Redefine acute care to combine fee-for-service (FFS) with care management.

#5in5_Blog_BannerBadly broken bones, appendicitis, hemorrhages and head injuries mean there will be a need for acute care hospitals no matter how the healthcare industry changes.

But we need to change how we think about acute care in relation to the rest of healthcare.

A traditional definition says acute care is the opposite of chronic or long-term care.

This either/or viewpoint makes it seem tricky to align acute care – which is often still covered under fee-for-service models – with value-based care.

Rather than juxtaposing the different kinds of care, it’s helpful to view them on a continuum.

The Healthcare Information and Management Systems Society, or HIMSS, says the care continuum represents all levels of health services over a period of time, which could include a lifetime.

That certainly includes acute care.

The goal should be finding ways to remove the episodic or one-off qualities of acute care and instead link it with the A-to-Z treatment of the patient.

Some health systems are already on this path – integrating care management programs into their workflow.

They are using analytics to identify patients most likely to be readmitted, coordinating with skilled nursing facilities, changing discharge procedures, and setting up protocols for communicating with patients after they return home.

Health systems are no longer focusing solely on the tasks of traditional hospital-based case management – like reviewing medical necessity and admission criteria.

They are working to improve transitional case management by creating teams to educate patients and care givers on treatment plans and to manage medication reconciliation.

ED visits: Not a sign of failure
It is also important to note that a hospital admission or an emergency department visit doesn’t always signal a failure of care management. Some patients will need this kind of care.

The Optum white paper Managing populations to improve individual care says these sentinel events provide data that improve analytics models. More accurate models better predict patient population needs and allow health systems to manage risk.

Defining success
Altering the view of acute care does require a change in how hospitals define success.

For example, HealthLeaders Media reported on New Jersey’s Virtua Health System. Executive vice president and CFO Robert Segin told HealthLeaders more than 50 percent of Virtua’s business is now based on outpatient revenue.

In New York Mount Sinai launched an advertisement announcing, “If our beds are filled, it means we’ve failed.”

Hospitals and Health Networks Editor Bill Santamour called the message striking. In his words, it highlighted hospitals’ transformation from “being strictly providers of care to promoters of health.”

Learn more in the #5in5 podcast Care management matters even in FFS settings.

Hear five questions answered in five minutes on staff training, reimbursement policies and cultural shifts that accompany the transition to care management.

About the author

Jay.Levine-1Jay Levine, MA, MBA, is the Vice President of Provider Population Health Management Solutions for Optum’s Consumer Solutions Group. He has over 20 years of experience supporting healthcare leaders and provider organizations in areas such as strategic planning, marketing, business development, physician practice management, and hospital operations.

Jay currently serves as a subject matter expert and strategic advisor to provider organizations establishing population health management capabilities to transition their clinical operations to a risk bearing entity. He has been featured in publications including Healthcare Executive and and presented at national conferences on the topics of healthcare strategy and marketing.

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