2014-2016 Road Map Themes: EVOLVING BUSINESS LANDSCAPE


GOAL
LTPAC providers should adopt and use health IT to facilitate innovative patient-centered business practices and drive improvements in quality, population health and continuity, as well as the reduction of the cost of care.
RATIONALE
There is broad recognition that we should dramatically improve the health care system by delivering better patient/ resident/ client experience (including quality and satisfaction); improving population health; and reducing our per capita spending. Pressures on traditional reimbursement streams are increasing. Payment schedules are being reduced while the unit care costs continue to rise. Efforts now underway to shift to new value-based and performance-driven payment models, such as Accountable Care Organizations (ACOs) and Bundled Payments, aim to manage the overall cost of care across settings while improving outcomes. More pressures to control spending and improve quality in LTPAC settings are expected over the next 2-3 years. Moreover, new payment models, as well as existing and emerging private pay opportunities, are emphasizing consumer experience and satisfaction with care.
As a result, new models are emerging in voluntary, as well as regulation-driven, partnerships. LTPAC providers are part of the solution: they offer lower-cost care settings and the appropriate resources for individuals who need support in chronic disease management, and short-term stabilization, rehabilitation, or support services needed by individuals to recover from illness. However, for LTPAC providers to prosper and survive in this environment, they need to innovate and improve the value they deliver to customers (patients, residents, families, other providers and payers). For example, pressures on short-term acute care hospitals to reduce re-admission rates and improve outcomes create new challenges for hospitals and new opportunities for LTPAC providers. As hospitals face financial penalties for re-admissions, hospitals are and will continue to seek partnerships with LTPAC providers who can manage, stabilize and provide rehabilitation and supportive services to discharged patients and reduce their re-admission rates. There are numerous federal, state, and private sector payer programs that encourage and support the formation of partnerships across the care continuum to improve care coordination and reduce unnecessary costs.
Health IT, including interoperable EHRs, HIE, telehealth, remote monitoring, and shared care planning and coordination tools, are key enablers for providing services efficiently, cost-effectively and in coordination with other healthcare providers. This makes health IT a business imperative for care providers and puts it in sync with national goals to improve care and population health, and reduce health care costs through the use of health IT. To adapt to these changes, LTPAC organizations should be innovative and willing to invest in exploring innovative partnerships with hospitals, physician groups, payers and other care providers and to share in the risks as well as rewards, inherent in these new service delivery models. A consumer-oriented approach, based on transparency in quality, satisfaction and cost, is needed not only to achieve high levels of care quality, but also high levels of satisfaction from customers, including residents, clients, family members, LTPAC providers and other care partners. This consumer orientation and transparency leads to more informed decisions and drives increasing competitiveness and consolidation in the marketplace.


KEY PRIORITIES
Encourage LTPAC providers to adopt and use health IT, including EHR advanced functionalities like analytics, quality reporting, clinical decision support systems (CDSS) and health information exchange (HIE) capabilities, as well as telehealth to demonstrate that these technologies can help them facilitate the following:

  1. Quality Improvement: Drive continuous quality improvement initiatives to enhance quality of care, including reducing unnecessary hospitalizations and hospital re-admission.
  2. Data Standards and Quality: The quality of data, including adherence to semantic interoperability data standards including vocabularies, performing quality checks at point of entry, are key to successful leveraging of IT in a quality improvement framework and health information exchange.
  3. Health Information Exchange: Exchange electronic health information across care settings to support coordination and continuity of care during shared care and transitions of care.
  4. Innovative Approach: Experiment with innovative business models, including integrated/coordinated care models, risk-sharing partnerships with hospitals, physician groups, ACOs, and payers in their areas of strong competencies to increase the likelihood of success.
  5. Documenting Results: Document and disseminate best practices, achieved quality outcomes (including reduced re-admission rates, client satisfaction and costs), and financial outcomes to other providers.


OBJECTIVES AND STRATEGIES TO PURSUE

  1. LTPAC providers should proactively adopt and use health IT to drive continuous quality improvement initiatives to improve quality of care, including reducing unnecessary hospitalizations and hospital re-admission rather than passively collecting the data necessary for mandated regulatory assessments and billing.
    1. LTPAC providers should not only implement health IT, but also deeply integrate it into care processes by collecting and sharing information in ways that streamline activities and allow for better management of resources and risks. This requires providers to train staff on benchmarking, process improvement, health IT, and the effective use of these systems to improve care.
    2. Providers should benchmark and measure the impact of health IT on business processes overall (care outcomes, cost of care total cost of ownership and return on investment) as part of their ongoing quality improvement and operations management efforts.

