Last month, the Centers for Medicare & Medicaid Service (CMS) released its final rule, which dramatically changes bundled payment requirements for many organizations. The rule cancels the hip fracture and cardiac bundled payment models that were set to launch on Jan. 1, 2018, as well as diminishes the Comprehensive Care for Joint Replacement (CJR) model. Now the rule requires only 34 geographic areas to participate in CJR instead of the previously-mandated 67The remaining areas will have the option to voluntarily take part going forward. CMS is also making involvement voluntary for low-volume and rural hospitals across all geographic areas.
In curbing bundled payment, CMS hopes to ease the burden on providers, especially small and rural physician practices. By offering greater flexibility in how different entities approach new payment opportunities, the agency aims to increase organizations’ commitment to and involvement in value-based care.
The constant amid the change
Although the shift in bundled payment may cause some organizations to rethink their value-based care strategies, the underlying principles behind these programs remain valid. Organizations must work to improve communication and collaboration between care settings to ensure positive clinical outcomes while reducing costs. In fact, by redoubling their efforts to improve care coordination, organizations can lay a stronger foundation for value-based care and make further progress towards improved quality and less waste.
How can organizations amp up their care coordination efforts? Here are two critical steps to consider.
Develop partnerships across settings. Due to the historically siloed nature of healthcare delivery, hospitals frequently lose sight of patients once they leave the acute setting. This is problematic if a hospital or health system wants to pursue value-based care because the organization does not have clarity around what happens with patients outside of the hospital—and this longitudinal view is critical. Moreover, as hospitals are held financially responsible for a patient’s care for 30 days after discharge—and incurring penalties if a patient unnecessarily returns to the acute setting—the need to have greater insight into patients’ post-discharge care is paramount. As a result, hospitals are looking to amplify their relationships with providers that span the continuum. For example, many are seeking partnerships with post-acute providers, including skilled nursing facilities, rehabilitation centers and home care agencies, to improve post-surgical care, and are aiming to foster relationships with primary care doctors to streamline information sharing on the front- and back-end of hospital admission. To address some of the socio-economic factors that might impact a patient’s post-discharge experience, hospitals are working with community resources, including transportation and meal services.
To realize stronger collaboration with these entities, hospitals first must commit to building partnerships. This must involve reaching out to various providers and discussing the best ways to communicate and coordinate care. Hospitals may even wish to create formal or informal post-acute networks with a variety of providers. When a patient needs a certain service, the hospital can then turn to one of these providers for help.
Leverage technology to cultivate cross-continuum communication. Once healthcare organizations have established relationships, they can employ technology to enable robust collaboration. For example, organizations can use care coordination solutions to match hospital patients with post-acute providers that fully meet their clinical, financial and psychosocial needs, setting the stage for a better post-discharge experience. Organizations can also use these tools to securely exchange key elements of a patients’ health record ahead of their arrival at the post-acute location of their choosing, facilitating a smoother transition and preventing care lapses or shortfalls. The post-acute provider can take the information sent by the hospital to set up treatments and therapies, so it can begin to provide the necessary services as soon as the patient arrives onsite.
If a patient is discharged home, a hospital can use a care management platform to drive greater collaboration within the care team. Mobile care tools can be especially helpful as these provide a virtual command center allowing all members of the patient’s care team to connect via an app and share information. Bluetooth-enabled equipment can capture and upload patient vitals, letting clinicians monitor the patient’s health outside of the care visit. The app can even send alerts if the patient’s readings reach concerning levels, prompting team members to change medications, send a nurse to the patient’s home or call the patient and family to intervene and prevent an acute episode. The patient can also use this tool to ask questions, and clinicians can respond and provide education through the app.
Ensuring success through collaboration
Forming relationships and leveraging care coordination technology should go hand in hand. To effectively use care management tools, providers must commit to partnering with other clinicians and establish relationships on which to build. These solutions can then take interactions to the next level, expediting efficient and effective communication. Organizations that embrace this degree of interaction will set themselves up for success with value-based initiatives in whatever form they take—even if they are outside the scope of bundled payment.
Luis Castillo is CEO of Ensocare.