Preferred post-acute provider networks have emerged as a strategy to reduce hospital readmissions. We share lessons learned from Cleveland Clinic and Baystate Medical Center when establishing a preferred SNF network.
Health systems of all shapes and sizes are creating post-acute provider networks. Recently, I spoke with the Cleveland Clinic and Baystate Medical Center about their experiences (Creating Preferred SNF Networks – Best Practices from Cleveland Clinic and Baystate Health). Cleveland Clinic is a health system with 14 regional hospitals totaling 4,500 beds and 21,000 discharges annually to 920 skilled nursing facilities (SNFs) across the country. Baystate Medical Center, the flagship 716-bed hospital of Baystate Health, an integrated delivery network serving western Massachusetts, discharges patients to 44 skilled nursing facilities throughout the area.
Tip 1 – Build Post-Acute Partnerships to Improve Outcomes
Dan Blechschmid, LNHA, MHA, FACHE, Regional SNF/LTACH Administrator for the Cleveland Clinic Center for Connected Care spoke to the importance of focusing on SNFs, “Once we started looking at readmissions and really diving in to what was causing those readmissions, a high percentage of our patients came back from SNFs.” In their evaluation, some facilities readmitted upwards of 50% to 60% of patients.
On one end of the spectrum, Cleveland saw facilities with readmission rates over 80%; on the other end, facilities were in the 2% to 3% range. The wide spread in outcomes was troubling. By partnering with skilled nursing facilities, Blechschmid remarked, “We thought we could address the variability.”
Similarly, Maura McQueeney, BSN, MPH, NE-BC, President of Baystate Visiting Nurse Association and Hospice and Post-Acute Executive at Baystate Health, noted that Baystate had a “spaghetti of loose networks.” By organizing these relationships, Baystate leadership hoped to influence quality and post-acute outcomes.
Tip 2 – Create a Standardized Evaluation Process
Cleveland Clinic created analytic tools to evaluate post-acute providers. Key metrics included referral volume, CMS Star ratings, readmission rates, and average length of stay.
Similarly, Baystate created a template for each SNF to complete. The template included questions about the facility such as CMS Star ratings, staffing levels, process expectations such as warm hand-offs on admission, and outcome reporting expectations such as a 3-month average of 30-day re-hospitalization readmission rates for sub-acute patients. Information was gathered through SNF self-report, site visits, and interviews. After data collection was complete, Baystate applied a weighting to the answers, assigned point values, and scored all facilities. This provided an objective and balanced way to evaluate SNFs.
Tip 3 – Invest Time in Clearly Defining Metrics
One of the challenges Baystate faced was understanding how post-acute providers collected and reported on metrics. For example, McQueeney remarked that when Baystate asked SNFs how readmission were calculated, they heard many different answers. Some SNFs started counting 30-day readmissions from admission to SNF; others factored in the inpatient stay. By developing an understanding for these nuances, Baystate was able to work with their partners to establish standardized measurements.
Tip 4 – Establish Shared Expectations
A core component of the Cleveland Clinic Connected Care program was SNF culture. In addition to meeting key metrics, participation in the network required that the SNF commit to a number of joint quality initiatives. Blechschmid noted that while many SNFs expressed an interest in being a partner, “[we] had to spend some time looking at the culture to see if they were really willing to work with us as a partner.” As part of the program, SNFs shared outcomes on regular basis so that they could work together to improve outcomes. Other provisions of the partnership included placement of Cleveland Clinic medical staff to manage Cleveland Clinic patients and joint participation in quality meetings.
Tip 5 – Keep the Door Open for All Providers
At the end of the evaluation period, Baystate selected 14 providers to include in its preferred network. However, it has since grown to 16 providers. Cleveland Clinic’s Connected Care Program includes 10 skilled nursing facilities. Both Baystate and Cleveland Clinic confirmed that these partnerships are evaluated on an on-going perspective. Facilities that were not initially selected have the opportunity to join the program if they demonstrate quality gains. Likewise the expectation of existing post-acute partners is that they will not only maintain but improve their care quality.
Next Steps
Establishing a preferred provider network leads to a better post-acute outcomes and a more coordinated care experience for patients.
Listen to Dan Blechschmid, Regional SNF/LTACH Administrator at the Cleveland Clinic Center for Connected Care, and Maura McQueeney, President of Baystate Health VNA & Hospice discuss how they developed preferred SNF networks for their health systems.
- What criteria are used to select SNFs for preferred networks?
- How to engage with and assess the SNFs in your referral network?
- How are preferred SNF networks helping to improve outcomes?
- What challenges remain for sustaining the success of preferred SNF networks?
