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The Power of Performance Data
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The key to unlocking strategic partnerships is the ability to demonstrate positive
performance data. In fact, ACO networks and those who own bundled payment programs
will require preferred PAC providers to report out on biweekly/monthly/quarterly reports
on performance metrics and key outcome measures to designated clinical care coordinators.
At the minimum, a PAC operator should have systems in place to swiftly and easily
demonstrate:
• Functional outcome measures
• Care coordination measures
• Patient engagement measures
• Organizational capability measures
• Composite measures
• Efficiency measures
• Disparity measures
• Performance Measures
Moreover, each provider ideally should also implement the use of internal scorecards to
capture the following:
• Re-hospitalization rates by diagnosis;
• Percent of patients discharged home/with home care/with out-patient referrals
• Average length of stay by diagnosis for both Skilled Nursing Facility (SNF) and Home
Health (HH) partner
• Quality Measures – sepsis/UTI, falls, cognition, etc.
• Five-Star Ratings
• Therapy intensity (minutes/week)
• Functional Status Changes/Length of Stay (LOS)
• Control group/peer benchmarking/ hospital & national standards
• Cost/episode by diagnostic group
PAC providers can also leverage the power of performance data related to marketplace
intelligence and data analytics specific to their referral sources. It’s important to understand
how a referring hospital’s reimbursement and cost is associated with readmissions,
Value-Based Payment (VBP) adjustments and/or Avoidable Hospital Days. Consider the
value of a savvy PAC operator who is can identify, and strategically execute, on interventions
that contribute to the mitigation of unnecessary costs for their referral source; a “Win-Win”
result in this scenario would surely hard-wire an important network partnership.
Operational Accountability
Providers across the post-acute care continuum are being held accountable for having
programs, tools and resources in place that objectively demonstrate a shift from quantity
to quality. Networks will continue to demand evidence of such sophisticated key quality
indicators as:
• Plans for seamless transitional care (as with the Project RED philosophy);
• Care pathways which support population health-oriented niche programs;
• Whether clinical programming /interventions align accurately with patients’ needs,
acuity and complexity;
• Appropriate patient/caregiver education;
• Specific internal and external communication protocols;
• Consistent compliance programming/training/auditing ;
(See Get Your Seat on page 10)
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Adviser a publication of LeadingAge New York | Spring 2016
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Staff selection and training based on a foundation of culture which supports health care
reform initiatives;
Ability to form strategic plan based on objective performance data (e.g.: Quality
Measures, Program for Evaluating Payment Patterns Electronic Report (PEPPER),
Casper, CMS Five-Star and Quality Measures).
Concurrent outcomes and cost analysis;
Ability to make good risk management decisions;
A clean claims process.
This transition away from the industry’s traditional focus on driving utilization is as much
an operational change as it is a cultural change. This may present a challenge for some
facilities, while other PAC operators embrace the opportunity and leverage their ability to
execute as a competitive advantage.
Prepared to take your seat?
To summarize, consider whether your community is well-prepared to build and sustain
meaningful, long-lasting partnerships with valuable networks by evaluating the industry’s
top ten “Value-Based Initiatives Across the Continuum of Care.” Has your PAC community
executed on the following:
1. Discharge planning that is integrated across the continuum of care
2. An integrated technology hub is in place.
3. Data & data analytics which support communication with upstream/downstream
providers
4. Model that can support an integrated post-acute continuing care network
5. Population health management capabilities for chronic care
6. Integrated cost reduction initiatives
7. Truly community-based programs
8. Network of case management/care collaboration
9. Clinical and financial partnerships
10. Payment models that share risk
Eventually, every PAC provider will be required to embrace this shift from volume to value
and integration with upstream and downstream partners will be a necessity.
The biggest challenge then becomes executing on the many initiatives, programs and
operational tactics. Because many PAC facilities do not have the necessary resources, they
may engage help from healthcare reform consultants, such as HealthPRO®. Some consulting
firms like HealthPRO® have been executing on innovative healthcare reform strategies
since the onset of ACO networks almost four years ago in the metro NY region. Once
thought of as only a therapy management team, HealthPRO® is a unique example of where
PAC providers can find highly qualified, specialized team of experienced leaders who can
support your interdisciplinary teams in making necessary changes.
Whether PAC providers choose to forge ahead on a strategic path independently, or
will enl