This whole Care Coordination thing screams opportunity for senior living!
By Steve Moran
If you go to a conference where they start talking about the post-acute world, it is a Scrabble-fest of acronyms and terms that everyone else seems to understand but leaves you scratching your head. Okay maybe it is just me, but I bet not. Here is a sampling:
Care Coordination, ACA, ACH, ACO, ADL, ALOS, Demonstration Projects, Pioneer AOs, Dual Eligible, Model One, Model Two, Model Three, CRJ, CMMI, CMS, CON, ED, EMR, IMPACT, LTC, LTAC, MCO, PACE, MSSP, Medicare Advantage, Waiver Program, QIO, Shared Savings, At Risk, Partial Risk, Full Risk, Fee for Service
It is baffling and confusing. It may have just been the right place and time for me, but the Wednesday afternoon NIC Spring Conference presentation titled “Participating in a Care Coordination Model” helped me better understand the big picture.
I hope this is helpful.
All You Really Need to Know
For a number of years I was a volunteer ski patroller, which means I needed medical training that was roughly the equivalent of a level 1 EMT. As I was taking the class, it was more than overwhelming with the scariest part being this: “When I get to someone who is hurt what do I do first?”
Then a physician did a presentation where he explained it in a way that was unbelievably simple and made perfect sense. It went like this:
Are they breathing? — If no, give them air
Is their heart beating? — If no, then do chest compressions
Are they bleeding? — Stop the bleeding
Is something broken? — Stabilize what is broken
Package and transport the person with the owie
That was so simple, now here is everything you need to know about
The Healthcare System
The healthcare system is broken. It is expensive to operate and even though we are spending a lot of money the results are not as good as they should be. The goal of all this healthcare reform is very simple; reduce costs and improve outcomes. If you can help do that there is almost certainly a place for you, if you can’t, you will likely be left behind.
You will frequently hear the term Alternative Payment Models (APM), which is a global term for programs that more closely align the quality of care with the cost of care. In other words, poor care equals poor pay and good care means good pay. More than that, though, these alternative APMs must not cost more than the current fee for service model (which actually rewards poor outcomes).
The government set a goal of having 30% of all Medicare fee-for-service payments shifted to APMs by the end of 2016, and 50% by 2018. The 30% goal has already been met, essentially a year early.
Care Coordination is the latest and greatest thing and the idea is that when there is a person, or more likely an entity, that is focused on getting a Medicare patient the best care (good outcomes) at the lowest costs, everyone wins.
This is great news for all of senior living — from skilled care, to independent living.
Hospitals are terrific when it comes to fixing things, but not so great at the rehabilitation part of process after the thing that is broken is fixed. Not only are they not so great at the rehabilitation part, they are also the most expensive way for rehab to happen. So expensive, in fact, that they they would oftentimes prefer to pay a post-acute provider to do the rehab piece, which will free up that hospital bed for the next person who needs fixing.
This whole Care Coordination thing screams opportunity for senior living:
Transitional Care Centers are a bit like luxury hotels with high-quality rehab. They do a great job of providing first class rehab at a cost that is much lower than keeping the individual in the hospital in luxury surroundings.
In many cases, that post-acute rehab doesn’t even need a transitional care center. Many assisted living communities have good rehab programs and even better living conditions at a cost below that of a transitional care unit.
In some cases, a person could be transferred home except they don’t have anyone to be with them. For these folks independent living may be just the thing for them: meals, housekeeping, maybe some home care and assistance in the case of an emergency.
I am not quite sure how we get there, but at the end of the day, assisted living, memory care and skilled nursing facilities are the ideal candidates to do care coordination. They know the residents better than anyone else and there are a few communities in the post-acute arena who are doing this because they know it it good for census and good for residents.
There are three key elements to being a player.
You Must Know Your Outcomes — This means you have to have accurate detailed data particularly with respect to rehospitalizations. If you don’t know you need to be tracking that data and creating, at least monthly, a report that shows how you are doing.
You Must Know What You Are Good At — It is easy to want to be all things to all elders, but I bet there are some things, some kinds of residents where you are exceptionally good. You need to know what that is and how to tell that story. If there are some things you don’t do so well, you should know that and be up-front about it as well.
Go To Lunch — You must figure out who the players are in the shifting healthcare world and get to know them. At first you need to mostly ask lots of questions, figure out what they are thinking and what they are working on. Ask them to evaluate what you are doing.
It used to be impossible to get to see these people, this is no longer true. They desperately need quality post-acute care providers to thrive.
That’s all there is to it. Low-cost, high-quality outcomes. It is crazy that after decades we are just now getting to this.