  1. Exchanging electronic health information across care settings to support care coordination during shared care and transitions of care is critical.
    1. LTPAC EHR vendors should pursue the implementation of interoperability standards.
    2. Providers should be encouraged to pursue implementing and upgrading to certified interoperable health IT systems.
    3. LTPAC providers should work on implementing HIE, directly with other provider partners and/or through state and regional HIE entities. This would entail working with vendors of other EHR systems, including hospital EHR vendors, as well as integration engines and other intermediary exchange facilitators, at least in the interim.
    4. Providers should evaluate the impact of HIE implementation on care outcomes as part of their ongoing quality improvement efforts, and in partnership with other providers to demonstrate the value of HIE, interoperability and certification. Engaging in this process would help provider partners identify: gaps in the information needed to be exchanged and standards required to support information exchange, necessary workflow changes and future health IT/EHR certification requirements.

  1. To experiment with innovative business models, including integrated and coordinated care models, risk-sharing partnerships with hospitals, physician groups, ACOs and payers in their areas of strong competencies, LTPAC providers should:
    1. have a culture that fosters innovation and a willingness to experiment and take calculated risk;
    2. understand the population they serve, their characteristics;
    3. understand how to measure the effectiveness of their programs including the impact of their programs on rates of hospital re-admissions, hospitalizations and emergency room visits;
    4. understand their own as well as their partners’ competencies to identify where they could add value efficiently and cost-effectively;
    5. understand the operating environment, market competitors, trends, prevailing care modalities in their market(s) and potential partners and opportunities; and
    6. understand their resources, cost structure and inherent risks and risk-sharing in the potential models they are considering.

Data obtained from benchmarking, quality reporting, CDSS capabilities and analytic tools as well HIE and telehealth can help providers accomplish these goals. We believe that partnerships with hospitals around hospital re-admission reduction program could present an immediate opportunity to pilot test these capabilities and provide an experimentation ground for these types of contractual agreements.

  1. Providers should document and publish the best practices as well as the outcomes of successful implementation on business, care quality, client satisfaction, utilization and cost to demonstrate the value of health IT-enabled LTPAC providers to the health ecosystem in not only peer-reviewed publications but also as case studies. Associations and the LTPAC Health IT Collaborative should encourage sharing and broad dissemination of provider best practices, lessons learned, case studies and advice to others through various dissemination activities, including shared learning collaboratives.


NEXT STEPS




For Provider Community:
  • Adopt and use interoperable health IT.
  • Use health IT to effectively drive quality improvement.
  • Participate in HIE.
  • Seek out partnership opportunities with other providers in the care continuum, health IT vendors, payers, and health information exchange organizations.
  • Understand your strengths, competencies, and risks and engage in experimenting in innovative models, including partnerships with hospitals and others.
  • Measure and document your outcomes.

Hospitals and physicians should be willing to meaningfully engage in HIE and innovative partnerships.

For Vendor Community:
  • Support interoperability standards.
  • Pursue Interoperability Certification.
  • Work with other vendors, including hospital and physician EHR vendors, integration engines, intermediaries and HIEs to help providers engage meaningfully in HIE.
  • Provide adequate training on the use of your product, including advanced features like analytics, CDSS, reporting and HIE capabilities to drive quality initiatives.
  • Be transparent about the costs of and support needed for product upgrades.

Hospital and physician EHR vendors and HIE Organizations should be willing to work with LTPAC EHR vendors on interoperability and HIE.

For Policy Makers:

  • Continue to support development, implementation and adoption of standards and certification programs that are relevant to LTPAC settings.
  • Support the identification of quality measures that are meaningful for LTPAC and vulnerable populations, particularly related to care coordination, the e-specification of such measures, and the adoption of such measures across the care continuum including by hospitals, physicians, and LTPAC providers.
  • Incorporate the use of these measures and standards in innovative care and payment models and demonstrations supported by CMS that have an LTPAC focus and health IT emphasis.
  • Incorporate the e-specified quality measures in EHR certification criteria.
  • Consider grants, low interest loans and financial incentives to smaller, unaffiliated and rural providers who are less likely to have the resources and the partnership opportunities to support their health IT and quality improvement initiatives.
  • Provide technical assistance to support the acquisition, implementation and use of health IT, HIE and the use of these technologies in emerging service delivery and payment models.