Real-time data and interventional analytics are revolutionizing payer contracts in post-acute care, leading to better outcomes. By leveraging real-time information, payers can identify high-risk individuals, prevent unnecessary hospitalizations, and improve the length of stay for residents. Collaboration between payers and post-acute care providers through shared data and incentives enhances the overall quality of care, benefiting patients transitioning to their homes.
Payer contracts and outcomes in post-acute care are being significantly improved through the use of real-time data and interventional analytics.
The reliance on claims data alone has posed limitations for payers in managing care and selecting partners in post-acute care settings. Claims data tends to be outdated and lacks the necessary level of detail for effective decision-making.
However, real-time information and interventional analytics are providing the missing details that help payers create post-acute care networks with distinct advantages for providers and patients. One notable benefit is the ability to identify high-risk individuals as they enter skilled nursing facilities or long-term care homes.
With real-time data, nursing home staff, physicians, and health plans can intervene promptly to prevent unnecessary hospitalizations or emergency room visits. The timely information also aids in determining the appropriate length of stay for each resident, taking into account factors like physical and cognitive functioning, as well as community resources. This way, unnecessary nursing home days and associated costs can be reduced, benefiting both the care provider and the health plan.
Moving from historical data to real-time data is key to achieving these improvements. Traditional analytics based on historical data are suitable for predicting trends at a population level but may not adequately address the rapidly changing conditions of individuals. On the other hand, interventional analytics uses live data from electronic medical records in post-acute care settings to intervene and modify outcomes in real-time, leading to informed and timely care decisions and avoiding avoidable hospital readmissions.
Data captured through claims or the nursing home’s minimum data set (MDS) arrives too late for meaningful clinical interventions. MDS data, for instance, may only be available between the 14th and 21st day at the facility for new residents, and it is typically done quarterly for long-stay residents, making it impractical for prompt interventions.
Real-time data enables health plans and post-acute care settings to engage in meaningful conversations about care strategies. By using real-time information, health plans can make targeted improvements in quality and utilization outcomes for their members. Moreover, sharing performance data with provider partners and reviewing cases for opportunities to enhance care fosters a more accountable relationship between the health plan and contracted facilities, ultimately benefiting vulnerable members.
When evaluating skilled nursing facilities (SNFs) and post-acute care providers, payers prioritize characteristics such as the cost of care episodes, which indirectly reflects the quality of care provided. Besides cost, payers consider several other metrics to assess the value and effectiveness of SNFs:
1. Direct SNF to inpatient readmissions: Timing of readmissions is crucial, with early readmissions indicating room for improvement in preventing complications.
2. Length of stay in the nursing home: A shorter length of stay indicates efficient care delivery, especially if readmission rates following discharge remain low.
3. Readmissions following the nursing home stay: High readmission rates after members leave the nursing home may indicate premature discharges or less than optimal discharge planning.
Engagement with various providers in SNFs and post-acute care settings is crucial, and technology, particularly real-time information and interventional analytics, supports physicians, physician assistants, and nurses in delivering quality care.
Real-time data also plays a significant role in improving payer contracts with SNFs and post-acute care facilities. Payers can financially incentivize favorable outcomes, such as reduced readmissions, by providing timely bonuses. This encourages nursing homes to focus on delivering excellent care and fosters collaboration between providers and health plans to improve patient outcomes.
Overall, leveraging real-time information and interventional analytics in payer relationships with SNFs and post-acute care settings leads to improved care management and stronger partnerships. By overcoming the limitations of old claims data, payers can intervene effectively to prevent hospitalizations, identify high-risk individuals, and improve the overall quality of care for their members.
