Many hospitals are turning to outside organizations to guide them in the development and management of their post-acute care (PAC) strategy. With the increasing penalties tied to readmissions, the growing prevalence of accountable care organizations (ACOs) and the advancement of bundled payment programs, hospitals are expected to provide care and guidance to their patients for 30 to 90 days after discharge. Whether the need is to better manage bundled payment models or address escalating readmission penalties, most hospitals lack the internal expertise and/or technology necessary to effectively manage these strategies.
If there are no internal resources available, many hospitals turn to professional service firms and technology companies that provide post-acute care network support services. The solutions range from providing software only to full PAC network management, which includes software, data analytics, reorganization of hospital processes, PAC provider network development and management, care redesign services, and clinical transitional care support.
Hospitals seeking outside resources often opt for the minimum support to save money. However, they may be paying a lot more down the road if they choose a solution based solely on cost. The less provided by an outside organization, the more hospital resources must be used. Many times, the lowest cost solution does not provide the best value.
In one instance, a hospital selection committee expressed to potential outside partners, that they were looking for a solution to purchase and run themselves. While this sounds like a solid approach to minimize spend, it underestimates the hospital staff time and resources required to effectively use the solution. Very few hospitals, if any, have idle staff who can operate the software and apply the necessary decision support. The cost of training hospital staff to implement the solution must also be considered, as well as the potential for the turnover of skilled staff and the training of new staff.
A hospital CFO recently recounted his experience using a “technical only” solution. The software helped the hospital decide what PAC provider would provide the best expected patient outcomes. However, the CFO stated that the process required significant hospital staff time to download data from CMS, enter it into the software, interpret the data, apply clinical insight to the data, provide operational input into the PAC provider selection (from only the acute-care perspective), provide clinical transitional care support to guide the patient through the care continuum, and receive and interpret the outcomes from the overall patient encounter. The solution required more than just hitting a button.
Another hospital executive stated that while the technology solution they used was effective at providing data analytics and informative dashboards, it did nothing to guide them operationally. “It provided us with great information, and we could see all of the levers, but we did not know which levers to pull,” he said. It was like operating without a manual. What good is a system if you don’t know how to use it?
Hospitals are entering a new era of care continuum management. They cannot be expected to navigate PAC with software alone. A full PAC network management partner might yield the best outcomes for hospital patients and might end up costing less in the long run.