In the current landscape of healthcare reform, healthcare systems, insurance companies and payers all are looking to fulfill the Institute for Healthcare Improvement’s triple aim of improving patient experience, lowering costs and improving population health — both during an acute stay and also after discharge. As a result, they’re building strategic performance networks comprised of vetted downstream providers and providers that can help them achieve this goal.
Senior living companies — including independent living and assisted living communities, as well as continuing care retirement communities (CCRCs, also known as life plan communities) — traditionally are not considered to be these downstream providers.
As someone having experience at the decision-making table with hospitals, and being a specialist in the senior living world, I see a unique opportunity for senior living entities to become a part of the preferred performance network. Senior living communities are viable candidates: not only do they manage at-risk populations daily, but they do so at lower costs, in a quality care setting that is preferred by the patient.
To leverage this opportunity, though, there is a need to bridge the gap between healthcare systems and the senior living world. It is my belief that a quality skilled home health provider of choice already existing within the preferred performance network serves as that very bridge. These providers know what pain points hospitals have, as well as the metrics that key decision-makers are interested in, such as outcome data, to help craft a mutually beneficial solution.
BAYADA Home Health Care has experience in piloting and sustaining such a model, helping health systems see the value in developing their own contractual relationship with senior living communities. And it has yielded positive results thus far.
In one specific example, BAYADA connected a hospital to an assisted living company as part of a preferred performance network and saved approximately $95,000 in potential spending for a single patient alone. This particular patient needed a hip surgery and was living in a hospital because she didn’t have a safe discharge plan due to poor social determinants of health. Medicare wouldn’t pay for her procedure unless she remained out of a hospital setting for at least 60 days.
In this program, the patient was transferred to an assisted living setting, where she received clinical care from the community wellness team as well as from BAYADA. She ultimately was able to meet Medicare’s requirements to have her hip surgery covered.
Perhaps just as important, the patient was able to spend a holiday in a comfortable assisted living setting instead of in the hospital. She not only was able to receive her surgery, but she also qualified for a brief skilled nursing facility stay after her procedure. And she worked with the assisted living community and hospital to secure safe post-acute living discharge plans.
When considering this one patient’s journey, it’s evident that there is room for health systems to come together with senior living entities in a collaborative effort to not only make a positive impact on patients’ quality of life but also to optimize limited financial resources at the same time.
The assisted living facility was able to drive revenue in an innovative way by receiving rent from a hospital and was able to develop a strong relationship with the hospital leadership team. At the same time, the hospital was able to reduce costs. The pilot model was so successful that it has been extended for another six months. During that time, the hospital will continue to pay the assisted living facility rent to house similar patients who otherwise would not have a discharge plan due to poor social determinants of health and therefore would need to remain in the hospital or become a risk in an environment that didn’t offer proper care.
It is innovative solutions such as this contractual agreement example, which bridged the gap between a hospital and assisted living facility by tapping into a creative solutions-building home health provider of choice, that answer the IHI’s triple aim. This way of thinking, if met with an open mind, offers senior living companies a bright future in healthcare.