There has been much written about innovations within hospitals, primary and other settings of care. However, as the population continues to age, post-acute and long-term care providers must also implement innovations to meet the health needs of an aging population.
Additionally, these providers need to align the delivery of their services to meet the triple aim of improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the cost of health care.
One of these innovative opportunities was the Bundled Payments for Care Improvement Initiative, which was a five-year Medicare pilot program. The initiative looked to connect various services that a patient receives across an episode of care (i.e. stroke, major joint replacement and congestive heart failure) into one fixed payment across various health care providers.
Providers in the program were at risk for any spending over this lump sum “target,” but were also able to share in some of the savings if expenditures were lower than anticipated. Ultimately, the specific goals of BPCI were to challenge providers to redesign modalities of care, increase efficiencies in care coordination, bolster the quality of services delivered and lower overall health care spending.
CareLink members acknowledged the systemic changes within health care reimbursement and delivery as a result of the Affordable Care Act. Therefore, CareLink and its members prioritized the early adoption of this innovative pilot and were eager to test their ability to be successful in a value-based model.
CareLink skilled nursing providers Saint Antoine Residence, Saint Elizabeth Home, Saint Elizabeth Manor, Steere House, St. Clare-Newport and Scandinavian Home Inc. stepped forward to participate, along with two member home-health agencies, Cathleen Naughton Associates and Visiting Nurse Home and Hospice.
These industry leaders recognized that participation was a risk, but they were willing to become the only Model 3 organizations in the Major Joint Replacement phase in Rhode Island. By stepping forward in the financial, “at-risk” phase of BPCI, however, CareLink members also recognized the rewards. Far more information could be gleaned through practical experience than participation solely in the data-analysis and evaluation phases.
In order to ensure success in this pilot, providers collaborated to evaluate current care paths and protocols, reviewed patient education materials and expectations, and shared best practices around major joint replacement. For consumers, this meant that expectations for discharge were promptly conveyed at the outset of an episode of care. Patients were engaged by an interdisciplinary team of health care professionals to monitor their progress, and “warm-handoffs” were completed when a patient was discharged back to the community. Providers also monitored whether or not these patients were readmitted to a hospital or had an emergency department visit during the episode of care.
As the program sunsets, CareLink members have been able to observe marked improvement in outcomes for this patient population, in addition to lower health care-related spending throughout the five years in which they participated. Most importantly, lessons learned and collaborative efforts from this pilot have permeated other clinical episodes and have benefited patients with other diagnoses.
Successful reform of the health care system must include efforts to improve the lives of people as they age and confront their complex health conditions.
It is important for Medicare, Medicaid and other payers to continue to offer innovative programming to allow post-acute providers to participate in the future of their industry in a meaningful way and for skilled-care providers to embrace innovation and change to make improvements in care.
Only through risk can innovations be made and CareLink’s early adoption and participation in this Medicare pilot is exemplary of how post-acute providers can collaborate to collectively improve the health for a growing – and oftentimes overlooked – elderly patient population in Rhode Island.
Joan Kwiatkowski is CEO of CareLink, a network of nonprofit post-acute and long-term care providers in Rhode Island.
