As the shift to value-based care continues to change the landscape of the healthcare industry, providers are embracing the reality that value-based care represents the future of healthcare in the United States. Driven by unsustainable costs, stakeholders’ push for value, and support from the federal government, value-based payment models aim to reduce spending while improving quality and outcomes. In some value-based care models, organizations are responsible for a specific patient population (such as those diagnosed with chronic kidney disease or end-stage renal disease) and are ultimately responsible for all costs related to that population.
To manage spending, it is critical for providers to consider the total cost of care. Total cost of care refers to the cost of all medical services consumed by a population of patients in a year, and includes professional, hospital, pharmacy, and post-acute care and services. To proactively manage the total cost of care, hospitals, health systems, ambulatory providers, and risk-bearing entities must identify opportunities to reduce costs as patients move across the continuum of care. One of the most important areas in which an organization can reduce costs is in post-acute care (PAC).
According to the Stanford Institute for Economic Policy Research, Medicare spending on post-acute care accounts for about $60 billion, or 15%, of Medicare spending every year. Additionally, failures in care coordination account for up to $78 billion in waste each year, according to a study published by the Journal of the American Medical Association.
While managing PAC spend is one of the most important ways to lower the total cost of care, it is also one of the most complex and challenging.
Finding quality care amidst growing demand is challenging
- By 2030, all 73 million baby boomers in the United States will be 65 or older
- 60% of Americans live with at least one chronic disease
Demand for post-acute care for older, higher acuity patients is on the rise and hospitals are finding it harder to place patients, leading to longer acute lengths of stay, and more time spent managing referrals. According to data from CarePort powered by WellSky, the average hospital length of stay (LOS) prior to PAC discharge is approximately one day longer in 2023 than it was in 2019. Additionally, while patient referrals to skilled nursing facilities (SNF) and home health agencies (HHA) remain high, rejection rates are also climbing with HHA rejection rates reaching an all-time high at 76%. Then, when factoring in the need to find care for patients with complex needs, more challenges can arise.
While demand for post-acute care is on the rise, finding quality care can also be a challenge. To make informed referral decisions and optimize PAC utilizations, organizations must build and manage a high-performing post-acute network with risk-adjusted, real-time, and payer-agnostic data to account for variations in provider quality and patient outcomes. The ability to place patients with in-network top performing providers can reduce readmissions and drive savings in PAC spend.
Without accurate, timely information about post-acute options, acute providers lack the visibility to make timely and informed decisions for their patients.
Influencing discharge with patient engagement
One of the most important ways organizations can be successful in value-based care is by influencing patient discharge, which can have a significant impact on both outcomes and costs. By engaging vulnerable patients on the benefits and programs available to manage their complicated needs earlier in their care journey, providers can influence the course of care, provide the patient with needed services and limit additional costs associated with poor outcomes. Additionally, when patients are involved in their own discharge planning, they are more likely to be aware of warning signs and take the necessary steps to prevent complications of their condition. This can lead to fewer readmissions and lower healthcare costs.
Visibility into factors like readmission risk, utilization history, and participation in value-based care programs, is critical for providers to efficiently address critical gaps in care and intervene, when necessary, as patients with complex needs transition through the continuum of care.
Reducing length of stay with predictive analytics
Hospitals, health systems, ambulatory providers, and risk-bearing entities are responsible for providing their patients with high-quality, coordinated care across the continuum while reducing the burden of care and costs. Depending on a patient’s condition and the type of care they require, there is significant variation in average length of stay (ALOS) among patients admitted to a SNF after acute inpatient hospital stays. Since SNFs represent a significant proportion of Medicare costs and are paid on a per diem basis, reducing medically unnecessary days from a patient’s SNF stay can have a significant impact on PAC spend.
Without insight into SNF ALOS and estimated LOS analytics, it can be challenging to make informed care decisions and hold PAC partners accountable. The use of predictive analytics – such as those that share expected LOS at a SNF – helps support clinical decision-making to improve patient outcomes, reduce post-acute LOS, and optimize post-acute utilization.
How CarePort®, powered by WellSky® can help
By leveraging CarePort’s suite of solutions, providers gain greater visibility into patient journeys improving patient care, care transitions, and outcomes. By being embedded in discharge planning workflows and providing insight into post-acute provider performance and estimated length of stay analytics, CarePort bridges the gap between providers across the continuum, powers intelligent, informed care decisions, and helps risk-bearing entities manage PAC spending.
Learn more about how CarePort®, powered by WellSky® can help your organization improve patient outcomes and decrease PAC spending with increased visibility, intelligence and influence.
