With health care providers now shouldering even more financial responsibility, it is incumbent on them to operate more strategically in their quest to deliver value-based care. Under the watchful eye of CMS, providers are seeing the addition of multiple measures related to payer spend for the CMS value-based initiatives.

Medicare Spend per Beneficiary (MSPB) was the first measure added to CMS’ Value-based Purchasing (VBP) program that evaluates the efficiency of a hospital compared to the efficiency of a national median hospital. Specifically, the MSPB measure evaluates the cost to Medicare for services provided by hospitals and other health care providers during an MSPB episode. Since the MSPB episode includes claims related to the 30 days post-inpatient admission, it is impacted by the spend related to inpatient readmissions and other post-acute care required due to hospital-acquired conditions and other adverse events.

“Post-acute care is where the provider has the ability to reduce payer spend,” said Theresa Knotts, MSN, RN, CPHQ, advisor, advisory services and performance management at Vizient. “Primarily, the question is where are patients receiving post-acute care and secondarily, what is the post-acute care practice?”

Two hundred and ten hospitals comprised the MSPB benchmarking study conducted by Vizient in July 2016. CMS provides hospitals with their MSPB claims data, which provides the utilization and related spend for each episode included in the calculation of their MSPB performance score. Prior to CMS providing this, hospitals had not had ready access to claims data nor data that told them where and when the patient received care from other providers. The Vizient benchmark study compiled the CMS claims data to provide critical insights related to:

  • Understanding the impact of their post-acute referral network
  • Identifying where the Medicare population served is going for the full episode of care and the related spend
  • Recognizing variation in utilization and spend for the Medicare population at the provider and patient level
  • Determining the drivers for high Medicare spend
  • Providing actionable data that hospitals may share with other involved providers
  • Identifying actionable opportunities to successfully reduce Medicare spend

In a follow-up to the MSPB benchmark study, 91 hospitals are participating in the Vizient post-acute care collaborative. As such, here are five creative strategies shared by Vizient members to decrease MSPB while also improving quality of care and person-centeredness:

1. Incorporate person and family activation assessment and shared decision-making in care planning (acute and non-acute).

“Person and family engagement is what it’s all about,” Knotts said. “The activation is where the patient and family become a part of the care team and share in the decision-making.

For example, a family member might have input into a care decision that affects the potential for diverting a readmission, based on their inherent knowledge of their family member.

2. Assign navigators as a primary point of contact to help patient and family navigate the health system, manage medications and connect with community resources. Navigators are much like outside connection points in that they ensure the patient and family gets connected to whatever health resource is needed. He or she is someone who the patient trusts and is part of the care team. For example, a patient who was recently treated with COPD might feel they need to go to the ED when they are short of breath. The navigator is the person the patient or family will contact who can walk them through procedures to properly assess the situation and also conducts home visits. These actions help the patient and family optimize utilization and avoid unnecessary cost.

3. Collaborate with skilled nursing facilities (SNFs) and home health to align LOS and visits with need. “Where the patient goes upon discharge, so goes the payer spend,” Knotts said. “Hospitals and providers have to partner with SNFs and home health providers to ensure the appropriate SNF LOS and number of home health visits. At the end of the day, we want the driver to be patient need.”

For example, every hospital has significant influence as to where the patient goes after discharge. Many times, benefit days drive the length of post-acute care versus the care needs of the patient. The focus must be on aligning the post-acute care resource utilization with patient care needs, which generally reduces payer spend.

4. Optimize quality and decrease events causing ED visits and readmissions through partnering hospital clinicians and SNF or home health. Through these partnerships, hospital physicians, nurses and other clinicians work side-by-side with the SNF and home health providers to best manage the post-acute care needs of the patient. Therefore, decreasing utilization of unnecessary ED visits and inpatient readmissions.

5. Partner with community pharmacies for medication reconciliation and follow-up. One of the most common causes for inpatient readmissions is related to medication management issues. Partnering with the patient’s community pharmacy assists in ensuring the patient receives the proper medication.

For information about Vizient’s MSPB and value-based care solutions, click here.

Published: March 14, 2017