Creating a Successful Post-Acute Care Strategy to Reduce Unnecessary Utilization by Barry P

Creating a Successful Post-Acute Care Strategy to Reduce Unnecessary Utilization By Barry P. Ronan, FACHE, Western Maryland Health System

n 2010, as Western Maryland secondarily. If an SNF Health System (WMHS) resident experienced a embarked on a value-based medical difficulty, staff care delivery journey, the would make a phone call Iboard of directors recognized to the medical director, that such transformational who would routinely send change necessitated a review the patient to the WMHS of our mission and vision ED for evaluation. statements, as well as our The time of day or core values. It was obvious severity of illness Key Board Takeaways that as our care delivery was irrelevant; the Hospital and health system boards should be model changed, our culture Barry P. Ronan, FACHE normal procedure aware of the deployment of the organization’s would, too. President and CEO was to send post-acute care strategies to reduce unnecessary Western Maryland The board felt that our core Health System the resident, by utilization. These strategies can include: values of integrity, innovation, ambulance, to the • Creating partnerships across the care contin- compassion, accountability, respect, hospital. Often, residents simply uum to better address patient needs and excellence still fit very well with were dehydrated. After receiving • Understanding the social determinants of health our organization’s new direction. We IV fluids, they would be returned that may be affecting the patients served by the amended the mission statement to to the SNF just a few hours later. hospital or health system better reflect the patient-centered Such trips to the ED are physi- • Developing a strategy to address patient needs approach to care delivery in tandem cally and emotionally taxing • Learning from organizations already involved with our intention to improve the health on an already compromised with reducing utilization to discover what and well-being of the community. Since elderly resident, not to mention established strategies can be applied at your the value-based model cares for patients costly because of the ambulance hospital/health system in the most appropriate setting, result- transfer and other resources • Educating the community and other providers ing in less acute care utilization and dedicated to the resident’s on what you will achieve through such significantly more care delivery in pre- diagnosis and treatment. Under strategies and post-acute settings, we changed the value-based care delivery and vision statement to reflect the need to global budgeting, each ED visit create partnerships with other providers constituted unnecessary utilization. care delivery models: that at some point throughout the healthcare continuum. Our goal and need was to make in the not-too-distant future, they too The relationships between WMHS’s patient-centered, value-based care the would risk penalties for overutilization. pre-acute settings and urgent care new norm. We had to move our relation- WMHS leadership continue to meet with providers, independent physician ship from one as a potential competitor the group of SNF leaders every other practices, ambulatory surgery centers, to that of a trusted partner, acting in month and the relationships we have diagnostic centers, and in-home concert for the good of the patient. established continue to mutually benefit providers were well-established. The Early in our value-based care delivery the SNF staff and the health system. goal with those relationships was to journey, we invited leadership from the solidify and enhance them, moving from SNFs to join WMHS leadership in a new relationships to working partnerships. venture called “Partnership to Perfec- However, relationships with post-acute tion.” Establishing trust was paramount “Alone we can do so care settings were more challenging for to this effort. During a series of meet- little; together we many reasons. ings, we focused on key areas beginning can do so much.” with education: we explained our new –Helen Keller Strengthening Relationships care delivery model and our goal to with Post-Acute Care Providers keep patients healthy and out of the hos- There are a dozen skilled nursing pital. Next, we asked for their assistance Collaborating across facilities (SNFs) in the area, including and support. We knew we could not the Care Continuum one of our own that regularly accepts achieve our goals without their coopera- In addition to working with SNFs discharges from the acute care setting. tion. We went on to train the SNF staff to remodel patient care, we quickly Owning one of these SNFs compounded on a variety of treatments that could be recognized that value-based, patient- the challenge of changing the performed in their facilities, placed RN centered care requires partnerships patient care model because it added transitionists, or liaisons between hos- across the continuum. From physicians inherent competition and posed a pitals and SNFs, in their facilities, and in and pharmacies to government entities, variety of trust issues. some locations, replaced their medical the faith-based community, and service For example, a typical scenario at that directors with SNF specialists (similar agencies, such as homeless shelters and time might include a physician with two to hospitalists, exclusively serving SNF senior living centers, we now collabo- positions: an independent practitioner, residents). Finally, we provided educa- rate with a multitude of organizations. primarily, and an SNF medical director, tion regarding the likely direction of

GovernanceInstitute.com OCTOBER 2018 • BoardRoom Press 1 When working with these partners, challenging patients has proven for transportation for one of our many our community health workers and effective, with a direct correlation to patients in rural locations, or setting up patient navigators focus on addressing reduced readmissions. remote monitoring in the home. the social determinants of health With the help of our partners, WMHS for recently discharged patients. also has created seven community Partnerships Key to Interventions regularly include gardens throughout our service area Post-Acute Strategy arranging for meals, transportation, to feed victims of food insecurity. In Partnerships with key providers medications, follow-up primary care addition to the community garden plots, continue to be the most essential com- physician appointments, and providing the health system maintains several ponent of our post-acute care strategy. telemonitoring equipment in patients’ plots and donates the harvest to the Our results reflect improved patient homes. Care coordinators follow up local food bank. Fruit trees encircle care and success: We have reduced with every discharged patient, address- some gardens, providing fresh fruit to admissions by 27 percent since 2011, ing any needs that may have arisen. anyone who maintains a plot. readmissions by 26 percent, and ED Care coordinators also are located in The goal of our post-acute care visits by 15 percent. Each improvement physician offices to assist patients with strategy is to provide patients is directly tied to our comprehensive avoiding unnecessary readmissions. with optimal care and for them to post-acute care strategy.  Teams of staff make an effort to see remain healthy upon returning to patients in locations close to where they the community. We have learned that The Governance Institute thanks Barry live, including churches, community patient-centered care must be personal- P. Ronan, FACHE, President and CEO centers, shelters, and even municipal ized, intensive, and involve one-on-one of Western Maryland Health System, buildings. These teams arrange for creative engagement. Nothing is “off in Cumberland, MD, for contributing follow-up appointments or find a the table,” whether it be arranging for a this article. He can be reached at primary care practitioner if the patient follow-up appointment with a primary [email protected]. does not have one. Providing transpor- care physician, obtaining medications, tation for some of the most medically providing healthy meals, arranging

2 BoardRoom Press • OCTOBER 2018 GovernanceInstitute.com