Trend Report

    Best Practices for Managing Narrow Networks

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    What, exactly, is a narrow post-acute network?
    Some hospitals have begun forming narrow post-acute networks in which they utilize and perhaps even contract or acquire the “best post-acute providers.” Preferred networks represent an aggressive new strategy by hospitals to gain more control over quality and costs in the largely independent skilled-nursing facility (SNF) sector.

    What are providers looking for?

    Health systems already using preferred networks have developed criteria for selecting SNFs using state health and safety reports and quality measures reported to Medicare. This includes how well nursing facilities prevent pressure ulcers, manage pain and provide vaccines. Hospital officials also scour Medicare billing data to review facilities’ average length of stay and what percentage of patients return to the hospital within 30 days.

    Here are some other criteria that have been used by accountable care organizations (ACOs) as they build out their continuing care networks: 

    • Compliance with federal and state regulations
    • Meets or exceeds median for federal quality standards
    • 30-day hospital readmissions rate at or below national/state norms
    • Patient satisfaction ratings at or better than state median
    • Patient and family engagement: data and tools
    • Attending SNF physicians include primary care physicians and extenders that are part of a health system’s physician network
    • RNs in the SNF 24/7
    • Use of INTERACT 3.0 tools—these tools, developed by Joseph Ouslander M.D., under a contract with CMS, include forms and processes designed to enhance critical thinking among nursing staff in SNFs to reduce hospital readmissions and improve patient outcomes
    • Appropriate nursing hours per patient day for subacute care (4.25)
    • Average length of stay for Medicare patients at or less than national average (<30 days)
    • Discharge at least 60 percent to the community following subacute care

    • Ability to share information electronically

    Is building a post-acute narrow network in your organization's best interest?

    Narrow networks may be a quick solution worth trying, but do they offer the best long-term solution for both providers and patients?

    While acute- and post-acute providers share the goal of avoiding unnecessary inpatient stays, a hospital’s facilities, protocols and standards are very different from those of an SNF. And the communication gap between hospitals and nursing facilities often is larger than anyone ever realized.

    How do we bridge the gap?

    In a word, technology. It is more important than ever before that hospitals be able to examine the full range of options available in the post-acute community in order to optimize the care patients will receive post-discharge. Rather than narrowing options for discharge planners, patients and families, better long-term outcomes could be achieved by leveraging technology and data to guide post-acute decision-making.

    By keeping the network broad and using technology to filter information, finding appropriate care at the right time for patients can more effectively be accomplished. Reliance on technology rather than narrow referral patterns can also allow members of a care team to focus attention on those patients at greatest risk for readmission, enabling early interventions and potentially eliminating return acute care visits.

       

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