Hospitals and accountable care organizations must perfect the art of partnering with “next care” providers to help improve quality outcomes.
“Continuous improvement” is the mantra for hospitals looking for the next best approach for improving patient care. Among all improvement goals, readmissions or rehospitalizations are always in the spotlight because transferring patients between care settings can result in high costs, financial penalties and poor patient experiences.
The solution to producing results that have a positive impact lies in collaboration. Hospitals and accountable care organizations (ACOs) need to learn the art and skill of partnering with “next care” providers. It doesn’t matter where the provider sits on the care continuum. What matters is developing a smarter network with solid partnerships that unite to ensure better outcomes.
The delivery of top-quality care, built on evidence-based practice and data-driven decision-making, needs to be the foundation of an organization’s collaborative network.
Spotlight on QI
Many partnerships employ some type of quality-improvement process to help deliver top-quality care. The most successful ones make the process part of the organization’s culture. Structured quality improvement provides a way to look at outcomes, metrics or measures of a particular process in an effort to keep achieving the desired level of success.
Some providers view it as a circular progression. First, they identify the measures they want to keep track of, like key performance indicators (KPIs) of good quality. Then, they identify how and when they’re going to measure the care and outcomes. Once they analyze current status in the identified areas, providers look to see what impact they could have on those measures. They determine the best strategy and implement their plan. After the designated period, they measure their KPIs; if improvement can be seen, they continue with their strategy. If there is a slowdown, then some degree of change is required. A static measure or outcome signals the provider has reached the limit in approaching the process in a particular way, and the plan needs to be modified for continued success.
Why the intense focus on QI? In the past, service providers were paid for the volume of services they provided. The greater the volume offered, the larger the reimbursement in the end. It no longer works that way. Increasingly, providers are paid according to the quality of their care.
Part of producing outcomes that matter in this performance-based environment comes from controlling hospital readmissions. Medicare has implemented incentives to reduce them, such as the Hospital Readmission Reduction Program. Financially, this initiative penalizes hospitals that have relatively high rates of readmissions.
The intended purpose is to try to avoid the heightened risk associated with patient or resident transfers between care settings. These risks can increase when patients get disoriented as they move from the known to the unknown. A simple miscommunication between two providers can have negative consequences on care. When a transfer is hurried, for whatever reason, important information about care plans, treatments or medications can end up incomplete or unclear, which can lead to lapses in care.
Building Strategic Partnerships
With everything that can affect the quality of care delivery, the situation clearly calls for strategic partnerships. The strategy discussion begins with a conversation on the merits of collaboration. Sharing data with partners along a continuum is a good way to establish meaningful key performance indicators and measurement decisions. Having the opportunity to collaborate, to come together and make decisions based on the information available helps to make a positive difference in outcomes. Successful partners use measures that have already been tested and found to be valid, reliable industry standards for measuring quality. When participating collaboratively with an ACO, both providers can use the data available to evaluate and monitor partnership performance.
During the initial stages of a partnership, data is aggregated and reviewed. As the partnership progresses, the strategy for the ACO convener or collaborative leader becomes deciding which provider to keep in the ACO or collaborative. If one provider’s numbers are considered outliers, that group should be asked about its ability to meet the benchmarks and expectations. In turn, the provider should be expected to respond realistically and collaboratively.
Initially, when entering into a partnership, one approach is to cast a wide net. From there, select a network that will meet the group’s operational needs, with shared goals and a commitment to excellence. Rarely does one partner fill every need. Many times, there are gaps that require thoughtful review of other providers that can cover those needs. Building a smart network like this goes a long way toward creating an environment that is innovative and one in which people flock to participate.
Continuous improvement of outcomes and building strong partnerships with the right providers have become the end goals for many care environments. The aging baby boomers want and expect a great deal from their golden years. This generation, like the federal government, expects quality for their money. To meet these demands, hospitals, ACOs, skilled nursing facilities and other providers will need to learn to perfect the art of partnering so quality outcomes, like hospital readmissions, will continue to improve.
Pam Kaiser, MSN, RN, is the vice president of provider solutions for Massachusetts-based PointRight, a business intelligence and predictive analytics solutions provider.