Us­ing big data to op­ti­mize post-acute care

Modern Healthcare - - INNOVATIONS - By Beth Kutscher

In­sur­ers us­ing value-based pay­ment mod­els pay healthcare providers based not only on the qual­ity of care they pro­vide in­side the hos­pi­tal, but also on what hap­pens af­ter pa­tients leave the hos­pi­tal.

Un­til re­cently, how­ever, in­sur­ers and providers did not have good ways of mea­sur­ing the cost-ef­fec­tive­ness of posta­cute-care providers, and pa­tients lacked clar­ity on what to ex­pect af­ter they were dis­charged. A 2013 In­sti­tute of Medicine re­port found that 73% of re­gional vari­a­tions in Medi­care spend­ing were linked to dif­fer­ences in post-acute care.

Brent­wood, Tenn.-based nav­iHealth is try­ing to change that by pro­vid­ing data and clin­i­cal ex­per­tise to help di­rect pa­tients to post-acute providers with the best out­comes and low­est costs. It has de­vel­oped an out­comes pre­dic­tion tool called LiveSafe, which has com­piled data from 800,000 episodes of care. Also, nav­iHealth as­sumes fi­nan­cial risk along with its clients, em­ploy­ing care co­or­di­na­tors to help pa­tients choose the most ap­pro­pri­ate post-acute-care sites.

“We cre­ated an eco­nomic model to take on the en­tire post-acute-care episode,” said CEO Clay Richards. “It’s lever­ag­ing the tech­nol­ogy and an­a­lyt­ics to cre­ate in­di­vid­ual care pro­to­cols.”

The com­pany, founded in 2011 with the back­ing of pri­vate eq­uity firm Welsh, Car­son, An­der­son & Stowe, has clients that in­clude health plans and provider sys­tems such as Kaiser Per­ma­nente, Dig­nity Health and High­mark. Us­ing LiveSafe, nav­iHealth can cre­ate per­son­al­ized care plans for pa­tients, said Dr. Clay Ack­erly, nav­iHealth’s chief clin­i­cal of­fi­cer. “It re­ally is a gamechanger for dis­charge plan­ning,” he said.

Last month, nav­iHealth sold a 71% stake of its busi­ness, for $290 mil­lion, to Car­di­nal Health, which has the op­tion to ac­quire the full com­pany within four years.

Ear­lier this year, nav­iHealth was se­lected as a “con­vener” for Model 2 of the CMS’ Bun­dled Pay­ments for Care Im­prove­ment ini­tia­tive, which cov­ers episodes of care last­ing up to 90 days af­ter dis­charge. Nav­iHealth is tasked with es­tab­lish­ing posta­cute-care pro­to­cols for the ini­tia­tive and pro­vid­ing data to par­tic­i­pat­ing hos­pi­tals to en­able them to pro­vide care within bud­get.

The com­pany is now work­ing with 75 hos­pi­tals in 24 states on the bundling ini­tia­tive. It also has a na­tional part­ner­ship with IPC Healthcare to pro­vide ser­vices at a sep­a­rate group of hos­pi­tals. The work on bundling be­gan in April, so it’s too soon to as­sess re­sults. But the com­pany says it has ev­i­dence that its tech­nol­ogy has re­duced hos­pi­tal read­mis­sions, im­proved pa­tient out­comes and saved money.

Pri­or­ity Health, a Grand Rapids, Mich.based health plan that’s part of Spec­trum Health, launched a post-acute-care man­age­ment plan for its 110,000 Medi­care Ad­van­tage mem­bers in Jan­uary 2014 us­ing LiveSafe. Nav­iHealth’s bench­mark­ing data showed that Pri­or­ity al­ready had a low level of post-acute-care uti­liza­tion—975 skilled­nurs­ing-fa­cil­ity days per 1,000 mem­bers. But the health plan thought it could do bet­ter.

Pri­or­ity em­bed­ded a dis­charge man­ager in its hos­pi­tals to en­sure pa­tients were sent to the most ap­pro­pri­ate post-acute-care site. The nav­iHealth data­base also in­forms pa­tients and their fam­i­lies about typ­i­cal out­comes for pa­tients with sim­i­lar con­di­tions.

“What had been miss­ing in the past is that (pa­tients and fam­i­lies) didn’t know what to ex­pect when they got to the nurs­ing home,” said Dr. Jay LaBine, Pri­or­ity Health’s chief med­i­cal of­fi­cer. “This will al­low peo­ple to make a more in­formed de­ci­sion.”

The ini­tia­tive has led to a fur­ther 15% de­crease in SNF days per 1,000 ben­e­fi­cia­ries, and also cut the av­er­age length of stay, LaBine said. Over­all, Pri­or­ity has seen a 13% re­duc­tion in its per-mem­ber-per-month costs in its Ad­van­tage pro­gram. More­over, Pri­or­ity has di­rected pa­tients to high-per­form­ing post-acute-care fa­cil­i­ties, while hold­ing lower per­form­ers ac­count­able.

Nav­iHealth’s Richards ac­knowl­edged that his com­pany’s model cre­ates win­ners and losers among post-acute-care fa­cil­i­ties. “Some providers that we work with see this as an op­por­tu­nity to re­ally dif­fer­en­ti­ate them­selves from their com­peti­tors,” he said.

Richards said the trend to com­bine pay­ments for acute and post-acute care will heighten the fo­cus on the cost-ef­fec­tive­ness of post-acute providers. He cited the CMS’ July pro­posal to launch a manda­tory Medi­care bun­dled pay­ment pro­gram for hip and knee re­place­ments in 75 mar­kets, hold­ing hos­pi­tals ac­count­able for out­comes up to 90 days af­ter dis­charge.

“We think hips and knees is the first wave and that will be fol­lowed by other con­di­tions,” Richards said. “We want to be the first mover to take ad­van­tage of that when it hap­pens.”

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