Today's health care leaders are juggling the demands and opportunities of a transforming market: New entrants are disrupting the status quo and traditional players are reinventing themselves. Payment and care models are changing. Organizations are searching for ways to innovate for cost and quality improvement. This last point certainly rings true for post-acute care, as health systems and health plans begin to view this industry segment in a new light—as one that can deliver more value and opportunities to their organization.
Consider the impact on Medicare, for example. More than one in five Medicare patients discharged from a hospital receives post-acute care. Moreover, the total impact of post-acute services on readmissions, ER visits, outcomes, and overall spending far exceeds the direct cost of post-acute care services. Because value-based payment models increasingly focus on costs and outcomes occurring inside and outside hospital walls, now is the time to rethink post-acute care strategies to drive value. Market pressures—including the expansion of bundled payment programs, the Medicare Access and CHIP Reauthorization Act's (MACRA) incentives for providers to join risk-bearing payment models, and readmissions penalties—further reinforce the need for organizations to take a new look at post-acute care.
To understand the industry's post-acute care strategies, the Deloitte Center for Health Solutions interviewed 36 executives from 27 organizations, including health systems, health plans, post-acute care companies, and professional associations. Their insights provide a useful roadmap for organizations as they look to boost post-acute care value.
The interviewed health systems agree that partnerships and quality initiatives are important elements of a post-acute care strategy:
- Partnering is preferred over owning
- Identifying the right partners is important
- Specific quality initiatives are the next step
Most health systems' initial clinical improvement efforts have focused on quality: They reviewed data on readmissions, acute care and post-acute care length of stay (LOS), and discussed performance with their top post-acute referral destinations. Several of the health systems have seen results from these discussions alone.
Some interviewed health plans are active in post-acute care, but this is not the norm. Most health plans we spoke with believe that their medical management approaches are reasonably effective at controlling costs and quality for their Medicare Advantage populations. And any further responsibility for improving post-acute care cost and quality falls to health systems. Other health plans take a more active role in post-acute care performance by developing new clinical models and analytics-driven decision-making tools.
The health systems and plans we interviewed see and understand that post-acute care belongs in their long-term strategy. The question, therefore, isn't whether to work with it—but how.
Read more in: Viewing post-acute care in a new light and download a checklist for developing a post-acute care strategy.