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Care transitions: 3 major challenges for post-acute providers

In today’s shifting changing healthcare environment made more complex by the ongoing COVID-19 pandemic, post-acute providers are looking for ways to simplify, streamline, and optimize care transition processes between multiple care settings and community resources. In this blog post, we outline three major care coordination challenges that post-acute providers are facing, and how CarePort’s comprehensive, robust solution can automate and improve these processes.

Staffing shortages  

Nursing home staffing shortages are not necessarily a new phenomenon, but the COVID-19 pandemic, a widespread labor shortage, and the Biden administration’s vaccine mandate for long-term care employees have contributed to an immensely challenging staffing shortage. One survey shows that 94% of nursing homes are facing staffing shortages, while another found that 53% of long-term care workers plan to leave their jobs and find one where vaccines are not required.

The pandemic has imposed unforeseen demands on nursing home staff, including new infection prevention and control measures such as screening, testing, and isolating residents to minimize transmission and contain the spread of the virus. This also means that fewer care navigators or social workers are responsible for coordinating care for an influx of high-acuity patients, delaying care transition workflows, referral response rates, and setting up patients to receive care at home.

How CarePort can help

Leveraging CarePort, post-acute providers can immediately receive and respond to referrals from hospitals, and then coordinate care with other post-acute providers and community partners when the patient is ready to leave the facility. CarePort’s easy-to-use system creates efficiencies throughout post-acute care management processes by handling the end-to-end transition process electronically, helping to expedite and streamline referral and care transition workflows. In fact, home health agencies that use CarePort Referral Management to facilitate faster referral responses can experience a 17% increase in new referral volume, and SNFs can see a 67% increase in new referral volume.

Higher-acuity patients 

More patients are opting to receive post-discharge care at home, leaving SNFs and LTACHs to coordinate care for more complex, higher-acuity patients that need more services to support their recoveries; in fact, CarePort data shows that the average patient discharged to a SNF is now more acute than in 2019, and also shows a seven percent increase in home health patient acuity from 2019 to 2020. Failing to address these patients’ needs – whether medical or non-medical – can ultimately lead to avoidable patient hospital readmissions.

How CarePort can help

CarePort allows post-acute providers to coordinate care with over 130,000 care and community-based providers across the U.S. including hospitals, SNFs, LTACHs, and home health agencies, as well as physical and occupational therapists, transportation services, and DME, among others. Managing all medical and non-medical referrals in one application is invaluable to care navigators and social workers looking to coordinate more services upon leaving a post-acute facility.

Lack of cross-continuum collaboration  

Healthcare is experiencing tremendous demand for patients to recover at home. Because many of these patients have more comorbidities and are higher-acuity, post-acute providers face an increased number of patients discharged home with additional needs and services. Post-acute care teams need to think about whole person care and how they can account for patients’ medical and non-medical needs to ensure a successful recovery in the home. Cross-continuum collaboration, communication, and transparency is critical to streamlining care transitions, managing patient outcomes, and improving value-based care.

How CarePort can help

CarePort enables post-acute providers to increase and enhance collaboration with their referral networks throughout the referral process by receiving and providing visibility into the patient care journey – including patient care information, medication reconciliation, services needed, work orders, medications, labs, transcriptions, and documents.

To learn more about how CarePort Referral Management enables seamless care transitions, visit our website or request a demo.

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