The value-based care discussion in skilled nursing is not new. But the landscape is changing significantly in the near term, with care providers having some unique opportunities based on how they respond. In this Payment Perspectives interview, PointClickCare EVP of Health System Solutions and Government Affairs Bill Charnetski shares his views on what SNFs can do to succeed, and how technology can help them along the way.
Skilled Nursing News: When it comes to the payment evolution that’s happening right now, what do you think skilled nursing providers need to do differently?
Bill Charnetski: The agencies have been talking about value-based care for a while. But it feels like there’s real momentum now that hasn’t been there in the past. In my opinion, skilled nursing facilities now have to embrace that shift from fee-for-service to value-based care. I think that many providers don’t fully understand how to take adavantage of the new model. In particular, they need to understand that you have to be willing to embrace the risks and rewards associated with value-based care. Embracing that shift is the starting point.
The value-based care model is looking at real patient outcomes with respect to the real cost of delivering those outcomes across the patient or resident journey. That now means that you’re looking into real data and data insights that underpin the whole information set that goes into that analysis. There’s a lot that comes from this, and I’d be remiss if I didn’t say I think it’s a huge opportunity for the system to take on risk because that will drive better outcomes. The fact you’re now being forced to manage that risk means you’ll do it at a lower cost if it works.
Our view is our customers won’t get there unless the policymakers provide them with additional investment into the technology that will be required to do these things I’ve just described: Reduce the tasks, improve efficiency — and, dare I say, productivity — , workflows, privacy, and communication between and among care settings. That all has to be on a digital platform.
What can skilled nursing providers do to prove their value to payers?
We’d like to help the SNFs and payers understand the critical role they play in the value-based care model. For a SNF, it now will be incumbent upon them to demonstrate their ability to manage through a number of different components: reduction to lengths of stay, successful discharges, all at a lower cost.
There are a lot that SNFs do on a daily basis that can affect that cost, such as safer and more effective medication management and adherence to specific vaccine measures. All of that has an impact on their Five-Star rating and scores. To look at the system from the policymaker’s perspective, it also contributes to savings of millions of dollars, and that’s the magic. Still, there are all kinds of value that SNFs bring. The question is: how can they prove that value?
I’ll bring it back to the notion that they’ll have to prove it, but they’ll need help in doing so. They’ll need to have the right systems in place and the right platforms. It doesn’t matter whose solutions they invest in, but we’ll need something to really bolster the data that they’ll need to provide to prove their value. They will need to establish a baseline, and they need to establish exactly what they’re doing differently. Then they’ll need to establish the delta, the amount of money saved in providing this higher outcome.
If they can do that successfully and provide that complete picture of all the services that a patient or resident is receiving, that’s the story that a SNF can tell.
How is healthcare technology supporting the shift to new payment models?
At the core of the technology is a seamless exchange of data. The health care industry has been focusing on the idea of achieving the quadruple aim. If you’re going to achieve that quadruple aim and accurately measure it such that you can engage in risk sharing and achieve today’s policy goals, then you need that proper investment in and proper execution of health information technology tools. Not to belabor it, but LTPAC never got the benefit of the massive investment of money that came at the time of the Affordable Care Act. That was billions of dollars that went in to create this type of technology.
The “meaningful use” approach wasn’t perfect, but it did provide that critical investment that enabled providers to improve care through interoperable technology, proper integration of technologies, and training. LTPAC should have the benefit of that investment now, but that speaks to equitable funding of health care. Long-term care providers are dealing with a much different healthcare environment with a much different patient or resident. Equitable funding on all fronts would allow LTPAC facilities like SNFs and others to streamline their operations, and keep care at the bedside, which benefits the residents.
An electronic health record also broadens administrative functions, and provides greater access to clinical and financial records. The next step will be to capture the real-time data at the point of care that will allow you to adjust your care delivery as appropriate.
Complete the sentence: If I could change one thing about the healthcare payment landscape, it would be…
… to provide more equitable funding to the LTPAC industry, to SNFs in particular.
The future of health care payment is…
Value-based care. It’s been talked about for a long time, but it’s coming and it’s good policy.
Is there a misunderstood aspect of skilled nursing payments that you’d like to debunk?
I think the most misunderstood aspect is that payments are always directly tied to outcomes. Sometimes they are, and it doesn’t mean that by coincidence you don’t have very solid outcomes, but they’re not directly tied to them as a matter of course. Ultimately, if you want a high-performing system, including long-term post-acute care that creates value in the system, the payments need to be tied to outcomes.