FutureFocus March 14, 2018 - Quality Data And Discharge Planning: Changes Ahead

Lisa Remington

In this week’s FutureFocus, we provide insights into how quality data influences discharge planning. Ongoing discussions at MedPAC are evaluating current discharge planning procedures and the future of the IMPACT Act for PAC providers. In another article, we focus on  Medicare reimbursement changing for physicians and new opportunities for post-acute providers to integrate chronic care management solutions. We provide resources and insights to tackle the topic. In the news, is talk about social determinants and the responsibility of providers. Learn how health systems, ACOs and payors are looking at different solutions.

Lisa Remington, President, Remington Health Strategy Group

Transportation barriers to healthcare, affect approximately 3.6 million Americans today. Missed appointments are a costly problem for providers and insurers, with estimates running upwards of $150 billion a year  in the U.S., according to the Washington Business Journal. The Transit Cooperative Research Program estimates non-emergency medical transportation, or NEMT, spending for Medicaid alone is $3 billion each year.  

Hospitals and Health Systems

Estimates suggest that 40–90 percent of health outcomes are attributable to social, behavioral, and economic factors. Despite broad agreement on the importance of addressing patients’ non-medical needs, little is known about whether and to what extent health care organizations operating under new payment models have addressed them. A study in Health Affairs of 32 ACOs provides insight to how they are addressing the non-medical needs of patients.

Three Non-Medical Needs Commonly Addressed by ACOs?

ACO leaders said that these needs were common among their populations, the needs affected how patients engaged in medical care, and the ACOs had the potential to address these needs.

  1. Transportation
  2. Housing
  3. Food insecurity

How Do ACOs/Hospitals Address Solutions to Transportation?

Many ACO leaders viewed transportation as a barrier for patients to receive timely high-quality care. ACOs addressed this need in different ways: Some ACOs collaborated with transportation companies, others relied on public transportation systems, and still others designed new programs. How an ACO met patients’ transportation needs varied based on the area’s geographic characteristics, such as its degree of urbanicity, and its transit infrastructure. ACOs in areas with high-quality public transit typically relied on existing infrastructure. For example, some ACOs gave transportation passes to patients before their appointments. One ACO provided monthly bus passes—which could be used for any transportation need—to all patients who had four or more medical visits per month.

ACOs in suburban or rural areas experienced challenges in meeting transportation needs because of poor infrastructure. One ACO invested heavily in a local community agency that provided medical transportation, so that the agency could expand its services. A rural ACO provided transportation services through an external for-profit transportation company. The ACO paid the company a per member per month rate that allowed it to provide comprehensive services such as a twenty-four-hour telephone line that the ACO’s patients could use to arrange immediate transportation for unscheduled emergency medical services.

Finally, one ACO in an urban area with poor public transportation was considering developing a mobile device application that would allow patients to request transportation from local drivers, who would be paid by the ACO.

A number of hospitals and health systems including Maryland-based MedStar Health  and HackensackUMC in New Jersey have partnered with rideshare companies like Uber and Lyft to cut down on no-shows and late arrivals. In addition, American Medical Response teamed up with Lyft to provide non-emergency rides for patients in 42 states, citing benefits to hospitals and health plans in reducing missed visits. And last year,  Blue Cross and Blue Shield said it would begin offering Lyft free to members of select BCBS companies to reduce missed appointments.

Health and Social Service Innovation: What Some Managed Care Organization Are Doing

Housing and Social Services

  • Consolidating health and social services in a single setting
  • Conducting housing needs assessments and supportive services in emergency department settings and developing shelter services for homeless patients following hospital discharge
  • Adding housing management as a plan offering and support for transitional housing
  • Emergency housing for refugees

Community Reentry for Formerly Incarcerated Members

  • Pilot reentry programs to complete Medicaid and plan enrollment before inmate discharge
  • Special needs assessment and support programs for formerly incarcerated members, including rapid enrollment into substance abuse treatment

Food and Nutrition

  • Provision of food in community locations
  • Support for community food bank operational and food-stocking costs
  • Coordination of home-based health services with food delivery programs
  • Coordinating senior nutrition programs with hot lunch delivery for members

By: Lisa Remington, President, Remington Health Strategy Group and Publisher, The Remington Report