Addressing Provider Network Optimization for Post-Acute Care

Post-acute care (PAC) remains a significant cost driver for ACOs, particularly regarding Medicare populations.

Why? Think of it as navigating a healthcare maze: multiple providers, specialties, hospitals, and facilities, each holding a piece of the patient's care journey.

Coordinating effectively in this fragmented landscape is akin to traversing a minefield fraught with gaps, duplications, and, consequently, readmissions. This makes managing the utilization and quality of PAC services critical for ACOs, not just to contain costs but also to ensure smooth care transitions and better patient outcomes.

The challenge deepens when PAC providers are out-of-network for the ACO, posing communication hurdles and limiting management over utilization and costs. Ineffective care after discharge often boomerangs back, resulting in readmissions and potential long-term issues for patients, ultimately penalizing the ACO.

And even if a PAC provider belongs to the ACO or health system, aligning incentives becomes another struggle. Lack of data exchange and mismatched goals can hinder efforts to truly impact the care delivered.

Further complicating matters, PAC providers can become a type of “dumping ground,” where health systems' owned facilities are frequently overwhelmed by the most complex and demanding cases, potentially escalating costs and readmission rates.

This challenge is notably pronounced in resource-strapped rural areas, exacerbating efforts to engage patients adequately. Consequently, meticulous monitoring and management of these patients by care managers become imperative to successfully oversee both the cost and quality of care.

So, how can ACOs realistically achieve post-acute care optimization?

It starts with having a collaborative approach across all your partners, including network management, care management, and population health analytics.

Access to actionable data regarding utilization and quality will also be critical to addressing the complexities and challenges of PAC, so choosing the right analytics platform is vital.

In this article, we discuss a collaborative and proactive approach to achieve provider network optimization with your post-acute care providers.

Take a Collaborative Approach with Network Partners

Optimizing PAC networks goes beyond identifying outliers in data. While an analytics partner with a powerful analytics platform can pinpoint problem areas at the facility, provider, and patient level, the real value lies in using those insights to steer patients toward optimal care settings and actively manage your network.

We often say that while data shines a light on the "where," effective care and network management transform that knowledge into actionable insights, ultimately driving positive outcomes for both patients and your organization.

Let’s now delve into key ways to effectively work with a partner and explore the impact through the lens of one of our ACO clients.

Step 1: Understand Your Network Utilization

• Know Your Players: Identify the PAC providers most frequented by your patients, along with the specific conditions or procedures leading to those transitions. This lays the groundwork for data-driven analysis.
• ‍Metrics Matter: Dive deeper with provider-specific metrics. For example, scrutinize the length-of-stay and cost in skilled nursing facilities (SNFs) or recertification rates in home health agencies. Remember, readmission rates and follow-up care rates are crucial indicators of care quality. Case in point, an ACO client discovered home health agencies re-certifying patients for over a year, highlighting potential unnecessary care and cost implications. Look for patterns that could indicate overutilization without benefitting patient outcomes.

Step 2: Shape Your Network

• Curate Your Crew: Based on your analysis, form a select network of PAC providers demonstrating the best outcomes for your patients. Share this network with healthcare providers and care managers to ensure patients receive optimal post-acute care.

Step 3: Engage in Open Dialogue

• ‍Talk it Out: Foster open communication with your PAC partners, sharing performance data from your analytics partner. Regular conversations enable the alignment of objectives and facilitate continuous, collective improvement in care delivery.
• ‍Go Beyond Analytics: Invest in a data exchange platforms to track real-time patient admission and discharge information sharing. This fosters proactive care coordination and improves patient transitions.

Step 4: Plan for Success

• Align Goals: Clearly outline and prioritize your goals and objectives (in-network utilization, reduced readmissions, etc.), and ensure they resonate with your partners.
• ‍Embrace Transparency: Discuss data limitations and work collaboratively to overcome them.
• ‍Empower The Team: Invest in training and encourage ongoing communication to achieve coordination of effort and effective data-driven decision-making across care teams.
•  Engage the Patient: Don't underestimate the power of patient engagement. Involve patients and families in care decisions to improve adherence and satisfaction.

Client Experience: Achieving Provider Network Optimization with Partner Support

A multi-state ACO client was able to reduce out-of-network utilization and improve patient outcomes by working with its internal and external partners

The ACO set clear objectives for readmission reduction and in-network utilization and closely collaborated with Koan Health to develop a strategy to establish dashboards and reports to pinpoint opportunities for improvement.

