Model 3, SNF, Episodes of Care

Enhancing the Delivery of Quality Care Through Collaboration between SNFs and among Post Acute Providers

Remedy recently convened 120+ clinicians and administrators representing over 90% of Remedy’s 437 Model 3 SNF partners from across the nation for the first-of-its-kind SNF Innovation Collaborative. This meeting highlighted the importance of collaboration on two fronts -- between Model 3 SNFs, and among all the providers in the post acute environment. 

The BPCI program presents unique challenges for Model 3 SNFs. Many of these challenges may seem simple but had not been fully anticipated in the design of the program and don’t have easy solutions. Most of Remedy’s SNF partners made a leap of faith with us based on a strategic desire to get valuable experience and a head start with value based payment programs that are likely to dominate the future of Medicare reimbursement for the SNF industry.  

However, this is a complex program that requires front line staff to get new data from hospitals, learn new processes, share data with Remedy, develop new relationships with other providers, and engage with patients and families in new ways.

When faced with so many new challenges, the Innovation Collaborative was a compelling opportunity to provide a forum for collaboration with other SNF pioneers facing the same challenges, in the same markets, and in different markets all over the country.

3 Key Reasons Model 3 SNFs Need to Collaborate to Succeed with Episodes of Care

Better problem solving: Sharing experiences leads to creative solutions to common challenges, as well as providing insights to address unique situations.  A key example is the challenge of identifying BPCI patients.  Some SNFs have found successful ways of working with hospitals to get the MS-DRGs needed to identify BPCI patients, but every situation seems to be different and sharing success stories, as well as failures, has helped our partners find more effective ways to get this information.

Faster learning: If SNFs can leverage the experiences of others, they may find swifter solutions to their challenges and avoid wasting time on efforts that don't work. For example, some SNFs who pioneered the use of our integration between Episode Connect and their facility EMR, were able to help other SNFs who started this process later come up to speed more quickly.

Community: Only 5% of the SNFs in the US participate in the Model 3 BPCI program. These pioneers find tremendous value in sharing successes and challenges from an emotional and motivational perspective. This was in evidence in April at the Remedy SNF Innovation Collaborative.  Ann Collette of Apple Rehab, and Brad Harris of Millers Senior Living who presented “Lessons from the Field,” told the attendees that this is the only forum where they felt so many other attendees could understand and relate to the challenges they faced, not just from the new business requirements, but from their executive management and front line staff as well.

Success with bundled payments for SNFs requires success in improving care for patients while simultaneously reducing costs not just in their facilities, but through the whole post acute continuum. This has never been done before and collaborating with other SNFs has been an effective way to improve our chances of success.

Collaboration Among Providers in the Post Acute Environment

With the patient at the center of healthcare redesign efforts, coordination across the spectrum of post acute care results in a much better patient experience. Here are five tenets of collaboration among providers:

It Takes a Village: While it’s always taken many different providers to care for a patient in the post acute environment, the BPCI Model 3 program motivates SNFs to lead the effort to be sure that the right providers are engaged at the right time in the post acute setting. While it takes a village, the village needs a mayor and SNFs are in a great position to fill that role.

Mind the Gap: Care coordination not only enhances patient satisfaction, it can also help providers eliminate detrimental gaps in care, as well as reduce the redundancies that drive up the cost of care.

Choose Wisely: It clearly matters who provides the care as there are wide variations in the quality of service provided in any segment of the post acute environment. Identifying and engaging the best providers will help drive the best outcomes.

The Patient is Key: Help provide care where and when it is preferred by patients. Home care has grown exponentially in recent years because so many patients prefer to heal in the comfortable, familiar environment of their own homes. But for some individuals who may lack family or community resources, post acute care in a supportive facility makes more sense. Care quality is optimized when it is aligned with patient preferences and needs.

It’s All in The Family: A supportive environment can hasten recovery, especially when community resources can address specific patient needs. Whenever possible, encourage the engagement of family throughout the episode, and help educate them about the patient’s condition and prognosis. Community resources from meal delivery programs to therapeutic groups can support and augment the care plan in place, leading to more successful patient outcomes.


Tagged: Model 3, SNF, Episodes of Care