Getting in on the Inner Circle: Preferred Provider Networks

The relationship between acute and post-acute care facilities is a complex one. They depend on each other, yet they don’t communicate nearly as much as they should. If post-acute care providers knew the obstacles acute care providers were facing, could they potentially help – and vice versa? We’ve got one simple answer: yes.

What Is a Preferred Provider Network?

The key to acute and post-acute care facilities helping each other starts with better communication. Many organizations are tackling this through Preferred Provider Networks, referral networks composed of select post-acute care providers. These networks are created by hospitals and ACOs to improve patient care, streamline processes, and contain costs. For example, when a patient is discharged, that patient is referred to a post-acute provider within the acute care’s PPN.

These networks have many benefits for both acute and post-acute care facilities. Hospitals and ACOs form preferred provider networks with high-quality post-acute care (PAC) providers to maximize patient volume and to facilitate care management partnerships. These programs also help acute care providers ensure quality patient care post-discharge, which also helps to reduce costs.

Once included in a PPN, PAC providers benefit from steady, predictable referral streams — keeping them busy without extensive outreach effort. However, post-acute care facilities who have trouble entering these networks can see these programs as a hindrance to their success because they miss out on patient referrals to PAC providers already in PPNs.

How Preferred Provider Networks Are Formed

So, how do post-acute providers get into PPNs? PAC providers can gain insight into acute care providers’ PPN selection process by considering how hospitals are measuring the success of PAC providers — data. While hospitals and ACOs likely measure different data points, most — if not all — use analytics for the purpose of evaluating consistency and quality of care.

Decisions are based on the resources they do have, the most important of those being data. Speaking of data, here is some data to support that statement:

  • 91% of hospitals are collecting data on their SNF partners, whether in-network or not
  • 77% of hospitals are hiring care coordination staff to support LTPAC Discharged Patients
  • 2/3 of hospitals are forming preferred partner networks

As it turns out, legislation is backing this push for informed patient referral process between acute and post-acute care. As of November 29, 2019, the Centers for Medicare & Medicaid Services (CMS) started to require hospitals “to provide patients access to information about PAC provider choices, including performance on important quality measures and resource-use measures” in order to receive funding — a strong incentive to collect referral data.

The bottom line, here, is that acute care providers are being pushed to use data to inform care coordination. Here’s the good news: while skilled nursing facilities (SNFs), home health agencies (HHAs), and other providers in the post-acute space do not have direct access to the hospital data used to form preferred provider networks, there are benefits to looking in their own back yards and examining existing and incoming patient data.

Steps to Become a Preferred PAC Provider

If you are looking to join a PPN, look first to the data. Gathering data within your organization will not only allow you to adjust and improve your internal processes, but it will allow you to send accurate, up-to-date data to your acute care partners, so they can make well-informed decisions about where their patients go for continued care.

The idea of collecting and presenting data can be vague and difficult to know where to begin. Here are three things you can do right now to get that process started.

1. Review Your Data

For many PAC providers, reviewing and making sense of data can be difficult and tough to prioritize. With so much data collected over the years, it can be difficult to find a starting point, let alone identifying and tracking key performance metrics. We recommend starting by answering the following questions:

Has your readmissions rate decreased year over year? It’s no secret that readmission rates are costly. Continued improvement of readmission rates year over year clearly shows continuous improvement and commitment to value-based care.

How are you doing against your peers? At the end of the day, if patient referrals aren’t coming your way, they’re going to your peers — which means that your peers are doing something better, or simply doing something you’re not. Find this information by reading up on online reviews. Skilled nursing facilities (SNFs) should pay special attention to Nursing Home Compare, Medicare’s online nursing home review system that ranks SNFs on a five-star scale.

Are there areas you can improve right away? Gaining access to a preferred provider network takes time and commitment to continuous improvement, but that doesn’t mean that post-acute care facilities can’t make small, immediate improvements. Look back at the data you’ve collected and identify what data would be nice to have in the future. Create a process to collect this data to gain long-term insights into the quality of patient care. Start asking your patients for more feedback and use that feedback to inform the patient care improvement process.

2. Identify Your Differentiators

After evaluating your EHR data and external review data from sources such as Nursing Home Compare, compare the two. Does your data match what Nursing Home Compare says about you? If so, this is your chance to focus on your strengths and determine how to best communicate them and how to improve them further. What about your top referral sources … why do they partner with you? Finding out what you’re doing well can be just as valuable as finding out what you need to improve. Maximize on the positive relationships your facility has with acute healthcare organizations to gain insight into your strengths.

3. Go on the Offense

Finally, post-acute providers should commit to continuous, data-driven improvement in order to gain and maintain access to PPNs. How? Through clean, interoperable patient data that yields valuable, actionable insights. In order to reach this ‘holy grail’ of patient data, post-acute care providers should consider a few things:

Where Data Is Entered: A lot of the time, patient data is manually entered into several different systems. This runs the risk of error, which in the world of healthcare, can be detrimental to patient outcome, a factor that not only harms the patient, but also a provider’s ability to become a valued post-acute care partner.

Unique Patient Identifiers (UPIs): How do each of your health data systems identify and differentiate patients? Different patient data systems use different codes (UPIs) to identify patients, which means that patient data belonging to one patient could potentially be attached to several different UPIs. This inconsistency in UPIs often results in incorrect treatment plans and billing — impacting the overall patient experience — and in serious cases, the health of a patient.

Connecting Patient Data through Integration: Many of the pain points PAC providers experience result directly from disparate patient data systems. With this in mind, it is only logical that the best solution for improving patient care with data is interoperability. Don’t know where to begin? See our guide to jumpstart interoperability at your organization. Only with interoperable systems can you proactively produce and share real-time patient care information and up-to-date performance statistics. By doing this, you and your acute care partners both gain a clearer picture of the patients you serve.

While it may seem like acute care and post-acute care facilities are not aligned, at the end of the day, the desired outcomes are the same: collaboration to create a better patient experience, fewer readmissions, data-driven insights to drive better business decisions, and patient-care alignment across the continuum of care. Whether you’re an acute care or post-acute care provider, don’t be afraid to ask about your opportunities for improvement, highlight the value of collaboration, and share best practices.

Ready to hit the ground running with clean, connected patient data? Read more on how integration improves care coordination between acute and post-acute care.

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