Cross-sector collaborations improve care
Healthcare providers that form partnerships with a wide range of organizations within and outside of the industry could prevent unnecessary utilization and better control costs, according to a new study.
Communities with active area agencies on aging, which leverage government and regional funding to coordinate social services for older adults in communities throughout the country, had lower hospital readmission rates, researchers found in a study published Monday in Health Affairs.
The agencies' informal relationships may indicate a denser web of interconnection across community organizations that can support the handoffs that help patients recover after being released from the hospital and avoid readmission, said lead author Amanda Brewster, an associate research scientist at the Yale School of Public Health.
Payment reform, population health initiatives and the CMS' Accountable Health Communities Model are providing venues for providers to refer patients to job placement services, housing organizations, transportation companies and other supplementary services that are increasingly important in determining health outcomes, she said.
"These results suggest that area agencies on aging could be a promising partner for healthcare organizations looking to connect patients with social services to fill gaps in social determinants," Brewster said.
Communities that had AAAs with the highest number of informal partnerships (18 or more) had a risk-stratified readmission rate decrease of 0.46 percentage points.
Notably, having broad formal collaborations was not associated with reduced readmission rates but was associated with higher Medicare spending per beneficiary. Counties with area agencies on aging that had 10 or more formal collaborations had annual Medicare spending that was $588 higher per beneficiary compared with those with the fewest formal affiliations. Informal agreements lend themselves to habitual collaborative work and joint priority setting, while formal relationships can be more restrictive, researchers said.
Most informal partnerships, or ones that weren't bound by a contract, were made with long-term care facilities, advocacy organizations and emergency preparedness agencies. Most formal relationships were between state health insurance assistance programs, Medicaid and transportation agencies. A majority of the nearly 2,000 counties studied had AAAs with programs to facilitate transition from institutional care and to divert patients from nursing homes.
Whether it's a church organization, business group or adult protective services organization, the types of partnerships varied based on the community, but Brewster and her colleagues have not yet analyzed what types of partnerships were most successful.
One example involves Dallas-based provider Baylor Scott & White Health teaming up with the city of Dallas to provide fitness and nutrition services that have helped cut hospital admissions by nearly 40% over five years.
Baylor Scott & White works with city-owned recreation centers to coordinate physical activity plans and partners with local churches that offer healthy foods and nutritional advice at farm stands in food deserts, said Dr. Donald Wesson, president of the Baylor Scott & White Health and Wellness Center at the Juanita J. Craft Recreation Center.
"We recognized that we needed to partner with people in the community to best deliver care," Wesson told Modern Healthcare in September.
The University of Texas collaborated with PricewaterhouseCoopers on Project Diabetes and Obesity Control, which involves community health workers, community centers, retail pharmacies and educational facilities in the lower Rio Grande Valley to engage patients, said Gurpreet Singh, a partner at PwC and its health services sector leader. UT teamed up with Wal-Mart and community health programs to offer free health screenings and education. PwC operates a secure health information pipeline to ensure that doctors have full access to the patient's data from clinics, retail locations or their homes.
Cleveland Clinic has an affiliation with the National Diabetes & Obesity Research Institute that is part of a 150-acre learning medical city in Mississippi that teams up with community centers and medical offices to help consumers combat chronic diseases. Cleveland Clinic can collect data that will inform its healthcare delivery models, Singh said.
While there can be some hurdles in ensuring patient privacy and data ownership, it's important to create these partnerships prior to embarking on major population health goals and to balance longer-term initiatives with operational efficiency and return on investment strategies, he said.
"Providers who participate in more cross-sector partnerships get a 360-degree view of the consumer and all interactions they may have with social workers and from a community standpoint," Singh said. "Having influence points outside of acute care can lower readmission rates and reduce costs."
Most area agencies on aging have a direct line to consumers with a disability or chronic illness, a demographic that healthcare providers are often most interested in reaching.
But these long-term initiatives aren't always prioritized given today's market pressures, experts said. Healthcare providers sometimes put off population health goals in lieu of ventures with more immediate potential return on investment like revenue-cycle management strategies or acquisitions amid unrelenting margin pressure.
While there are programs like the CMS' Independence at Home Demonstration, which rewards home-based primary care for Medicare beneficiaries with multiple chronic conditions, as well as a broader value-based push from private insurers, a relatively uncertain reimbursement arrangement can be a sticking point, said Kristen Barlow, senior consultant of research at the Advisory Board Co.
"Finding ways to make these practices financially viable in the current reimbursement environment is tricky," she said. "But as systems transition to value-based care through ACOs, bundles or Medicare Shared Savings, there is a renewed interest in community-based, smart investments to improve care delivery."
Hospital readmissions often occur because of the simplest things—inadequate food sources, loneliness or a lack of access to primary care, Barlow said. Providers are increasingly looking to cross-continuum and cross-industry collaborations to fill those gaps, she said.
"There is a lot of unmet need in the senior population," Barlow said. "Community-based ports and non-healthcare service providers can provide a lot of wraparound services that impact their condition in transportation, loneliness, food—all of which are vital to physical well-being."
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