Last week we continued our thought leadership webinar series with a presentation from Nick Stupakis, Vice President of Highmark Home and Community Services. This newly created subsidiary of Highmark Health is focused on transforming quality, service, and value in the post-acute space through an innovative payer-provider network management model. Nick spoke in-depth about the strategies Highmark has leveraged to develop a value-based partnership structure that includes the full spectrum of PAC settings—skilled nursing, home health, LTACs, and IRFs. Below we share a brief recap of the key ingredients Nick identified for building successful partnerships between payers and PACs. Visit our website to download the full webinar recording.
The growing importance of the PAC space
A number of factors are converging to bring increased scrutiny and attention to post-acute care. As the healthcare system shifts away from fee-for-service, the government and commercial payers are looking to make care more efficient and affordable by moving patients to the lowest cost care setting that is clinically appropriate. Along with the flood of Baby Boomers turning 65 and becoming Medicare-eligible, this is changing the nature of care delivery. Nick predicted that within five years we’ll see exponential growth in utilization of post-acute, retail, and alternative care settings, whereas inpatient will experience a sharp decline. Yet the post-acute setting is also where the quality and cost of care vary the most, creating a significant challenge for payers, ACOs, and other entities that are discharging patients to these settings. Building partnerships with PAC providers is the most direct route to actively managing quality, service, and cost in the years ahead.
Key ingredients for successful PAC partnerships
A few key themes emerged from the discussion around Highmark’s strategy for building a strong PAC network. Their ultimate goal is to help patients return home, which means they’re making a deep investment in PAC partnerships and they are also extremely focused on quality.
- Sharing actionable data with PACs
Highmark has found that data transparency and insight are critical to achieving quality. They provide SNFs and home health agencies in their network with quarterly scorecards with metrics that go far beyond simple rehospitalization statistics. Data is gleaned from multiple sources, including the health plan’s claims, clinical assessments, and publicly available data such as Medicare star ratings. The quarterly report also shows PACs how they stack up against other facilities in their micro-market.
- Extending value-based reimbursement to PACs
Post-acute providers have largely been stuck in fee-for-service, and have been rewarded for the volume of services provided instead of the quality of services (for information on upcoming changes to CMS SNF models, view our recent blog). By providing scorecards with quality metrics, Highmark is able to identify the high-performers and drive increased referrals to these facilities. Highmark is also working through a phased approach to shifting the reimbursement mechanism for its post-acute providers, providing financial incentives to deliver superior patient care. Reimbursement mechanisms are particularly important levers for home health, where the most vulnerable patients are being transferred after SNF or LTAC stays.
- Working with engaged leaders
Highmark’s network performance team ranked PACs by the level of engagement of the providers’ leadership. They simultaneously ranked providers by claims. What they found was that generally speaking, engagement and claims rankings aligned. When PAC leadership is engaged, the clinical outcomes are good.
To learn more about building a strong post-acute network, and to learn tips for PACs to prepare for a value-based world, download the full webinar recording.