Ten years ago, Margaret Hastings was preaching about the move among providers to form continuums of care.
Today, as executive vice president of the Institute of Medicine of Chicago, Hastings still emphasizes the development of integrated systems, but for different reasons.
The patient, she explains, is now in the driver's seat.
"We're seeing more of a focus on the personal preferences of the individual," she says. "People want a more homelike setting than the regulated, hard-tile floors of nursing homes. Long-term-care providers are offering packages of services tailored for changes in individuals' levels of care."
Hastings plans to highlight the social and economic forces behind such trends during seminars at the ACHE Congress scheduled for 10: 30 a.m. and 2 p.m. on Tuesday, March 4.
Called "Partnerships and Trends in Managed Care, Long-Term Care, and Integrated Delivery Systems," the seminar will look at the evolution of long-term-care providers' relations with payers and other providers.
Hastings says another trend she plans to spotlight is the gradual move of managed care into the long-term-care arena.
"The emphasis in the managed-care area should not be on the (healthy), employed person but on the population who uses the most acute and long-term resources," she says. "The evolution is realizing that this is where the escalating costs are and the incredible demand is. The positive aspects of managed care, such as upfront assessment and better integration, need to be applied to long-term care and chronic care."
But for managed-care organizations to find long-term-care services as appealing health plan options, integrated delivery systems need to include them in their folds, explains Ritch Steven, administrator of Chris Ridge Village in Phoenix. Steven will join Hastings as a speaker at the seminar.
"With managed care, long-term care isn't on the radar screen," Steven says. "They're concerned with the costs of hospital and physician care. They're looking for convenience and don't want to sign 15 contracts."
Steven says Chris Ridge, which includes a 150-bed skilled-nursing facility and a 239-unit independent-living community, was saved by increased integration with the other providers owned by its parent, Phoenix-based Baptist Hospitals and Health Systems. In 1990, Chris Ridge lost $3.8 million and had occupancy levels near 75%, he says. But now it has returned to profitability, the nursing home is close to 93% occupied, and the independent-living community is 99% full.
He says the system turned Chris Ridge around by more closely aligning it with the system's flagship hospital, Phoenix Baptist Hospital and Medical Center, and home-care agencies.
Chris Ridge and the hospital integrated services and departments. The boards of the two providers shared decisionmaking roles and management staffs were combined. In addition, they began to share the same case management plans and began sending each other referrals. And Chris Ridge was included in the system's managed-care contracts.
"The geographic diversity and range of services of the system enabled us to get there before the other guys," he says. "It's also of critical value to hospitals to include a post-acute continuum as part of an integrated, managed-care environment. If you don't own it, you better affiliate with it. This will be your profit center in the future."