Health system interest, along with the ongoing pandemic, has continued to drive referrals away from skilled nursing facilities and toward home health programs in 2021.

WellSky, a data analytics company focused on providers across the care continuum, has seen a 15% increase in discharges to home health programs that would normally be reserved for a SNF. 

Referrals to a more institutional setting, meaning your traditional nursing home, has dropped upwards of 20%, according to WellSky CEO Bill Miller.

Miller chatted with Skilled Nursing News about the future of home health programs and skilled nursing facilities within the wider post-acute space, a shift in where certain care services are rendered and how technology investment plays a role in the larger picture of referrals, discharges and transitions in care.

This conversation, which took place Dec. 21, has been edited for length and clarity.

Looking back on 2021, how have home health programs, including SNF-at-home, affected skilled nursing facility intake?

It’s a little bit of a chicken or the egg thing, separating the effects that they’ve had on volumes and referrals and placement. I think they would probably be pretty different without COVID. Just between 2019 and 2021 we’ve seen at least a 15% increase of the people being discharged to the home that might otherwise have been discharged to SNFs. SNF referrals just in this last quarter, compared to pre-COVID quarters, are down at least 20%.

Is that because hospitals are actively trying to engage in these new models of care, or were there capacity issues and they just couldn’t take patients and because of COVID? It’s hard to get perfect clarity about that, but what we do know is that the trends are undeniable.

Predictions for home health programs in 2022?

This trend … of how care is delivered is still pretty small, but it’s taken a really strong foothold and as you know COVID I think sped it up probably for good. The models are starting to prove out better care and lower costs, but more importantly, I think it starts answering the call about more and more of us expressing our consumer preference to age in place, to die at home with dignity, to recover at home if possible. We’re all seeing that that is certainly a tailwind to some of these changes.

You said the shift might be driven in part from hospital system interest?

They’re diving in. Just this last month, there were at least 83 health systems and 187 hospitals operating in this acute hospital care at home initiative. People are jumping in and I do know they’re grappling with … making smart choices about where a home setting would be appropriate versus a SNF. That’s where WellSky comes in. By having enough data about patient conditions and comorbidities, we can see who is more appropriate and who’s going to thrive better in a SNF setting than being discharged to home.

Talk to me more about how WellSky fits in with transitions in care and patient discharges.

I think one of the advantages that we have, particularly as our clients perceive us, is because we’re not just a home health entity, we’re not just a software provider to SNFs, software provider to palliative or hospice care facilities. We advocate for all post acute space, space that is growing. The volumes are going to support that, regulatory changes are going to support that, consumer demand is going to support that. We’re ubiquitous, we don’t really try to shape discharges to specific clients.

Any big picture insights you’re seeing from the data, about the post-acute care space?

There’s more investment occurring in the post-acute space than we’ve ever seen. It’s unprecedented the amount of consolidation, private equity dollars flowing into the space. Look at the announcement of Oracle buying Cerner, by all accounts the number one or number two provider of [electronic medical systems, EMR] in high acuity settings and health systems. Big tech companies are making big investments in health care, like $28 billion bets on health care and on Cerner.

Will those big tech investments flow down to the skilled nursing industry?

I do think that the investments will reach the shores of SNFs over time. I think unfortunately, the post-acute space has suffered from underinvestment at times. It’s part of the healthcare ecosystem that’s emerging really rapidly, and lots of dollars and investments are being made and a lot of talent is entering the space. I’d be optimistic and I’d be on my toes if I owned a SNF, if I owned a home health agency, because a lot of things are moving quickly.

So big tech is playing catchup, investing now in the post-acute space?

It’s suffered from underinvestment for decades. I bet you could go back for many, many years and not find any year where the investments in post-acute breached $1 billion across an entire year and now, WellSky makes $1 billion-plus investments over this past year, itself.

How have decades of underinvestment shaped the post-acute space, in terms of what WellSky does?

Everybody was sort of a stovepipe to themselves. ‘I’m a SNF EMR company, I’m a home health EMR company. I don’t really talk to the outside world other than maybe Epic or Cerner. I’m not necessarily interested in sharing data with insurance companies, nor am I interested in them seeing how I deliver care.’ All of these are gone. The systems have to reflect the fact that those days are gone, and data has to be a lot more transferable. It has to be a lot more transparent. We have to make systems that are mobile-earned and more intuitive. Five years ago, you’d be surprised at the number of agencies that were just working on paper, the number of SNF organizations working on really, really old systems.