Driving improvements that benefit all

Helion's quality improvement process and best practice education resulted in a readmission reduction of 21% and 16%, respectively, at two high volume skilled nursing facilities (SNF).
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THE CHALLENGE

Two high volume skilled nursing facilities (SNF) under the same ownership were in danger of network termination due to consistently poor outcomes, low engagement, and plenty of volume shift options in an over-bedded, urban market. Both facilities ranked at the bottom of their micro-market and struggled with high readmission rates and ED utilization, which subsequently had a negative impact on their total cost of care. Both facilities had suboptimal, disengaged leadership and participated very minimally in any Helion quality improvement efforts.

Local hospitals were hesitant to shift any volume to facilities due to poor outcomes and engagement, and since both skilled nursing facilities were located in urban markets, there were many other facilities that provided better outcomes for members to choose. Without significant improvement of quality and engagement, the SNFs would face termination from the network.

HOW OUR SOLUTIONS MADE A DIFFERENCE

Helion prides itself on being able to guide its partners to better outcomes, and we know that that requires a foundation of trust and a willingness to work with our partners to identify gaps and develop solutions that we know from experience will drive improvements.

Leveraging tools from our Network Conditioning and Provider Development toolkits, Helion’s work included:
  • Getting leadership at the provider organization to communicate the importance of improving outcomes
    and commit to supporting an effort to drive improvements.
  • Working with leadership at the corporate and individual SNF levels
    to identify and evaluate current-state gaps, identify best practices, and agree on what needed to change
  • Getting the specific SNFs to create and commit to an action plan
    that included steps to improve their performance.
  • Reviewing and improving processes
    for patient transfers between SNF and acute care settings, post-discharge follow-up procedures and escalations, home health provider vetting and integration, and 72-hour care conference discharge planning
  • Instituting bi-weekly calls
    to discuss progress against identified goals.

Results

The new processes and reviews allowed for deeper coordination between the SNFs and hospitals as well as harmonization between corporate and facility leadership on action planning. Over a 24-month period, after evaluating gaps, improving engagement, and deploying improvement efforts, dramatic improvements were realized:

Q4 2017 vs Q4 2019:

Micro-Market Rank:

  • SNF A moved from 10th place to 1st
  • SNF B moved from 10th place to 2nd place

Overall Ranking (Cumulative % Score of Weighted Ranking Metrics):

  • SNF A moved from 59% to 87%
  • SNF B moved from 43% to 79%

Risk-Adjusted 30-Day Readmission Rates:

  • SNF A moved from 28.9% to 7.98%
  • SNF B moved from 26.9% to 10.8%