Insights learned from a recent focus group Real Time Medical Systems conducted with 10 experienced health plan executives about their organization’s relationship with skilled nursing facilities (SNF) and what information they use to help drive both quality and value with their SNF partners.

With one out of five hospitalized patients discharged to a SNF returning back to the hospital within 30 days, establishing a strong SNF network is key to improving member outcomes, meeting quality measures, and managing spend under Medicare Advantage; however, it can be difficult to achieve due to limited visibility on how care is delivered in skilled nursing settings. 

Real Time Medical Systems (Real Time) recently sat down with 10 highly experienced health plan executives to learn how their organizations collaborate with SNFs and what information about their members treated in those SNFs would help drive both quality and value.

Understanding short- and long-term goals

A common challenge health plans face when interacting with their SNF partners is misaligned incentives. One executive noted that SNFs are traditionally focused on the short term, both economically and clinically, where payers must take a longer-term view. While SNFs are working to lower readmissions from the SNF back to the hospital, they tend to be less focused on discharge planning–explaining relatively high readmission rates in the days following SNF discharge. Because SNFs are generally paid on a per diem basis, reducing average length of stay (ALOS) is not a top priority. However, that mindset has started to change as SNFs adopt value-based care strategies to garner increased market share of an ever-dwindling number of referrals to SNFs in general.

With the goal of providing wholistic, patient-centered care, health plans require access to relevant, timely, and concise patient data once members are admitted to post-acute care so they can obtain more insight and influence on care delivery and discharge planning. This way, they can ensure available member benefits and services are managed in a cost-effective manner during the entire episode of care. They can also better support a safe transition back to the community. 

Contracting with cost and risk in mind

Health plans are all about driving quality outcomes and achieving cost efficiencies. Sharing risk is also part of that equation. One focus group participant pointed out that in a perfect world, the health plan would evaluate medical, pharmacy, and behavioral health costs as part of any shared risk agreement with the SNF. The executive also admitted that it’s been difficult to consider offering upside and/or downside risk with an entity when there is such limited visibility into how care is actually being delivered in the SNF setting.

Another said that getting access to real-time SNF data is key to knowing what measurable quality and utilization metrics can be effectively managed by the SNF and health plan as part of such a value-based contractual agreement.

Two participants described a network strategy that is focused on lower readmission rates and lower ALOS in exchange for higher referral volumes. They concurred that access to real-time data would enable them to better prepare for quarterly meetings with their SNF network instead of solely relying on anecdotal explanations for an uptick in readmissions or ALOS by the facility. Having access to the same set of SNF-level data enables health plans and facilities to have a much more insightful and productive dialogue…whether those discussions get down to the patient level or not.

Driving better relationships and outcomes with post-acute analytics

A consistent theme that emerged was the ongoing need for more timely information about the status of health plan members in the SNFs and access to facility level data to measure performance, identifying facilities that continue to warrant preferred network status. 

Post-acute data analytics allows health plans to access live member data in real-time directly from the EHRs in skilled nursing facilities. This way, they can see relevant structured data including vital signs, medication compliance, and demographics, as well as unstructured data such as keywords in progress notes, without having to navigate the fragmented, unwieldy “rabbit hole” of each facility vendor’s EHR. At the network level, they can use PAC data to standardize care, risk stratify the PAC network, and assess facility data metrics and performance indicators to ensure members are referred to high-quality providers.

Effective collaboration and data transparency between health plans and post-acute care providers represents a prime opportunity to enhance cost-effective, quality care across the continuum while improving clinical and financial outcomes. 

To learn more on how health plans can better collaborate with SNF partners through post-acute analytics, register for the upcoming RISE webinar Close the Gap on Post-Acute Care Performance and Payment with Live Data, on December 8, 1:30-2:30 pm, EST. Registration is free for RISE Association members.

About the author

Steven Stein, M.D., chief medical officer, Real Time Medical Systems

Dr. Stein’s vast knowledge of the post-acute market guides the clinical advancements of Real Time Medical Systems’ Interventional Analytics platform for post-acute providers, health systems, ACOs, and managed care organizations. Prior to joining Real Time, Dr. Stein held chief medical officer positions at both Trinity Health Continuing Care and UnitedHealthcare, leveraging his expertise in population health, managed care, and high-risk patient program development to improve care outcomes.

Dr. Stein received his B.A. from Columbia, his M.D. from Cornell, a Master’s in Health Services Administration from the Harvard University School of Public Health, and did a geriatric fellowship at Harvard Medical School, where he subsequently served on the faculty. Board-certified in internal medicine and geriatrics, Dr. Stein also proudly served on the White House Council on Aging for both the Clinton and Obama administrations.