Post-acute integration strategies in an era of accountability

Abstract

The Institute of Medicine, in its 2001 Crossing the Quality Chasm report, recommended greater integration and coordination as a component of a transformed health care system, yet relationships between acute and post-acute providers have remained weak. With payment reforms that hold hospitals and health systems accountable for the total costs of care and readmissions, the dynamic between acute and post-acute providers is changing. In this article, we outline the internal and market factors that will drive health systems’ decisions about whether and how they integrate with post-acute providers. Enhanced integration between acute and post-acute providers should reduce variation in post-acute spending.

Changes in Postacute Care in the Medicare Shared Savings Program

“…4,5,10,11 For example, ACOs can direct patients to a preferred network of more efficient SNFs and can employ, or partner with, clinicians and case managers to follow the care of patients in SNFs. [12][13][14] Research to date, however, has not demonstrated the extent of savings in postacute care in the ACO programs after 2013, the source of these savings, or the strategies used to achieve them.…”

Strategy and risk sharing in hospital–postacute care integration

“…With uncertainty surrounding future institutional volume (inpatient and SNF) growth, it is often not in the hospital's best interest to add more fixed assets to its real estate portfolio. (McHugh, Trivedi, Zinn, & Mor, 2014) Both acquisition and contractual agreements also concentrate referral patterns to a fixed geography, potentially complicating new growth opportunities. As it relates to HHAs, the hospital may be more willing to vertically integrate, as there is no fixed asset risk, and the hospital can maintain staffing flexibility to respond to changing needs.…”

Accountability of Hospitals for Medicare Beneficiaries’ Postacute Care Discharge Disposition

“…Whether this development is accomplished by ownership of the facility or via contractual arrangements should be locally determined because no universal solutions are available and the quality of local facilities varies. 7 Second, appropriate financial arrangements will be necessary, including shared risk between the hospital and skilled nursing facility, because these business relations take time to evolve. Premature switching to another partner can be costly given the level of investment necessary to achieve smooth clinical and administrative communication processes.…”

“…Whether this development is accomplished by ownership of the facility or via contractual arrangements should be locally determined because no universal solutions are available and the quality of local facilities varies. 7 …”