Identifying Barriers at the Bedside Is Key to Working Toward Solutions with Regulators, Partners William Altman, Kindred’s Executive Vice President for Strategy, Policy and Integrated Care, appealed to participants at Kindred’s fourth Clinical Impact Symposium, Care Transitions Across the Continuum, to share barriers they are facing at the bedside with company leadership, so that they might more effectively work toward solutions with regulators, managed care plans and partners. The 400-participant audience is made up of clinicians and managers form Kindred facilities across the nation.

Today’s healthcare environment is based predominantly on a fee-for-service model, Altman said, but that will be changing. The healthcare landscape of the future will likely be characterized by:

  • A larger role for managed care providers and Accountable Care Organizations (ACOs)
  • A significant change in payment structures, including the provision of a set of services for a fixed fee
  • A greater focus on care management across the continuum of care

“This transition to future world of integrated care and integrated payment is going to be challenging,” Altman said, and there will be many conflicting messages as we collectively try to navigate it.

Kindred is uniquely positioned to take advantage of the changing healthcare landscape. Many of our recent successes play directly into the goals collectively set forth by the healthcare system in the United States. Kindred’s Transitional Care Hospitals have achieved a 12 percent length of stay decrease (with an even more dramatic decrease in certain markets, including Las Vegas). Nursing and Transitional Care Centers have achieved a 27 percent decrease in length of stay, and we’ve lowered rehospitalization rates by eight percent in both hospitals and skilled nursing facilities, providing a high level of value to our hospital, health system and payor partners, Altman said.

However, Kindred will face challenges in adapting to the new environment as well, he said. Payment rules designed to address fee-for-service issues may inhibit innovation around patient-centered integrated care models and may unnecessarily increase the cost of care, he said, and those evolving issues will need to be addressed. The 25-day Long-Term Acute Care (LTAC) Hospital length of stay requirement for Medicare Advantage patients, he added, may negatively affect a move toward patient-centered care, because it dis-incentivizes reductions in length of stay. Under the proposed model, there are currently no government incentives for post-acute providers to reduce rehospitalizations. These challenges underscore the need for Kindred leadership to hear from the field about anecdotal barriers to care.

As we move toward the future, Altman suggested several factors to consider in designing integrated care models:

  • In each market, we must consider the structure of the physician practices, hospitals and health systems. Is there a dominant provider? What is the physician composition? Are they employed, staff-model physicians or are there many independent practices?
  • Does managed care have high or low penetration in the area? What is the dominant managed care organization in the market?
  • We must pay attention to avoiding the creation of redundancies.
  • Have ACOs penetrated the market and if so, how much?

Innovation will be necessary in this new world, and bright, forward-thinking people on the ground and in the field will be key to successful evolution for Kindred and the entire American healthcare system.