The Importance of Real-Time Collaboration Between Payers & Post-Acute Providers

Collaboration forms the foundation of an effective partner network, and shared access to real-time comprehensive patient data fuels this collaboration, enabling proactive care and better outcomes. However, data sharing between providers and payers across the care continuum often faces challenges. Siloed repositories,  countless input devices, misaligned workflows, incompatible technologies, and regulatory hurdles are just a few of the barriers that hinder smooth coordination, leading to a data gap between acute and post-acute settings as patients transition between caregivers. 

A connected network that supports data exchange, accessibility, and visibility allows payer and provider teams to bridge this gap and coordinate care effectively, meeting the evolving needs of an aging population. 

Collaboration Is Key to Better Patient Outcomes

Access to shared clinical information in real-time equips health plans and providers with the data necessary to deliver accurate diagnoses and treatments in the most suitable setting, ultimately enhancing patient outcomes and reducing overall healthcare costs. A connected network enables the seamless flow of comprehensive patient clinical data, admissions, and discharge information across the care continuum. This enhances care coordination allowing health plans to anticipate changes in patient status earlier. The outcome is improved patient results, as care teams collaborate to provide appropriate care and manage overall health – a fundamental principle of value-based care.

Value-based care is grounded in delivering effective care, not simply more care. When patient data is well-coordinated, fewer redundant tests are conducted, preventable readmissions are reduced, and care is delivered in the most appropriate facility. Health plans can assist providers in optimizing discharge timing by gaining visibility into what was previously a “data black hole”: post-acute stays. This is especially beneficial for high-utilization aging populations and the caregivers supporting them.

The Clinical and Financial Benefits of Real-Time Visibility

Real-time visibility and collaboration between health plans and post-acute care providers can significantly improve clinical and financial outcomes by:

• Optimizing case manager workflows with insights into recent admissions, hospital readmission risk, and estimated discharge dates
• Enabling case managers to actively monitor patients during transitions and post-acute stays
• Giving case managers timely information about SNF admissions, clinical assessments, and medication reconciliations
• Identifying members at high or rising risk of readmission, supporting timely interventions
• Enabling health plans to monitor length of stay (LOS), anticipate discharges, and support patient follow-up
• Reducing readmissions and LOS to improve quality scores (HEDIS, Stars) and financial returns

My Patient Is Your Patient: Hospitals, Clinics, SNFs, and Health Plans Are in It Together

It’s important to consider the benefits of collaboration from several perspectives within the healthcare ecosystem. Data-driven insights gleaned from real-time information shared across the healthcare continuum empower all involved to identify trends, improve value-based care, and lower costs by reducing readmissions and optimizing post-acute LOS.

As a longtime champion of collaboration between healthcare stakeholders, Samantha Vosloo, director of value-based care for PointClickCare, has observed that, “Providers and payers are realizing they have to work together to survive in a managed care world. The most common thing that I overhear is a call for standardization of data when moving patients through the continuum of care. Also, there’s concern with obstacles and misinformation between partners that prevent efficient care transitions.”

In addition, she notes that, “There’s an increased appetite from the SNF market to engage in value-based care arrangements with risk-bearing entities, whether that be pay for performance, pay for quality, or truly risk-sharing.” All agree that clear visibility benefits everyone, including — and most importantly — the patient.

Improve Collaboration With PAC Management

PAC Management from PointClickCare is enabled by real-time clinical insights and provides visibility into admissions, discharges, status reports, LOS, therapy documentation, and individual patient charts. Additionally, readmission risk indicators and insights from PointClickCare’s predictive return to hospital (pRTH) algorithm enable care managers to prioritize and intervene with patient care during the post-acute care stay, improving Centers for Medicare and Medicaid Services (CMS) quality measures and performance to drive network improvements.

If you’re looking for ways to improve collaborative, proactive care, take a look at PAC Management for Health Plans and request a demo to see what it can do for your organization.