Top five strategies for managing post-acute care

The time is now for health plans to focus on post-acute care (PAC). Improving PAC management offers the rare opportunity to simultaneously improve quality, save money, and enhance patient experience. Until recently, many plans have focused on more traditional areas for improving quality and achieving savings (such as expanding utilization management or negotiating lower provider rates), despite the fact that up to 25% of a Medicare Advantage plan’s total costs of care pay for PAC services and 20% to 25% of those costs may be waste. Commercial and Medicaid plans traditionally have lower per capita PAC costs, but there are potential savings on a smaller scale for those plans as well.

There are five key elements to a successful PAC plan:

• Make home the default discharge destination. Making home the default destination for patients being discharged from acute care hospitals requires resources and expertise. Plans must be able to influence discharge planning in acute care hospitals, inpatient rehabilitation facilities (IRFs), long-term acute care hospitals (LTCHs), and skilled nursing facilities (SNFs) across their networks. There is no substitute for working with facility clinicians or using onsite case managers, who can work with discharge planners and coordinate the multiple home health services that many patients will need to successfully complete their rehabilitation and recuperation at home. Successfully guiding patients home not only reduces costs, it is safer in that it can reduce the risks of falling and facility-acquired infections. For elective procedures, planning for post-surgical discharge to home instead of to SNF can reduce costs while making it easier for patients to go home and stay home.

• Collaborate with PAC providers to manage the length of stay in inpatient rehabilitation settings and home health agencies. The second important strategy for managing PAC is to actively manage length of stay in inpatient facilities. Most SNFs caring for Medicare patients are paid per diem, which means that they are financially motivated to keep their beds full and prolong length of stay. Evaluation of the geographic variation in Medicare payments for episodes of acute illness found that about three quarters of the regional differences in cost were related to differences in PAC utilization of inpatient facilities and home health services, according to MedPAC. This means that the variation in costs reflects differing practice patterns rather than different medical needs of the patients. Reducing length of stay to what is clinically appropriate for individual patients requires using concurrent review of inpatient facility stays, authorizing fewer days at a time, and tactics like putting case managers onsite at SNFs to collaborate with discharge planning teams and help them ease the patient’s transition home. 

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