If you manage bundled payment programs, there’s a good chance you also manage something else: the financial penalties that come with exceeding parameters set for episodes of care.
One way to reduce or avoid penalties is to collaborate with post-acute partners who deliver consistent, high-quality outcomes. In fact, research shows that a narrow network is one of the keys to lowering preventable readmission rates.
And case managers can play a pivotal role in the process, ensuring there is clear communication as patients move from one level of care to another. Here are five ways to improve care management and, ultimately, reduce penalties:
1. Assign case managers to oversee bundled programs. Let dedicated case managers oversee specific patient populations, such as bundled programs or surgery type. These managers will have, or develop, the experience needed to direct patients to the right level of care.
2. Identify and track high-risk patients. Not every patient needs to be part of your care management program but it’s important to identify those who do. Some criteria might include older patients who live alone or the risk level of surgery. Prioritize patients who may need high-touch intervention. These patients may not be part of bundled programs but often benefit from increased communication.
3. Optimize length of stay. Gone is the automatic default of a set number of days paid by insurance. Instead, work with your network to determine how to get patients home at the right time.
4. Designate a point person at each post-acute agency. These are the people who will keep the hospital case management team updated on changes in patient status.
5. Maintain an open line of communication. Constant feedback is key so care managers know when to intervene. For example, if they know a patient is experiencing weight gain or not feeling well, they might take the patient to a primary care physician before he or she decides to admit to the ER. Two-way communication will help you provide the right level of intervention at the right time.
See how Northwestern Medicine (formerly Centegra Health System) has leveraged Prepared Health to connect their PAC network, reduce readmissions and make bundles profitable.