their loved one, he said. 

SNFs provide the best care

Fortunately, in terms of quality outcomes, SNFs continue to lead the pack, according to data Trella Health presented this week.

“This migration away from SNFs is actually hurting outcomes,” Ian Juliano, CEO of Trella Health, explained.

A case study looking at the 3,300 high-acuity fee-for-service patients that flow through the University of Pennsylvania system annually showed that patients who weren’t treated in nursing homes received worse care and were more likely to be sent back to the hospital.

“Sixty-three percent of their patients are not getting post-acute care, it’s usually higher in the industry,” Juliano explained. “Over a fourth of all those patients are going back to the hospital. That’s almost 1,000 patients that should have gone to a SNF.”

SNF and home health data from Q4 2020 further illustrated the advantages of facility-based care, in terms of better adherence. Medication adherence typically describes the extent to which patients take medication as prescribed by their doctors correctly.

“Home health adherence was less than two-thirds compared to SNFs at over 85%,” Juliano said. “This is the thing you need to make hospitals aware of. The next time you want to put that high-acuity patient into home health, particularly if they aren’t as high on the socioeconomic scale, they are much better off going to a SNF.”