As the share of healthcare delivered by 30,000+ post-acute providers continues to grow, hospitals and health systems are working closely with these providers to lower the cost of care and improve outcomes.
Spending on post acute care can often account for more than 50% of an episode’s total cost of care.
Variations in post acute care quality is significant with 30% of all discharges to post acute care being readmitted
Patients are choosing the highest quality post acute providers only 20% of the time
To address this, hospitals and health systems currently employ a number of tactics to influence post acute care providers. These tactics vary in cost and effort but often do not realize their intended goals due to a number of barriers.
There is a need for disruptive innovation in the transitions of care setting as hospitals have to respond to the pressures of the healthcare landscape and better manage post acute care outcomes.
Vanderbilt University Medical Center (VUMC) is a 1,131 bed hospital system with a wholly-owned home health agency and joint ventures for both inpatient rehabilitation and home infusion.
For the time period of May 1, 2018 through April 30, 2019, Vanderbilt University Hospital placed 12,495 patients to post acute settings. The dispersion of the referrals to different post acute settings is outlined in the table below:
There is a need for disruptive innovation in the transitions For patients going to one of the above mentioned dispositions, the average length of stay was 9.75 days and the average 30 day readmission rate was 15.1%.
Vanderbilt continues to be challenged by a daily bed capacity problem which creates significant queuing in the ED because floor beds are occupied. Furthermore, the acuity of patients at VUMC coupled with their complex, psychosocial needs creates discharge barriers that are challenging to resolve which delays discharges when the patient is medically ready.of the healthcare landscape and better manage post acute care outcomes.
In 2019, VUMC partnered with a leader in care transitions (Aidin) to introduce a technology based solution for post acute referrals. Key solution components highlighted below:
Process re-imagined
Provider database & open market referral
All providers, in network and out of network, indicated which referrals they want to receive. These preferences were managed in a database and continuously updated by Aidin. Staff entered the discharge date, level of care, zip code, insurance information and clinical needs of the patient into the technology platform to query the database for all providers that are possible matches. (i.e. accept the insurance, cover the service area, provide the clinical needs). Based on the list of matches, staff sent the referral to multiple providers and allowed providers to respond with acceptance or declination – this forced an ‘open’ market model for referrals where similar providers were competing to win the patient.
Provider characteristics tracked and displayed
All providers in the database had characteristics or metrics that they were tracked against (subset below). A provider’s performance against the characteristics was visible to all staff members as he/she initiated referrals.
Referral auction step introduced
Once the referral was sent to multiple providers with the ‘best’ characteristics, providers were provided a time limit within which to accept or decline a patient. For each referral, providers earned credit toward their characteristics / metrics. This empowered staff to pick providers with highest quality outcomes, encouraged providers to respond to patients referrals timely and urged providers to improve their metrics to continue to referrals from VUMC.
Patient/family choice
After providers had submitted their availability, staff printed a choice list for the patient & family that contained information about providers that had accepted the patient. This information packet included pictures, details about the facility and metric performances of those providers (such as Medicare readmission rate). Patients and family were given time to make a decision, after which the staff reserved the bed with the provider using the technology platform.
As seen in Figure 1, 77% of SNF referrals, 72% of home health referrals and 60% of IRF referrals were sent to 2 or more providers.
For every patient, there was an average of 2.5 providers available and willing to provide care – this was even higher for SNF (4.5) and Home Health (3.3) placements (Figure 2). This points to untapped capacity in the post acute provider space that this open marketplace process avails for staff and patients.
Of patients given a choice of 2 or more providers, 92% chose the highest quality provider compared to a MedPAC reported avg. of 20% (as seen in Figure 3).
In this open market process, 89% of patients were placed in the first contact to providers (Figure 4). Additionally, in this new process, only 11% of the referrals required a second touch compared to a 30% baseline that was observed in the traditional process. This elimination of rework contributed to 0.19 day LOS reduction that was observed (Table 1).
Let’s transform healthcare together
