Deloitte and Touche Report: Robust Post-Acute Strategy is Critical for Implementing Value Based Care and Population Health

“Post-acute care looks like an archipelago of little islands with no bridges. Consumers are at a loss about which island to approach, with poor transportation and communications options.”

That is the opening quote, from one of the 36 physician executives interviewed for a recently released Deloitte and Touch report, “Viewing post-acute care in a new light: Strategies to drive value.”

The realization that the total impact of post-acute services on readmissions, ER visits, outcomes and overall spending far exceeds the direct cost of post-acute services has awoken health systems to the need for strong post-acute networks.

Most of the executives interviewed preferred partnering for post-acute care as opposed to owning but stressed that identifying the right partner is important. With referrals as leverage, health systems are seeking post-acute partners that are willing to collaborate on:

  • Reducing LOS at post-acute settings
  • Lowering readmissions, particularly those in Medicare Accountable Care Organizations (ACOs)
  • Improved utilization by shifting appropriate patients from a skilled nursing facility (SNF) to home health; and,
  • Ability to sustain performance on patient experience measures.

The difficulty health systems have in finding these post-acute partners lies in the tremendous variability in quality of care across the segment. Deloitte points out that post-acute care variability accounts for 73% of variation in total Medicare spending. Some of these key variables include:

  • Top-performing SNFs LOS average LOS is less than 24 days while low-performing SNFs average 34 days – a $4,000 per stay difference.
  • The top 25th percentile SNFs have a 7.8% rate of potentially avoidable readmissions while the 75th percentile has a 13.6% rate - nearly double.
  • Industry-wide SNFs have a 30-day rehospitalization rate of 22.8%.

Tackling these issues will surely take time but building a bridge between acute and post-acute requires a strong transitional care program. For post-acute providers growing market share and referrals is key to competing in today’s environment. To do that providers must work to decrease variability, show demonstrable quality results and deliver on the promise of quality care in a lower cost setting.

For SNF providers initiating a transitional care program that utilizes discharge phone calls to follow patients through the 30-day all risk readmissions window can assist in tempering variability. Further, being able to report these activities back to referral partners demonstrates a commitment to value based care and population health and positions the organizations as a high value partner worthy of inclusion in the network and a higher rate of referrals.

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