Advances in medicine and growth in life expectancy have ultimately led to an increase in the complexity of cases in health systems throughout the country. Patients are presenting with more comorbidities and requiring coordinated, multidisciplinary treatment.
This was an issue well before the COVID-19 pandemic, which has since introduced “long-hauler” patients into the system. These patients require care from multiple specialists and around-the-clock advanced nursing care.
“Health systems are going to have to be able to provide very specialized care, all within their own continuum, to support medically complex patients and make sure they have the best possible outcomes.”
When patients leave the hospital and are placed in the care of other organizations, their health system loses control over their care and ultimately has little influence over whether the patient is readmitted, a key metric by which providers
are judged, especially under emerging value-based reimbursement models. Health systems that co-locate more of the continuum on their campus stand a better chance of avoiding these negative outcomes while capturing post-acute revenue.
“Our focus on financials is not and should not necessarily be the driving force behind how we care for our patients, but we all know that our ability to be reimbursed and manage costs is, in many ways, paramount,” Breier said. “Co-locating
services helps with reimbursement in a number of ways, but it is particularly helpful in coordinating care in very complicated cases.”
Although fee-for-service currently makes up a significant portion of most providers’ reimbursement, it is dramatically declining, especially for the older population of patients most likely to need post-acute care. “If you have coordinated,
specialized care that’s creating better outcomes and better financial results, that’s going to win in either paradigm, but as managed care and other value-based reimbursement becomes a bigger part of the equation, it will be even more
important to conduct care in a way that makes the most of the limited funds we’re given,” Breier said.
Breier credits a host of waivers, passed by Congress and regulatory agencies both before and during the COVID-19 pandemic, with loosening regulations and allowing for more flexibility in the settings in which care is delivered. Various changes have
allowed providers to be more flexible in how they use specialized beds in their hospital, allowing them to ease capacity and better manage strain on the ICU. These changes were a successful pilot for how care transitions can be improved through
integration of the care continuum and improved care coordination.
“The public health emergency and related waivers highlighted the value of partnerships, particularly between acute care hospitals and post-acute hospitals in relieving capacity and providing the specialized medical and rehabilitative care that
COVID and post-COVID patients required for a full recovery.”
While the pandemic has empowered leaders to break down barriers to innovation, it also has brought on a looming behavioral health crisis. Public health experts said in a British Medical Journal blog that they believe “the mental health
impact of the pandemic is likely to last much longer than the physical health impact.” Health systems face a shortage of physicians across specialties, but it is particularly hard to staff behavioral health beds. The need for behavioral
health services was already rising well before the pandemic, but the public health crisis is expected to exponentially increase that need. Telepsychiatry will help resolve gaps, but it won’t fully solve for significant inpatient needs –
providers will need to expand capacity on their own campuses.
“There is an unsustainable level of growth in behavioral health demand, and it’s a serious issue that is having an effect not just on patients’ mental health, but their comorbidities as well. We’ve got to get our arms around
it.”
Finally, a wave of consumerism across healthcare settings is requiring health systems to exert more influence over the patient experience across the care continuum. Consumers have access to more data and information about healthcare organizations
than ever before and are increasingly doing their own research to determine the best setting of care for themselves or their loved ones. This behavior of “shopping” for care isn’t limited to ambulatory care—patients are
demanding convenience and quality across the continuum and are more educated about their options, especially after the pandemic. Breier believes this preference is ultimately driving patients to choose a post-acute care option that allows them
to go home as quickly and safely as possible.
Getting patients home is important to providers as well, and can be an important differentiator. One of the most critical ways leaders can set their organization apart from its competitors is knowing how to provide the right care in the right setting,
and having the tools at their disposal to do it at the highest level of quality. When more specialists and advanced nursing resources are available in the space where patients receive post-acute care, providers can offer more intensive, cost-efficient
interventions that expedite the recovery process and get patients home faster. And for many providers, it will be important to not only make multiple services available, but also to ensure that beds can be used for differing services as demand
shifts, whether that be behavioral health, rehabilitation or other needs. As care increasingly moves to telehealth or outpatient, it’s important for leaders to consider how their inpatient facilities will evolve to remain cost-efficient
and responsive to emerging needs.
“The healthcare environment we’re in today is arguably more challenging than it has ever been,” Breier said. “Health systems across the country are being forced to quickly adapt and respond to rapidly changing patient needs,
all while maintaining financial stability and high-quality outcomes. Our view of the world is that co-locating multiple services
on a single campus and offering these specialty services
within a system’s own continuum really does open
the door in many ways not only to more high-quality
programs that have a positive impact on the health
system, but more broadly on the community itself.”