Insurers using value-based payment models pay healthcare providers based not only on the quality of care they provide inside the hospital, but also on what happens after patients leave the hospital.
Until recently, however, insurers and providers did not have good ways of measuring the cost-effectiveness of post-acute care providers, and patients lacked clarity on what to expect after they were discharged. A 2013 Institute of Medicine report found that 73% of regional variations in Medicare spending were linked to differences in post-acute care.
Brentwood, Tenn.-based naviHealth is trying to change that by providing data and clinical expertise to help direct patients to post-acute providers with the best outcomes and lowest costs. It has developed an outcomes prediction tool called LiveSafe, which has compiled data from 800,000 episodes of care. Also, naviHealth assumes financial risk along with its clients, employing care coordinators to help patients choose the most appropriate post-acute care sites.
“We created an economic model to take on the entire post-acute care episode,” said CEO Clay Richards. “It's leveraging the technology and analytics to create individual care protocols.”
The company, founded in 2011 with the backing of private equity firm Welsh, Carson, Anderson & Stowe, has clients that include health plans and provider systems such as Kaiser Permanente, Dignity Health and Highmark. Using LiveSafe, naviHealth can create personalized care plans for patients, said Dr. Clay Ackerly, naviHealth's chief clinical officer. “It really is a game-changer for discharge planning,” he said.