For health plan leaders tasked with finding ways to manage the cost and quality of care delivered to their members, it is frustrating when patients with nearly identical diagnoses and levels of function follow different courses of treatment.
Nowhere is this truer than in post-acute care. In 2013, the Institute of Medicine (IOM) identified post-acute care spending as the primary driver of regional Medicare spending variation. In fact, the IOM report suggested that eliminating post-acute care variation would decrease the overall variation by 73%.
The root of this variation is often a mix of supply-driven demand and misaligned incentives. Areas of the country with high concentrations of long-term acute care hospitals or inpatient rehabilitation facilities often have much higher utilization rates, even if a skilled nursing facility or home health provider could provide care comparable in quality and at a much lower price.
So, what key metrics or statistics should a health plan use to assess its potential to better manage post-acute care?
Here are some ideas:
- 30-day readmission rates for members utilizing inpatient post-acute care. Readmissions from facilities—directly from a facility or within the days immediately following discharge—are strong indicators of quality.
- Skilled nursing facility length of stay, adjusted and unadjusted for readmissions. Skilled nursing facilities are paid on a per-diem basis. The first 20 days of a stay are typically covered 100% by the health plan before a per diem co-pay of approximately $160 kicks in for the member. As a result, a large concentration of discharges occur around Day 20. With high-quality medical care and therapy, average length of stay across a large plan can be decreased from more than 20 days to 15 to 17 days.
- Post-acute yield following a hospital admission, overall and by setting. About 40% of Medicare patients receive post-acute care after a hospitalization, but there’s wide variation in that percentage and the level of care based on hospital and regional practice patterns. Yield to an inpatient rehabilitation facilities can range from 2% of discharges to more than 15% percent, depending on the region of the country.
- Trends in resource utilization groups or levels. Health plans should measure how their resource utilization group categories for skilled nursing facilities have changed over time. Last year, the Wall Street Journal reported that the percentage of days billed for “ultra high” therapy patients had increased from 7% in 2002 to 54% in 2013. The average charge for an ultra high therapy patient is $560 a day, compared with $455 for a “very high” patient.
In addition to these metrics, companies like mine are introducing new measures that will help both providers and health plans better manage post-acute care. NaviHealth’s proprietary assessment technology, nH Predict, draws from a database of more than a million patient outcomes.
Each patient is different, but by identifying similar patients, our predictive analytics can help set expectations for recovery. These personal-level goals are key to ensuring that a patient receives the appropriate therapy and medical care. Our assessment technology can also detect variance between predicted functional recovery and actual functional gain. Variant metrics levels the field, reducing the risk of “cherry picking” healthier patients while recognizing providers that consistently provide the right therapy and medical care.
Empowering care teams to match patients to the right level of care, in the right place, at the right time is critical to success in a value-based care environment. But these factors can’t be managed without the ability to measure them, and that’s the foundation upon which efficiency in health care rests.
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.