Regular bi-weekly calls with dedicated experts on both sides ensured continuous evaluation and opportunity identification. Sharing insights across the teams and utilizing PAC-specific dashboards empowered informed decision-making.

Custom reports on home health and other problem areas enabled network optimization, quality assessments, and regional comparisons.

Optimizing our PAC network requires more than just technology. It requires a collaborative ecosystem where data empowers informed decisions, communication bridges gaps, and patients remain at the forefront. This approach helped us improve patient outcomes and reduce costs, shared a multi-state regional ACO executive.

Pinpoint Improvements with Population Health Analytics

ACOs and health systems must also leverage analytics platforms adeptly to optimize post-acute care.

By dissecting and analyzing data across various dimensions such as care type, diagnosis, and patient complexity, ACOs can pinpoint areas for provider network optimization in post-acute care and drive impactful interventions.

1.    Understand Key Metrics

When delving into PAC analytics, it's crucial to assess a spectrum of metrics, including:

• Post-Acute Care Type: Categorizing care types like rehabilitation, skilled nursing facilities (SNF), hospice, and home health.
• ‍Diagnosis or Procedure and Patient Complexity (Risk Score): Analyzing patient conditions and complexities to tailor interventions.
• Current Network Status or Affiliation: Identifying affiliations and networks for collaboration and benchmarking.
• Total Admissions: Tracking episode count and patient volumes to gauge workload and resource allocation.
• ‍Length of stay or Usage of PAC: Monitoring the duration of care episodes to optimize resource utilization.
• ‍Cost per Day and Cost per Patient: Assessing financial implications and identifying opportunities for cost reduction.
• ‍Readmission Rate: Evaluating the effectiveness of care transitions and continuity.
• ‍PCP Follow-Up Rates: Ensuring seamless transitions and post-discharge care.

2.     Identify High-Impact Areas for Improvement

By utilizing trend analysis and predictive models, ACOs can uncover areas with the most significant potential for improvement. This includes:

• Patient Engagement: Enhancing patient involvement and adherence to care plans.
• Care Transitions: Streamlining transitions between care settings to reduce readmissions.
• Resource Utilization: Optimizing resource allocation and reducing unnecessary costs.

3.     Track Progress and Measuring Impact

Implementing data-driven interventions is only the first step. Continuously monitoring the effectiveness of these interventions and iterating as needed is crucial. This involves:

• Implementing Interventions: Deploying targeted interventions based on data insights.
• Continuous Monitoring: Regularly tracking metrics to assess the impact of interventions.
• Iterative Approach: Adapting strategies based on ongoing analysis and feedback.

Client Experience: Using an Analytics Platform to Reduce Readmissions

This same multi-state ACO client demonstrated effective use of Koan Health’s Datalyst platform to drive improvements in post-acute care.

Datalyst helped them discover a regional home health organization’s unnecessary recertifications, as well as identify home health agencies that provided effective and efficient care.

Armed with these insights, this ACO devised an action plan that translated into a 13% PMPY reduction in home health recertifications over 4 years, saving them roughly $6 Million over that same 4-year period.

Datalyst is turning insights into actions for this ACO with:

Year-over-Year Analysis: Utilizing Datalyst to track PAC performance over time, focusing on core areas like rehabilitation, SNF, hospice, and home health.

Actionable Insights: Deriving actionable steps from custom dashboards to target specific areas for improvement.

Comparative Analysis: Comparing performance across providers to identify opportunities and benchmarks.

Episode-Level Insights: Leveraging post-acute care custom dashboard updates to gain in-depth insights into readmissions and resource utilization.

Combining the power of Datalyst's analytics with Koan Health team's deep expertise has transformed our approach to network optimization. We can now collaboratively identify, analyze, and address inefficiencies at a granular level, leading to improved patient outcomes and optimized resource allocation, shared a multi-state regional ACO executive.

Time to Act and Optimize Your Provider Network for PAC

The road to a truly optimized PAC network isn't a sprint, but a data-driven journey powered by collaboration and patient-centricity.

By leveraging the insights unearthed through population health analytics, ACOs move beyond guesswork and target opportunities for improvement with precision. Remember, empowering teams with knowledge and fostering open communication with partners are equally important ingredients for success.

Take the first step today. Partner with an analytics team that aligns with your goals and shares your commitment to patient well-being.

Together, you can illuminate the path forward, transforming your PAC network into a well-lit beacon of efficient, high-quality care. With the right tools and collaborative spirit, you can ensure your patients find their way towards health and well-being.

Interested in learning more about Koan Health's Datalyst? Send us an email and we can schedule a demo with you.

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