Optimizing your Post-Acute Network: 5 Steps for ACOs and DCEs

To succeed under value-based payment models and risk-sharing models, you need to prioritize coordination across the continuum of care. While most Accountable Care Organizations (ACOs) have focused on acute or hospital stays, optimizing relationships with post-acute care partners is critical to keeping costs down. According to his article in the New England Journal of Medicine, Robert Mechanic stated that post-acute care is the largest driver of overall Medicare spending variation – leaving a bigger opportunity to optimize But how does your ACO design and manage a PAC network to deliver high quality care at lower costs for your beneficiaries? Start with the following five steps to create your PAC partnership strategy:

1. Identify your network’s goals
2. Assess where you are in the network-development process
3. Find and implement your “quick wins”
4. Manage partner relationships
5. Identify areas for overall improvement in post-acute care

1. Identify Your Network’s Goals – Where Can you make an impact?

First, remind yourself of your goals as an accountable care organization (ACO) or direct contracting entity (DCE). Which benchmarks are you excelling at and where can you improve? Does your ACO tend to treat a certain high-risk category more prevalently than others? How can you find and attract PAC partners who specialize in these categories?

Consider how your PAC network can best align with your focus and the areas where you have the most opportunity for growth. If you serve populations with diabetes or cardiac conditions, partnering with home health agencies that have strong performance metrics for those diagnoses will help you provide a seamless care experience. If you serve an aging population with high instances of chronic disease, partnering with palliative care providers that excel in decreasing end-of-life costs will help drive down your overall costs and increase your chances of benefitting from shared savings.

2. Assess Where You Are in the Network-Development Process

Your best moves to optimize your PAC network will depend heavily on where you are in the network-building process. If you are a new ACO, your priorities will differ from those of more established ACOs who have robust existing PAC networks. DCEs are still very new to the market and, while your organization may already have experience managing capitated risk, you’re still in the network-building phase. For an organization like this, an earlier point in the development process, you should first look at your own performance metrics to determine where you have gaps in care. You can then examine metrics for prospective partners to see where you can start to fill in care gaps and coordinate care.

If you already have a PAC network in place, it’s important to continually assess, optimize, and improve it. Start by identifying any gaps in care. Are there specific case mixes that could use improvement? How are you performing with all of your patient populations? Identify areas for improvement, such as level of acuity and diagnostic category focus.

Aside from care gaps, you can also optimize your post-acute care network by determining where you can address overflow. If your current PAC partners don’t have enough capacity for your volume, it’s time to find new supplemental partners who can serve the patients who are falling through the gaps right now.

As you analyze overflow and gaps, it’s worthwhile to take a look at your regional data. Do you have more overflow in a specific region? In this case, you’ll want to focus on attracting more PAC partners in that area that can help you coordinate care for those patients.

If you have a fairly well-established network, it may be time to take the next step in optimization, to develop relationships with preferred providers. Analyze the metrics available for your current partners to see where they excel, and you can start to develop a tier system for referrals that will help decrease costs and improve care.

In a robust PAC network, it may be time to narrow it down to improve performance, and a tier system can help. For example, if you have 20 SNFs in your network, you’ll want to ensure that your providers refer the top-performers. Accessing provider data can help you differentiate your top five or 10 preferred partners. With the right metrics, you can take a closer look at who should really be in your network based on quantifiable performance indicators.

3. Find and Implement Your “Quick Wins”

Whether you’re building out your network or honing it down to the most effective partners, focus on your “quick wins” – the places where you can make the smallest changes that have the biggest impact. As you do this, for simplicity’s sake, focus on one care setting at a time. If you know that you have gaps in home health, begin there. If hospice or skilled nursing has always been a blind spot, begin with one of those. Work your way through each care setting until you’ve found all of the most obvious areas for improvement in your network.

When it comes to defining what a “quick win” is, you need to look for PACs with characteristics that support the value-based care priorities of high-quality, low-cost care. Then think about the right way to utilize your PAC partners:

• Refer end-of-life patients to hospice earlier – early utilization in the last 30 days of life is shown to reduce avoidable hospitalization and decrease total cost of care
• Take advantage of the 3-day SNF waiver to reduce the length of hospital stays and cut down on inpatient costs
• Consider if certain patients are better suited for home health rather than skilled nursing settings – lower acuity patients are less likely to need the increased costs associated with congregate care settings

4. Manage Partner Relationships

Developing an optimized post-acute care network isn’t a set-it-and-forget-it process. So, once you have your network in place, how do you manage your partner relationships and network performance on an ongoing basis? Build data analysis and reviews into a quarterly maintenance plan.

Establish a system to conduct quarterly reviews with your partners. These should highlight partners’ strengths and weaknesses, and among other metrics, they should include discussion of cost in relation to quality. For example, do you have partners that consistently excel in quality but are regularly over cost? As you review partner performance, establish benchmarks for performance that can help optimize their performance to bring more value to the network.

As you evaluate new and existing partnerships, you can use key metrics to create score cards for:

• Total number of Medicare patients they treated
• Total number of Medicare patients that were attributed to your organization
• Total cost of care for the regular FFS and the attributed FFS patients
  • Per Member Per Month (PMPM)
  • Per Member Per Year (PMPY)
• Average length of stay for the facility
• Readmission rates for the facility

Using traditional PAC quality metrics will give you a good indication of how they will impact your ability to meet CMS benchmarks. When in doubt, show them the metrics you’ve used to evaluate them. Compare them with other PAC organizations and help them see the mutual benefit of improving their processes.

5. Identify Areas for Overall Improvement in Post-Acute Care

Whether you’re just getting started or you’re optimizing a robust network, it pays to identify areas for improvement in post-acute care for your network. As you dig into the data, look for trends that can impact your overall cost. For example, are you getting patients to the right care setting at the right time? If you’re seeing a lot of patients admitted to SNFs, readmitted to hospital, and then admitted back to skilled nursing, you could have an under-utilization issue. Those patients may still need home health services after release from a SNF. In this case, increasing home health referrals could reduce your readmission rate and decrease cost of care.  

By diving into the data, you can identify areas where your network may have gaps or where you aren’t utilizing your network partners as much as possible. Developing and maintaining a successful post-acute care network is an ongoing process that requires access to data for your network, your partners, and your competition. Trella Health gives you the transparency you need to see the whole picture, identify areas for improvement, and create a comprehensive network that works for your patients and your goals.