Three years ago, Northwestern Medicine's hospital in Crystal Lake, Illinois, was paying penalties averaging $300,000 a year to the Center for Medicare and Medicaid Services. One challenge: preventing its bundled payment patients from making a U-turn back into the hospital.
When hospitals select preferred providers, they often rely on skilled nursing facilities or home health agencies that they’ve built relationships with and trust. Providers may be friends or long-time partners. Or, they might bring in lunch or treats for hospital staff. All too often the referral flow is based on doughnuts and not data. But in a value-based care environment, data matters.