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What constitutes a high-performing facility in today’s data-driven culture of value-based care? According to Shawna Zabkiewicz, Director, Value-Based Care Management at OrthoIllinois, the data speaks for itself. This is why it’s critical that physicians and case managers alike understand how to utilize data to drive the development and accountability of a post-acute network.

At the 2018 Musculoskeletal Leadership Summit, Zabkiewicz discussed the importance of developing a post-acute network in value-based care, sharing key insights on how to recognize top performing providers in your market, as well as how to influence providers with meaningful data points.

Doctors in a meeting at hospitalIn this two-part series, we’ll be sharing the six steps that were essential in developing a data-driven post-acute network for the Orthoillinois Value-Based Care Department. Read on for the first three steps:

  1. Identifying Post-Acute Services and Potential Partners

During the initial stages of this process, there are a number of areas you want to define. These include:

  •      The facility’s current utilization of post-acute services

Determine your current utilization of post-acute services for the procedures you are including in your network. Be sure to review skilled nursing, home health, and outpatient therapy.

  •      Services needed to support patients through post-op recovery

The services Orthoillinois looked at adding to their post-acute network were: skilled nursing, home health, nurse practitioner groups, inpatient acute rehab, home care, therapy, transportation, pet boarding and respite care. Do you have the ability to provide transportation for your patients? Are there waivers available to you through the various value-based care programs?

  •      Different data elements needed to measure the performance of partners

Critical data elements include: CMS star rating (Zabkiewicz recommends following a standard of no less than three stars), length of stay, readmission rate, ER utilization, infection rates, the patient experiencing rating, community reputation, use of technology, staffing, and participation in advanced payment model or a value-based care program.

  •      Potential partners in each category

When identifying potential partners, Orthoillinois started with the most utilized services: skilled nursing and home health. From there, they determined providers in the area via the CMS Nursing Home Compare website to identify the providers in their area and get a baseline on their performance related to Medicare claims. The next step is to talk to your hospitals and get a hold of their case management department. These case managers are a wealth of knowledge when determining what facilities and agencies are open to accepting patients readily and providing good care.

  1. Creating Strong Partnerships with Post-Acute Providers

Once you’ve shortlisted the facilities you want to work with based on the criteria shared above, there are a number of further considerations to take:

  •      Engage senior leadership

Start at the top. Engage the senior leadership at the partnering facility, as well as senior leadership at your own organization. “Take your CEO, to the site visit, as well as your medical director and any surgeons open to visiting the facility,” says Zabkiewicz. “Definitely bring your case management or joint coordinator staff to that visit, and get a tour of the building.”

  •      Does it pass the “SNIFF test”?

A site tour allows the case managers to see how the staff interact with patients, how well the patients are groomed, what the environment is like (is it updated, is equipment in good repair)? These are all elements you want to pay close attention to.

  •      Consider the selling points

The tour also prepares case managers to talk intelligently about the partners in your network and the benefits of each. Keep in mind the patient ALWAYS has a choice.

  •      Discuss expectations

Of course, it’s important to sit down and share your expectations with the partnering facility. This would include your communication protocols, therapy protocols, and functional discharge criteria.

  •      Begin a test period

Orthoillinois’ test period involved sending five patients through (where care was appropriate), and monitoring all of the quality metrics mentioned (readmission, length of stay, etc.). They also collected feedback from patients about their stay at the facility, and measured how well the facility communicated. Once you determine your initial test period and it is successful, add the facility to your network.

  1. Holding Partners Accountable to Protocols

When you have all of your partnering facilities established, the next step is finding a way to hold them accountable to the protocols you have set up, and the services you want for your patients. Zabkiewicz recommends doing this in the following three ways:

  •      Develop a scorecard

The scorecards track each facility’s performance year over year. They look at key metrics such as: volume of patients, total cost (which shows how many dollars you have brought to that agency), average length of stay, cost per case, cost per day, readmission volume and readmission rate. Then they have a section where they take a deeper dive into the readmission diagnosis, assessing potential ways to prevent that readmission. And they also collect feedback through a patient experience survey, which is illustrated in a patient satisfaction graph on the scorecard.

  •      Schedule routine meetings

It’s crucial to set routinely scheduled meetings with each one of these partners, Zabkiewicz explains. In the beginning, you’ll find everyone ready to go with guns blazing out of the gate. But as time goes on, it’s easy for them to revert back to their old ways. Orthoillinois meets with each of their partners on a monthly basis, using the time to review any patient concerns that come up, to review performance, and to discuss innovative ideas for enhancing your goals for value-based care.

  •      Streamline communication

As mentioned earlier, the communication protocol is of utmost importance. This is why it helps to establish a point of contact at the facility – someone you can reach out to in the event of an emergency.

Be sure to read Part 2 of this series as we take a closer look at patient education, promotion and more.