How One Large Hospital Delivered Better Care with a Multi-Provider Network

Healthcare providers and payers are moving beyond the technical integration of healthcare reform and into a new phase of developing the organizational dynamics needed to launch lasting initiatives and new models of care. This evolution requires close attention to the mechanics of partnership development across the healthcare continuum, as well as an examination of how attitudes, behaviors, and perceptions play a role. Investing in relationships can help illuminate what each entity needs from the others to transform an agreement into a productive partnership. For one academic hospital seeking progressive ways to streamline costs and deliver better care, the latest phase has been all about collaboration and transformation.

The Highlights

• By developing and implementing a multi-provider partnership initiative, our large academic hospital client was able to address an annual $12 million in avoidable costs
• Our project resulted in the successful implementation of a community care network with 20 skilled nursing facilities and two home health agencies
• We developed progressive, customized programs and policies that further improved coordination and desired outcomes, including improved efficiency of the throughput of patients within the hospital, as well as an overall reduction in readmissions, emergency department utilization, and skilled nursing facility average length of stay

The Opportunity

Like many health organizations today, our client, a large academic hospital, recognized the importance of preparing for a value-based, accountable care environment and the need for new strategies to match. For this hospital, internal concerns regarding unnecessarily long lengths of stay and inefficient throughput, which were estimated to potentially cost over $12 million annually, were among the initial drivers for seeking to capitalize on the opportunity to align their patients and services with high performing post-acute care providers in their geographical area to develop a new care network.

As part of this project, the hospital also identified its responsibility as transcending into the post-acute environment to ensure that downstream providers are maximizing value through the delivery of efficient and high-quality care. This position arose from the reality that hospitals are increasingly required to take on significant financial risk in relation to patient outcomes, even after they leave the facility, with mandatory programs currently placing at least 6% of Medicare’s inpatient payments at risk. Though it may seem a small percentage, this is equivalent to $16 million for a hospital.

The Approach

Our approach focused on the development of customized programs to help the hospital adapt its systems to meet its objectives of streamlining costs while delivering better care. Our work required not only an understanding of the financial and operational aspects of network development, but also the ability to integrate perspectives from multiple provider types and stakeholders. Fortunately for everyone involved, this is where Collaborative Consulting shines.

The hospital’s focus on ensuring quality of care throughout the downstream providers was the lens through which we created a robust RFP and on-site assessment process to create a new multi-provider care network. We believe that partnerships aren’t simply agreements on paper – they’re relationships that require collaboration and communication. This is why we also created opportunities to facilitate dialogue between the hospital’s leadership and post-acute providers during both the RFP process and the final implementation launch.

Creating the network itself wouldn’t have been enough on its own – we leave no stone unturned when it comes to developing a plan to sustain the programs we help our clients implement. Heading into the launch, we developed a process and specific metrics to track, monitor, and evaluate the effectiveness of the network. In addition, we helped place an employee experienced in PAC networks into a new full-time director position to oversee the network and continue facilitating communication among the multiple providers.

The Potential Realized

With a custom strategy and sustainable implementation plan, we enabled this hospital to meet its objective of developing and implementing a new community care partnership, with 20 skilled nursing facilities and two home health agencies joining the network. The client also saw immediate effectiveness, including improved communication and coordination, from the implementation of their customized programs and processes.

Remember that effectiveness monitoring process? The first round of data analysis found that the PAC network successfully met initial targets in nearly all measurable metrics, including improved efficiency within the hospital by reducing door-to-bed time for admitted patients. Also, expectations were far surpassed for readmission reduction (11.8% for skilled nursing facilities and 5.7% for home health agencies), emergency department utilization (5.92%), and average length of stay for skilled nursing facilities (13.8 days). Utilization of network providers for necessary discharges also significantly improved following inception of the network.

Ultimately, all of these numbers are indicators. But what do they tell us? That through purposeful partnership and a sustainable approach, there is potential to achieve better care delivery while repositioning to significantly streamline costs. For this academic hospital, this is the best of both worlds.