This blog post was provided by Secure Exchange Solutions, part of the Rhapsody ecosystem of trusted partners. Learn more about Secure Exchange Solutions and other Rhapsody partners.
The long-term goal of delivering effective healthcare depends upon several patient-focused, short-term goals. These goals include optimizing post-acute care and reducing preventable hospital readmissions by streamlining clinical and non-clinical care coordination after hospital discharge.
Watershed Health is an organization passionate about solving this critical challenge and has developed a closed-loop technology platform that expands collaboration beyond a health system’s walls and makes it easier to build and maintain high-performance post-acute networks. Provider networks adopting the platform consistently see improved patient outcomes, including reduced hospital readmissions. Watershed’s clinical success has led to rapid growth. Watershed is currently working with multiple major national payers and over 1,000 provider organizations.
Leveraging Leading Interoperability Solutions
- Corepoint Integration Engine helps Watershed Health easily connect high-performing networks and community resources to enable them to work together more effectively. Corepoint streamlines EMR integrations, making deployment and data integration fast and cost-effective, which helps facilitate Watershed’s rapid market expansion.
- Secure Exchange Solutions (SES) provides Watershed access to a nationwide clinical data exchange network to enable secure bi-directional communications between healthcare stakeholders. Watershed uses Direct Secure Messaging and Event Notifications technology to help facilitate better collaboration within post-acute care teams and improve patient outcomes.
Improving Provider Engagement
Clinical challenges associated with workflow inefficiencies may arise that lead to adverse patient outcomes and increased expense. The cause can sometimes be attributed to the lack of effective provider engagement, which is necessary for effective collaboration and information of the patient’s status in their care path and the clinical workflow.
Clinical data shared within the care team workflow informs the evidence-based care enabling providers to meet their quality assurance and performance improvement benchmarks on their patients. Added benefits include improving outcomes and increasing financial performance.
Reducing Preventable Hospital Readmissions
Hospital readmissions often result from medical errors and complications attributed to poor discharge procedures and lack of integrated follow-up care. Therefore, high readmission rates are detrimental to patient care outcomes and can be directly connected to the lack of provider engagement. Readmissions are also estimated to cost the industry more than $25 billion annually, and therefore directly affect the business’s financial bottom line.
The Hospital Readmission Reduction Program (HRRP), is a Medicare value-based program that encourages hospitals to improve communication and care coordination to engage patients and caregivers in discharge plans to reduce avoidable readmissions. According to KHN1, over the lifetime of the HRRP program, 2,920 hospitals have been penalized at least once. That is 93% of the 3,139 general acute hospitals subject to HRRP evaluation and 55% of all hospitals.
In value-based care models, hospitals may take the brunt of the penalties, but poor post-acute care/home care environments are often the real problems. Post-acute care includes home health, behavioral health, FQHCs, skilled nursing and rehab facilities, etc., or any stakeholder involved in taking care of the patient both clinical and non-clinical after discharge. The HRRP program, is designed to enable better visibility into patient admit and discharge activity by all post-acute caregivers and meeting these requirements will eliminate penalties and help to improve quality scores and subsequently increase reimbursements.
Increasing Referral Management Effectiveness
The revenue challenges hospitals and health systems face under new payment models combined with the pressure to reduce costs have healthcare leaders seeking more effective solutions to manage patient referrals. Approximately one in three primary visits results in a referral2, which requires providers to have solutions in place that can effectively manage the referral and ensure proper clinical data exchange of critical patient information to improve care coordination and patient outcomes. Relying on legacy healthcare technology and manual processes such as paper and fax does not help streamline workflows and may impede the delivery of actionable information to care teams.
With more than 40% of in-network patients leaving the referral pathway, providers need to know the (who, what, when, and where) of their patient’s activity, such as a hospital (admit and discharge) to properly coordinate and collaborate care effectively. Implementing a system/process which focuses on streamlining clinical exchange to support provider engagement will help to keep referrals in-network and improve the transition from fee-for-service to value-based care.
Meeting CMS Value-Based Reimbursement Requirements
The CMS value-based reimbursement programs are focused on improving patient outcomes and delivering care based on specific quality measures that pay providers based on the quality of care they give to their patients, rather than the quantity of care given. Listed below are seven value-based programs3 with the goal of linking provider performance of quality measures to provider payment that is informed by effective clinical data exchange:
- End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
- Hospital Value-Based Purchasing (VBP) Program
- Hospital Readmission Reduction Program (HRRP)
- Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
- Hospital Acquired Conditions (HAC) Reduction Program
- Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
- Home Health Value-Based Purchasing (HHVBP)
As much as we might try, we cannot do everything. Embracing the power of partnerships and recognizing that “we are better together” helps foster greater collaboration and enables us to leverage best-in-class technology solutions as a force multiplier—collectively making a bigger impact on improving healthcare.
By leveraging best-in-class standards-based, clinical data exchange and interoperability solutions that support provider engagement and collaboration in the care continuum, Watershed Health has shown that readmissions can be significantly reduced, leading to better patient outcomes and substantial cost savings for providers and payers. As a result, the long-term goal of improving patient outcomes while maximizing the return on investment for value-based programs will be achieved.
- 10 Years of Hospital Readmissions Penalties: https://www.kff.org/health-reform/slide/10-years-of-hospital-readmissions-penalties/
- Dropping the Baton: Specialty Referrals in the United States: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2011.00619.x
- What are the value-based programs?: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs