The 2010s brought significant change and innovation to the healthcare industry. Now that we have entered the new decade, we wanted to take a moment to reflect on the industry over the past ten years. To do so, we recently sat down with three of CarePort’s thought leaders – Tom Martin, Matt Gagalis and Mike Ipekdjian – for their unique perspectives on the trends within healthcare over the past decade, and what we might expect to see in 2020 and beyond.
Tom Martin, Director of Post-Acute Care Analytics
Over the past decade… the post-acute space has increasingly rewarded providers who demonstrate high quality of care through CMS publicly reported quality measures and programs.
CMS’ quality reporting programs’ measures are evolving. Once focused on measuring patients while in their prospective care setting, measures are becoming more patient-centric and increasingly prioritize patient outcomes following discharge from the post-acute setting.
CMS’ Five-Star Quality Rating System, implemented in 2008, was originally based solely on measures occurring within SNFs. Those SNFs with higher Five-Star ratings were rewarded with higher volume and occupancy, and could accept patients of higher reimbursement types.
Programs such as QRP and VBP, which began in the latter half of the decade, went so far as to directly tie Medicare fee-for-service reimbursement to quality, including participation and performance in the programs. Most importantly, all of these programs introduced measures that track patients back into the community or another care setting after discharge from the SNF. Though providers have historically not tracked patients across and out of care settings, measures shared on Nursing Home Compare are no longer based solely on the period of time a resident is under a facility’s direct care. Key to success across these programs is understanding what happens to patients after discharged into the community or another care setting.
Matt Gagalis, Head of Payer Market Development
Over the past decade… there has been recognition that change is required, and the implementation of value-based care has helped achieve better quality.
Ten years ago, value-based care was not prevalent outside key markets like Boston, Southern California, Southern Florida or innovative provider organizations such as Cleveland Clinic or Geisinger. However, CMS, HHS and other governing bodies have long understood the importance of value-based care and have made continued efforts to prioritize the alignment of incentives across stakeholders. As a result, there has been significant adoption of value-based care arrangements, and we’ve seen, for example, the number of ACOs grow to more than 1,500 nationwide covering more than 40 million lives. Most importantly, today’s value-based arrangements have learned important lessons from the mistakes of the past to focus not only on cost savings, but quality improvement as well.
Since 2010, quality of care has improved across a host of key metrics, and increasingly aligned incentives for payers and providers are closely correlated to this shift. For example, in the most recent measurement year, more than 80% of Medicare Advantage members were in a plan that was rated 4 Stars or above. The shift to value-based care has been foundational to these improvements, however this is only the beginning. With incentives more aligned than ever before, innovation will continue to fuel quality improvement in the next decade through data, analytics, remote monitoring and new care delivery models.
Mike Ipekdjian, Director of Customer Success
Over the past decade… there has been positive momentum in improving quality, outcomes and coordinated care, but resource issues remain.
Within the last ten years, there has been an increasing emphasis on care coordination, but resource issues remain. Critical to quality care is the ability to manage patients, intervene and prevent readmissions, but the teams required to support care coordination have historically been under-financed and understaffed.
In the shift from volume to quality, care coordination teams have unfortunately experienced limited financial resources and understaffing that prohibits them from effectively managing a high volume of patients. Though some teams are well-funded and well-resourced, most care coordination teams are in their infancy, or organizations are just beginning to think about better management of patients. Regardless of a team’s size, care coordination technologies such as CarePort help providers more effectively manage patient populations and drive more efficient transitions between different levels of care.
Unfortunately, resources needed to positively impact these patient populations (e.g. case managers) are difficult to find, and funding and resourcing care coordination teams will be a challenge that continues in the new decade. Scaling care coordination services has been, and will continue to be, a slow process.
The proliferation of technology over the past ten years now allows us better insight into patient activity and movement to improve efficiencies and historically dysfunctional workflows. Technology has driven improved communication and enabled the ability to affect change by measuring clinical performance in real time, versus waiting for three- to six-month-old claims data.
Interested in learning more about CarePort, and how we can help your organization in the new decade? Reach out.