Kindred's new integrated-care market approach operates under the company's Care Management Division, created last August and combining its home-care, hospice and palliative-care services. Under the integrated-care approach, patients referred by hospitals to Kindred facilities are assigned a transitional-care nurse, who acts as their care navigator throughout the duration of their post-acute care. Members of Kindred's post-acute care team and the client hospital share real-time access to patients' electronic health records.
The transitional-care nurse provides the patient's primary-care physician with a weekly summary of progress on the patient's conditions, addressing any concerns or questions the doctor raises. There is also medical oversight provided by staff physicians at each Kindred care site. The transitional-care nurses continue counseling the patients even as they return home, overseeing the delivery of needed medical equipment and medications as well as arranging transportation to visit their primary-care physician.
Kindred has contracted for the past five years with the Cleveland Clinic for the coordination of post-acute care for that health system's patients in Cleveland. “Healthcare reform is pushing all of us to figure out how to take care of a patient in a very seamless manner across different venues where they receive healthcare,” said Dr. Eiran Gordeski, director of the Cleveland Clinic's Center for Connected Care. “We definitely want to work with post-acute care providers who are thinking about the continuum of care and are trying to make that transition of patients from one venue to another as seamless and as safe and as well-coordinated as possible.”
The Cleveland partnership was selected last January to take part in a three-year CMS demonstration of a bundled-payment model based on performance accountability for episodes of care. The medical director for the Cleveland Clinic's Center for Rehabilitation, who also serves as chief medical director for Kindred's integrated-care market in Cleveland, is providing medical oversight for the demonstration.
Under the CMS' Bundled Payments for Care Improvement initiative, Kindred is responsible for the health outcomes and cost of treatment for Medicare patients diagnosed with seven conditions—chronic pulmonary disease, congestive heart failure, major joint replacement, sepsis, pneumonia and other respiratory infections—for 60 days after discharge from the acute-care hospital.
The demonstration involves both upside and downside risk. Medicare sets a target price based on historical fee-for-service payments over 60 days post-discharge for Kindred's population of Medicare patients, with a discount built in. Payments are made at the usual fee-for-service rates, after which the aggregate Medicare payment for the episode is reconciled against the target price. Any savings go to Kindred and may be shared with its provider partners. But Kindred has to repay Medicare for any amounts incurred above the target price.
Brent Feorene, president of Colonnade Healthcare Solutions, a Westlake, Ohio-based post-acute strategy consulting firm, said only a few other large post-acute providers have the size and resources to organize a broad, coordinated post-acute care model on the same scale as a Kindred, such as Nashville-based Brookdale Senior Living and Baton Rouge-based home health giant Amedisys. That leaves most other post-acute providers with the choice of getting acquired or collaborating with other smaller firms to survive.
“There is an attempt by some players that have the technology and capital to build something that could be called a post-acute solution so that you could work with a managed-care plan or an ACO,” he said.
Amedisys is another post-acute provider moving to adapt to the new world of ACOs and other alternative payment models. During the past several years, it has focused on coordinating care with acute-care providers to improve patient outcomes. “Care coordination is what's going to be necessary to solve a lot of the fragmentation of healthcare that we have,” said Dr. Michael Fleming, Amedisys' chief medical officer.