How skilled nursing operators are using data to drive partnerships with hospitals, ACOs and other collaborative organizations

The skilled nursing industry has many uses for the data it gathers, whether that’s for reporting purposes, operational efficiencies, or demonstrating outcomes to patients and their families.

But those that operationalize their data on an even higher level have an opportunity to not just promote their care and services to individuals and prove their performance to the Centers for Medicare and Medicaid Services (CMS), they also can prove themselves as worthy — and essential — partners to acute-care providers and value-based care organizations.

“Using [data] as an instrument, nursing homes are able to position themselves as a partner and demonstrate specific clinical expertise,” says Joe DeMattos, President and CEO of the Health Facilities Association of Maryland, an association representing more than 150 skilled nursing and rehabilitation center members in Maryland. “Whether that is informal in a referral network or formal in an Accountable Care Organization (ACO) type of relationship, it’s the data and the clinical outcomes that tell a story.”

Particularly as SNFs — hard hit financially, clinically and operationally by the COVID-19 pandemic — stabilize and recover in 2021 and beyond, this ability to differentiate through data-driven metrics and reporting will become even more critical.

Telling the true story with data

While providers are required to collect and submit claims data that can help shape the story of where they excel, an analytics platform is a critical tool to further define that story and identify outliers that may be skewing a provider’s performance metrics. It can also provide a more timely look at performance versus CMS data that lags weeks and often months, and doesn’t consider the patient’s outcomes post-discharge.

“With claims-based data, it’s great that you can see the journey that the patient has taken, but it doesn’t truly tell the story of just the nursing home,” says Karen O’Driscoll, VP of Post-Acute Solutions for PointRight, A Net Health Company. “The nursing homes could have high rehospitalization rates when you look at its claims-based data, but it may not have anything to do with them. [The rehospitalizations] may have been after the patients were discharged back to the community. What we’ve been able to do with PointRight is help them say ‘Here are our real-time quality outcomes’ as opposed to claims based data that has a lag time.”

The implementation for PointRight, a data analytics platform serving skilled nursing provider organizations, includes a historical analysis of two years of past data, for comparison purposes, which helps create the real-time perspective for SNFs and their partners.

O’Driscoll points to an example of one PointRight user struggling to increase its star rating, despite having recently put process improvement measures into place. Its two-star rating had been preventing it from being able to participate in a local ACO, a position which, if achieved, would allow many opportunities for the organization. When PointRight analyzed the facility’s current data, it found its rehospitalization rate was relatively low, due to the process improvements recently implemented; it did not align with the current star ratings data.

“The star-rating data still reflected some sense of their past,” O’Driscoll says. “It wasn’t truly telling the story of how they were currently doing.”

By creating reports and showing trends over time, essentially charting the improvements, the provider was able to re-engage the ACO and show the missing data to make a case for participating.

“The ACO was blown away by it… and they offered a position within the ACO and preferred provider network,” O’Driscoll says.

Partnerships, preferred providers and building referral networks

As value-based care continues to grow, the opportunity for skilled nursing providers to participate in collaborative organizations focused on quality outcomes is paramount. Particularly as they recover from financial losses due to the COVID-19 pandemic, these operators need to examine every opportunity to improve their reimbursement potential by delivering quality care.

While the opportunities vary depending on state and locale, ACO participation is rising significantly, according to CMS data released prior to the pandemic. As of its 2020 report, CMS counted 11.2 million Medicare beneficiaries served by health care providers in ACOs, up more than 7% from 10.4 million during the same period a year earlier.

Likewise, Institutional Special Needs Plans (I-SNPs) present opportunities for providers to launch or join SNF-specific Medicare Advantage plans for qualifying individuals, which have been ticking up steadily over the last five years, and referral partnerships have never been more important as they were during the pandemic and will be following it.

“There are dozens of examples every month where a better clinical match is made between a hospital and a nursing home because of the better type of care for the person as demonstrated with PointRight data,” DeMattos says. “We saw this during the pandemic, where in certain geographic areas there was limited SNF capacity and where you had to keep people moving safely across settings.”

By proving areas of specialization with data, nursing homes can continue to solidify their position in the post-acute care environment in the post-COVID era as well.

“It used to be that hospitals would look at their data and say “You are my vendor,’ [about a nursing home],” DeMattos says. “With the uptake of [data use] they are able to form collective and referral networks. It’s less about the hospital viewing the nursing home as a vendor and more with the data and exchange of ideas as a fully vested partnership.”

DeMattos points to specialties among SNFs, such as cardiac care and other niche services, that can align hospitals directly with post-acute care providers for the best patient outcomes.

Toward those ends, both O’Driscoll and DeMattos participate in the Maryland Post-Acute Care Collaborative, a group of hospitals, health systems and post-acute care participants working to standardize and improve care delivery across the state.

Looking ahead: A universally data-centric industry approach

With all of the market factors influencing the skilled nursing industry through the pandemic and recovery from it, data will become increasingly important in driving conversations with prospective partners all invested in the same goal: better patient care.

“Because things have been so turned upside down during the pandemic, and also all the scrutiny with those standard measures that exist, it’s going to be critical that nursing facilities have something that they can take into those conversations,” O’Driscoll says.

As the industry regains its footing, that information may ultimately be a deciding factor for those SNFs that continue to operate and succeed.

“Even pre-COVID, we were trending as an industry toward being more universally data-centric,” DeMattos says. “Those organizations in the post-acute care environment that do not have access to a data analytics platform are really those that will [fall behind].”

To learn more about how PointRight analytics can help your organization form partnerships and participate in referral networks, visit PointRight’s solutions for hospitals and health systems.