Tracking Live Data Key in Setting Up a Post-Acute Care Network

As skilled nursing providers look for ways to better position themselves to participate in accountable care organizations (ACOs) in a world increasingly interested in value-based care, post-acute transparency is key when hospital systems look to establish a preferred skilled nursing facility (SNF) network.

“Not all of your SNFs are created equal,” Phyllis Wojtusik, executive vice president of health system solutions for Real Time Medical Systems, said during a webinar on managing risk within a post-acute network. “You may have three or four where you send a significant amount of volume to. One of the things you might want to think about is tiering your network for your population.”

She recommended that for those looking to establish a preferred SNF network, hospital groups need to analyze discharges to SNFs, identify high performers and invite those high performers to participate in network activities.

Advertisement

In her view, volume drives SNF participation and adoption of clinical standards.

“If you’re sending a facility two or four patients a month, that might not be enough to get adoption,” she said.

Wojtusik said that high-performing SNFs, the SNFs in the top tier in a post-acute care network, typically get at least 10 patients a month.

Advertisement

“That doesn’t mean that those lower volumes can’t be in your network, they might be in tier two,” she said. “Understanding how you manage tiers in your network plays a role in how you bring these facilities to the table for value-based care and how you manage risk with them.”

As skilled nursing operators look to build back hospital referral volume post-COVID, one strategy moving forward is to become that preferred post-acute partner within their network.

After the year that ACOs had in 2020, it’s one way that SNFs can move away from their traditional silos and join the push to value-based care and alternative payment models.

Medicare’s largest alternative payment model, the Medicare Shared Savings Program accountable care organization (ACO) model, served 10.6 million seniors in 2020, and saved Medicare $4.1 billion, according to data released by the Centers for Medicare & Medicaid Services (CMS) last week.

Collectively the program saved Medicare $4.1 billion last year, and $1.9 billion in gross revenue after accounting for shared savings payments compared to $2.6 billion and $1.2 billion the year before.

While participation in ACOs decreased in 2020, the National Association of ACOs recently called for lawmakers to pass the Value in Health Care Act of 2021, which is expected to strengthen the Medicare Shared Savings Program by recognizing and rewarding ACOs.

A separate analysis by the Moran Company showed that the bill could increase participation in ACOs and save $280 million over 10 years.

“Most ACOs that I’ve seen, if they don’t have a preferred network, they are developing one,” Wojtusik said. “While I would say the majority of these ACOs already have them, they are starting to narrow their network. They are understanding who their high performers are and how they can drive quality outcomes and move the needle on savings.”

When establishing a preferred SNF network, hospital groups will analyze its discharges to SNFs with data on volume by facility, case type and average length of stay in SNFs. With that data high performers are identified, defined by readmission rates, average length of stay and patient satisfaction, and are invited to participate in network activities.

One way skilled nursing facilities can get that invite and better participate in ACOs is by using live data.

“If you’re relying on old data that helps you look back to see where you’ve been, I would strongly suggest that you use live data and what I mean by live data is actual clinical and quality data directly out of the SNF electronic medical record (EMR),” she said. “It really helps you manage patients at that level here and now.”

Typically, predictive analytics or claims data can be three to nine months old and it takes CMS around a year to change CMS star rating, she said. Minimum data set data can be up to 30 to 90 days old as well.

“Using live data can help get operators the feedback they need immediately,” Wojtusik added.

Companies featured in this article: