How Investments In Tech Help Narrow Networks and Patient Choice Coexist

by Luis Castillo on Aug 8, 2018

Physician Using LaptopRight now, two phrases are shaping the post-acute care conversation, and at first glance, it appears as if these two concepts are diametrically opposed to one another. The first phrase is “patient choice.” The second is “narrow network.”

Patient choice is something that most patients rightfully consider to be important. The concept of the family doctor is ingrained within the consciousness of the average citizen. The idea that an insurer can come around and say a particular physician is going to be out of network, and thus prohibitively expensive, draws the ire of people who want the right to see the person they’ve entrusted their care to for years.

Then, on the other hand, we have the idea of the narrow network. As hospitals struggle to contain costs and ensure the facilities they refer patients to meet certain performance standards, thereby reducing the risk of readmissions that trigger huge financial penalties, the idea of establishing a set of preferred partners holds mass appeal.

You can see how these two ideas could stand at odds to one another. It’s in a hospital’s best interest (and often financial interest) to discharge patients to a facility that’s most capable of ensuring the appropriate level of care for that individual. But the hospital also has to provide the patient with information about their prospective choices and honor that person’s wishes — even if that patient is choosing a hospital that their own providers might want to dissuade them from.

It begs the question: Are these two ideas compatible?

I would say yes, narrow networks and patient choice are indeed compatible. In fact, when looking at the letter of the law itself, it’s possible to both establish a narrow network and ensure patient choice and to do so in a way that honors that most cardinal healthcare rule: to serve the patient’s best interests.

The key is to be upfront about the narrow network and the financial interests that tie the associated facilities together. When presenting a patient with a list of prospective post-acute organizations they may be transferred to, it’s well within reason that hospitals list the preferred, narrow network facility first. As they do so, they can explain to the patient the current relationship and explain the reason for it: because these facilities have historically achieved the best performance.

Hospitals must act transparently, providing assorted data and quality metrics to the patient in order to help them make a sound decision about their care. In the ideal narrow network, one where hospitals evaluate a post-acute facility’s performance and then partner with the highest achievers, the facilities that stand out will be the very same that stand out to the patient.

Thus, it’s in all facilities’ best interests to create narrow networks, not just for their own well-being but for that of the patient.

When presenting post-acute discharge choices, having a narrow network available that's been studied closely to determine what organizations truly deserve a spot, hospitals are looking out for a patient’s overall wellness. They've made an objective decision based on the data to partner with these facilities and are now explaining to the patient the calculus behind that decision and allowing them to come to a similar conclusion. And if they conclude otherwise, they have that option and hospitals have the ability to honor their choice.

At my organization, we talk about it as the Netflix effect. When you’re at home trying to find something to watch and so many options are presented, it’s difficult to land on a choice. But when you see a section of recommendations that are "based on your interests,” you have a means of narrowing down your options. And you can still decide to watch something entirely different!

So it goes with the presentation of facilities within a narrow network. Rather than just handing over a piece of paper with a list of dozens or hundreds of post-acute facilities and saying, “good luck,” hospitals can close in on the facilities that best meet patients’ needs and bring those to the front of the queue. They're not telling a patient they can’t go to a certain facility, they're showing them the highlights of facilities that will treat them with a certain degree of care.

Doing this necessarily requires hospitals to have a long-term plan and an investment in an IT solution capable of sifting through the vast array of data at their disposal. Rather than build from scratch, it's in hospitals' best interest to rely on third-party software to meet this goal. Predesigned tools can provide rankings based on any number of metrics chosen by the case manager, with customization options for listing preferred partners within a narrow network. It's not exactly drag-and-drop, but once an in-network partner has been identified, getting them added is mostly a matter of inputting data. There's also a good chance that tools will have the major post-acute providers in a given geographic area already in the system.

In most cases, this software does not require integration with your current EHR system, meaning it can act as a standalone solution that lets you refer to providers as necessary. However, some can actually integrate with many of the tools themselves, so that there's an unbroken chain of causation leading from the care plan all the way to the patient choosing their post-acute facility (or facilities). Patients also have the option to verify electronically that they have been presented with the necessary choices.

Patient choice and narrow networks can and should be aligned. By partnering with facilities that meet a certain threshold of care, hospitals can help patients sift through the data to make a valid, educated choice about their care.

Originally posted on Forbes Technology Council (view original).

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Meet the Author

Luis Castillo has more than 30 years of experience in healthcare information technology. Prior to joining Ensocare, Castillo served as senior vice president at Siemens Healthcare, where he was in charge of IT sales, service and marketing. He was responsible for developing alternate markets, sales strategies and sales channels in order to grow the healthcare information technology business. Luis’ broad and deep experience has served to hone his leadership skills and business acumen, and he is a sought-after participant in strategic initiatives and global partnership efforts. He earned his Bachelor of Science degree in political science from Haverford College in Haverford, Penn.