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.
Helion prides itself on being able to guide its partners to better outcomes, and we know 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.
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.
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: