In Health Care, Who You Know and How Well You Know Them Makes a Difference

In a previous blog post, we emphasized that in providing good health care it is important who you know. Knowing your supporting specialists, hospitalists, skilled nursing facilities, and home health providers is now a key element in reducing costs and getting better clinical outcomes.

Knowing where your Accountable Care Organization (ACO) patients are going for post acute care could potentially remain outside of your management unless the ACO takes an active role in becoming part of that decision. At the same time that the ACO is assuming responsibility for the total management of the attributed patient, hospitals are being pushed to extend their care beyond the hospital walls. Hospitals must now monitor re-admission rates and carry extended patient responsibility for the CMS-initiated Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) care models.

Adams and Phillips recent hospital-centric article on how “downstream providers will have a growing effect on health systems’ reputation and bottom line” contains important clues for the local ACO.

As hospital executives begin to extend their reach beyond the hospital walls, this creates an opportunity for the ACO leadership to reach beyond the hospital walls and help establish the infrastructure to bring the clinical coordination of the patients’ needs in the post-acute setting. Your data analytics system should help you establish “informational credibility” with your local hospital(s) as an initial step in becoming a trusted partner. Keep in mind that your goals are similar:  reduced cost and better care in your language means the same as smoother transitions and few re-admissions in their language.

Not every recently hospitalized patient needs a SNF or home health service. On the other hand, every post acute patient will need an easy transfer to the post-acute process. That means that the ACO physician offices must be prepared to manage the volume and complexity of the patients that require immediate follow up. Additionally, since the patients “total cost of care” drops to the ACO’s bottom line, the ACO has a vested interest in a SNF’s quality track record and re-admission rate. Home health referrals require thoughtful consideration rather than mindless signing just to keep the desk clear. The hospital also needs to know about the efficiency of the providers that assist in the bundled care program. The ACO may have a strategic advantage by understanding and sharing the claims data regarding those patients that is loaded into your analytic system each month.

There is no question that the selection of clinical care partners requires a rigorous approach that demands a broad understanding of cost and quality. The ACO is in a position to create and manage the strong networks that hospitals need in this brave new world.


Craigan Gray

About the Author

Craigan Gray, MD, MBA, JD

Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings rich experience from private practice, hospital leadership, and governmental health-benefit programs. Prior to joining Salient, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. In addition to an MD degree, Dr. Gray holds an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.

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