Insights Magazine Volume IX - Page 16

(continued from page 13) process for a patient while in the hospital to the actual patient admission into the SNF, the process is not only resource intensive and often confusing, but typically varies by hospital and SNF. The Value Network would create standard processes so each discharge and related admission are predictable, automated and easier for all stakeholders. 2. Delivery of Care: Once the patient is in the SNF, the delivery of care must be consistent so any provider in the Value Network has standardized, measurable outcomes that can be reviewed, compared and used for quality improvement. By utilizing standardized care guidelines, the variability in the care and lengths of stay can be minimized. Patients with the same diagnosis and similar simultaneous disease states presented at different SNFs within the Value Network would be expected to have similar lengths of stays and positive outcomes. If they did vary, the IT solution would contain the data to perform a root-cause analysis to determine the factors that created the difference. If the care guidelines are different with varying expectations, comparative data analytics will provide little value. 3. Discharge: The SNF discharge process typically begins upon admission. However, when the patient successfully completes his/her care, the actual discharge varies significantly by SNF and necessary support services often fall through the cracks. The Value Network IT solution would prompt those involved in the discharge process with the patient requirements and document that those required needs are in place. This would include capturing the patient experience and ensuring the discharge is to a safe and supportive environment. Otherwise, when the patient’s needs are not met at discharge, the opportunity for emergency department visits and hospital readmissions increases significantly. 4. Post Discharge: When the patient has been discharged, the SNF must continue contact with the patient to again minimize the opportunity for emergency department visits and hospital readmissions. That ongoing patient engagement should create an avenue for communication between the SNF and other caregivers and the patient. By maintaining a strong relationship with the patient after discharge, the SNF can identify any patient needs that could be mitigated prior to an emergency department visit or readmission. The Value Network IT solution would monitor those communications and related interventions (if any) to determine common causal factors that could be improved upon and reinforced with the providers in the Value Network. This would help reduce unnecessary care costs and improve the patient experience throughout the market for the Value Network providers. Achieving the Triple Aim Only by connecting the Narrow Network providers and using a common IT solution can the acute providers and payors evolve the Narrow Network into a Value Network. By capturing all of the care-related patient throughput and delivery in a uniform and predictable way, the Post- Acute Value Network© can truly reduce cost, improve care and enhance the patient’s experience. LEARN MORE VIDEO: Why Value Networks Are the Future of Health Care Learn how setting up a Post-Acute Value Network© ensures geographic coverage and survival for health care providers. View the video at 14