Beyond the walls of the hospital: prosper in the care based on the value

Whether it is to improve the results for vulnerable and post-sued patients to build collaborative networks using real-time data for a measurable impact, it can take several different approaches to provide quality care and be reimbursed in the world-based care world. In an interview, Steve Holt, vice-president of government affairs, PointClickcare, has discussed how hospitals and ACOs can succeed with alternative payment model programs (APM) such as Ahead, Team and Aco Reach has Representation of quality benchmarks.

CMS wants each individual with Medicare to be part of a care program managed by 2030. This objective has stimulated the development of alternative payment models, as part of the CMS / CMMI banner, to understand how to fold the cost curve without sacrificing the quality along the way – one of the largest care of care.

Holt said that the team model paved the way for new APM models.

“The team model, in particular, is really the first body of a large -scale alternative payment model on the government through the types of suppliers. It is a very strong indicator of the trajectory that we have with these models. It is prudent to assume that these alternative payment models will continue to be management.

Holt says that sanctions for sub-performants will probably take the form of sticks. It is essential to understand the importance of being an active participant, to establish good relationships and to focus on the service of the best possible care.

“When you take a closer look at the team model, which focuses on high -risk episodic care packages, I would say that it becomes even more important to understand how to make sure that these high cost treatment groups are managed effectively and effectively. More importantly?”

Virtual care and effective care coordination solutions have an important role to play. The risk is that if you are not at the forefront and you are not actively involved in reflection on the implementation and establishment of relationships in your network as part of your health system strategy, your organization will be left behind. If this happens, it will be extremely difficult to catch up once these alternative payment models become commonplace.

So where should hospitals and ACOs focus on improving results for vulnerable and post-sued patients? Holt has identified the transitions of care as an area where the health industry has had difficulties because the transition of the care of a hospital or another acute framework for a qualified nursing establishment, a rehabilitation center or a domestic environment can create a “black hole” of data. In these circumstances, it can be difficult to work with partners to monitor the health of a patient, if they improve and if care is provided in an appropriate and efficient manner. The deployment of technology and processes to improve communication beyond the walls of a hospital or another installation to increase and improve the coordination of care is essential in these situations.

Hospitals must establish more strict partnerships with their downstream post-sued care providers, to ensure the sharing and coordination of transparent information. It starts with detailed output summaries and precise reconciliation of drugs. This also includes the possibility of showing when and where the patient is referred to reduce the clinical administrative burden for these admission care teams. In this way, healthcare providers can provide care proactively, rather than react to a patient’s health changes, according to Holt.

In a post-Aiguë framework, such as a qualified nursing establishment, an assisted life establishment or a home health establishment, the commitment of the patient and their families is of crucial importance. They must be aware of the treatment plan for loved ones and outing instructions. They have conversations around the social determinants of health and social needs to avoid unnecessary readmissions. It is really a question of identifying how these care teams work effectively together rather than trying to completely rethink the workflows between the care parameters that may not integrate transparently.

“Innovation is essential for an effective service provision model where care transitions are often the main indicators of negative results and the most important cost engines,” said Holt. Holt said that as alternative payment models such as Team and Ahead, he thinks that communication, a well-trained workforce and technology will be the greatest differentializer of this time of shared risks and connected care.

“I really wanted to focus on the importance of communication, labor and technology. These three things have to work together and effectively to succeed, whether or not you are in an alternative payment model,” said Holt

CMS has established more difficult benchmarks to help hospitals and ACOs improve the quality of care and costs. Holt has described certain practical strategies that hospitals and ACOs should use to meet these new expectations, especially when taking care of high-risk and post-sued patients.

According to Holt, three key things are necessary. First and foremost an effective communication between the different care provision parameters.

Second, the workforce and the training of the workforce in these various healthcare establishments so that they can prosper and carry out the best possible care. Third, the increase in their work thanks to technological investment, by ensuring that the best possible tools are at hand to offer the best possible care for these patients. Patients in this care tend to be a high risk and high cost.

Holt also argued for an increase in technological investments in senior and behavioral health care establishments to allow better cross collaboration.

“We use exit summaries of our qualified nursing establishments which are automatically sent to the emergency room (ED),” said Holt. “If this patient is released and appears again to the emergency, these emergency care teams already have complete visibility where this patient comes from, why this patient presents himself in the emergency, and he is able to really relaunch this care provision once the patient is admitted.”

Alternatively, when a patient is returned to an emergency service and sent to a qualified nursing establishment, PointClickcare tools help fill this patient file and ensure that relevant information is available for qualified nursing institutions. This makes the patient’s integration process without seam, said Holt.

Holt noted that PointClickcare can be used to configure an alternative payment model or a risk -based model for a cohort of patients to follow against APM CMS benchmarks to generate the results these APMs need. Its technology can also be applied to assisted life in support of the patient’s treatment plan.

Holt offered an example focused on the management of drugs for patients.

“If you look at the average senior who is admitted to a qualified nursing establishment, they are 11-12 prescribed pharmaceuticals. To a complication requiring a visit to the emergency service, it can offer a setback to the health of an elderly patient which he cannot recover easily. »»

Holt stressed that interoperable communication is vital to ensure that the crucial data of patients can be exchanged between the care teams transparently and significantly.

In these care transitions, where care teams must proactively manage patients at high risk to avoid unnecessary readmission, predictive analysis tools have an essential role to play, Holt underlined.

“DSE systems can facilitate the task of care managers, whether with ACO, the health system or a risk entity. We must make our tools as user as possible, so that caregivers do not spend endless time to treat technology, as opposed to the provision of real care, “said Holt.

The congress promulgated the Hitech law in 2009 to promote investments in technology supporting interoperability between health care organizations. This decision has also established significant use requirements, forcing health care organizations to share patient data between ambulatory environments and active care.

But the Heech law has neglected investments throughout the continuum of care for the elderly and the continuum of behavioral health care, observed Holt. Consequently, Holt said, “you have seen an important divergence of technological sophistication between care establishments, and this is what led to a spectacular fragmentation of IT systems. This is why you do not necessarily obtain transparent communication between healthcare establishments.

To achieve that the objectives of care, innovation and collaboration based on value are essential to help alternative payment models to be successful. Having a reliable technological partner is essential to success.

This box breaks down the alternative payment models discussed in this article::

Photo:: Supatman, Getty Images