Five Ways to Integrate Better Care Management and Cost Containment Supporting Post-Acute Care Needs

The following is a guest article by Mary Kay Thalken, RN, MBA, Chief Clinical Officer at Ensocare in Omaha, Nebraska.

The U.S. Census Bureau projects the 2030s to be a transformative decade for the U.S. population. By 2030, all baby boomers will be older than age 65. This will expand the size of the older population so that 1 in every 5 residents will be retirement age. By 2060, the U.S. is projected to grow by 79 million people, from about 326 million today to 404 million.

This 2030 demographic population milestone combined with the desire of older Americans to live independently makes it critical that acute and post-acute care organizations proactively develop strategies, tools and solutions to enable them to live healthy, self-sufficient lives for as long as possible.

One outcome of older generations living longer is the associated likelihood these same individuals placing added stress on an already strained healthcare system (a study warns the number of seniors with four or more chronic diseases is expected to double by 2035). The costs of caring for these individuals will be high, and hospitals, integrated health systems and medical groups expanding their scope of practice into the post-acute care space can expect to assume financial risk for healthcare utilization eventually, if not imminently.

These provider organizations need a roadmap to reduce avoidable costs while supporting the unique care management needs of an increasingly aging population. Here are five ways to support initiatives:

1. Adopt a platform approach to connect and adapt technology advances that support the function of a new care management model

Facilities need adapting technologies to move away from the labor-intensive, clerical processes fraught with tremendous redundancies, waste and rework. A platform approach integrates and supports multiple IT tools used by the care coordination team in the redesign of an enterprise care management plan that is efficient and is heavily reliant on evidenced-based practices.

This approach is really a matter of harnessing current and emerging technologies to support your plan’s care delivery options ­fortified by a fully vetted network of post-acute care providers. Ideally, the tools are the best suited for coordinating an individual’s care needs no matter which care setting is best for their next-level care needs: transition from acute hospitalization to post-acute care such as a skilled nursing facility; home health services delivered in the home; inpatient rehabilitation facility; or a long-term acute care hospital.

To support our aging patients long term, it is no longer adequate to just offer an available hospital bed. I recommend starting with automating the complex discharge management process in consort with patient transitions across care settings ­– ensuring seniors do not get readmitted unnecessarily and that their condition does not deteriorate.

2. Partner with other healthcare providers on quality and cost initiatives

Already, provider organizations locally and state-wide are forging risk-sharing alliances to escalate value-based purchasing and bundled payments at the macro-level, specifically accountable care organizations (ACOs). Payment model partnerships are critically essential to ensure the highest level of quality care at the lowest costs.

Yet, despite our country’s economic growth and declining unemployment, we have a long way to go to improve quality outcomes as healthcare costs including exorbitant premiums and deductibles and household medical debt continue to skyrocket. In this context, providers must now, more than ever before, work collaboratively to contain rising costs so that their pooled patients continue to receive the best access to care; and, that includes paying close attention to vulnerable senior patients on Medicare exposed to high out-of-pocket costs.

3. Establish a high quality, low-cost post-acute care provider network that automates placement and referral management

Automate the placement and cross-continuum referral management and placement process to facilitate patient transitions to the most appropriate facility upon discharge. I recommend investing in building a well curated post-acute provider network within your surrounding area that can be managed and maintained and that its core care coordination competencies are benchmarked against distinct quality metrics.

To assure cross-continuum performance tracking, define and monitor KPIs such as, for example, the pinpointing of post-acute care providers accepting a large variety of patient referrals or appearing to accept only those deemed financially appealing, the quickness—or not—of engagement in responding to your referrals, and the number of times over a specified duration that they admit or decline your patients.

In an era of accountable care, using an automated solution that provides the full continuum of data will help take your partnerships to the next level of performance. You’ll be able to identify facilities executing the highest quality care possible whether the individual is a stroke patient, has pneumonia, is recovering from an accident, or managing complex chronic or disabling conditions requiring round–the-clock monitoring. You’ll also gain a stronger sense of whose patients are constantly being re-admitted for hospitalization or are just filling beds.

At the end of the day, making the best post-acute care placement decision on behalf of your patient’s needs and wellbeing is an organization-wide imperative.

4. Identify areas of coordinated and centralized oversights to improve care management such as staffing, IT investments and performance tracking

This strategy is really about optimizing your care management model to assure that each transitioning patient is given the right amount of time needed to determine the intensity and duration of their post care – including psychosocial needs and social determinants of health, proven to play significant roles in overall health and healing.

Efforts to manage one or more conditions must be coordinated employing a team approach to guarantee integration of medical and non-medical services and insurance coverage for certain levels of care or a particular diagnosis. Review the functions required to access gaps in the clinical and non-clinical care needs provided by different departments that can be realistically scaled across your organization. It’s possible to fill those gaps through optimization of your staff and resource utilization management. As well, invest in enabling automation to lessen the care team’s workload implementing manual, time-consuming processes.

Of course, monitor and measure the impact of the overall performance of your redesigned care management model structure through quality metrics and outcomes of each caseload in terms of size, costs and patient acuity needs. The data will inform decisions to ensure patients are receiving the care they need while creating a balanced, effective workforce and environment.

5. Implement social engagement opportunities to meet the unique needs of older adults

The Silver Tsunami is bringing attention to the critical need of providing community resources to seniors. Thankfully, many acute and post-acute care providers are paying closer attention to, for example, arranging medical transportation to and from appointments, offering a digital, interactive care plans that are easy to use and follow, or offering wearable technologies and apps to track vital signs to promote a healthier lifestyle.

This developing trend will bring more engagement and provider interaction since indeed, seniors are expected to be more informed in their self-care. Providers recognize that what happens in a patient’s social environment has a direct impact on the patient’s wellbeing; and accordingly, many are instituting dedicated care coordination teams targeting the management of social determinants of health of high-risk and rising-risk patient populations.

Additionally, community-based organizations are forming digital resource hubs focused on long-term care management of chronic diseases. These hubs are springing up across the country to connect and service patients and their families and friends. Approximately 40 percent of a person’s make-up is a combination of genetics and illness and 60 percent is the external forces and systems shaping the conditions of daily life. Providers must redesign their care management models to make community resources readily available to pick up where clinical oversight leaves off and to influence better outcomes.

As U.S healthcare spending spirals out of control accounting for nearly 18 percent of the nation’s GDP, healthcare leaders unceasingly question how to do a better job mitigating costs. One solution: Redesign your care management model to include post-acute care and services to better meet your individual patient needs and place emphasis on addressing social determinants of health.