Improving Recovery, Reducing Readmission Rates Through Care Coordination

Saleem Alinur and Sharon Lee, vice presidents of managed care at Kindred Hospitals, share strategies for improving outcomes for medically complex patients, emphasizing how care coordination meetings at the LTACH level can benefit both payers and patients.

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Welcome back to Pop Health Perspectives, a conversation with the Population Health Learning Network, where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we are joined by Saleem Alinur and Sharon Lee, both Vice Presidents of Managed Care at Kindred Hospitals, who will be talking about care coordination. Thanks for joining today. Would you like to introduce yourselves?

Saleem Alinur: My name is Saleem Alinur. I'm the Vice President of Managed Care for the East District for Kindred Hospitals. My background primarily has been in the payer space, so with the managed care companies, national companies. And I've also had some provider experience working with hospital systems as well, so I bring both of those experiences to this position.

Sharon Lee: And hello, my name is Sharon Lee. I am the Vice President of Managed Care for the West Division at Kindred Hospitals. I have been with Kindred for about 7 years, and my main background is on the provider side, mainly in the dialysis space. I have worked with large national companies and I've worked for startup companies.

Thank you both Saleem and Sharon for joining us today. Saleem, why don't you start by briefly telling our listeners about Kindred Hospitals level of care and what role they play in the care continuum?

Mr Alinur: Sure. Kindred Hospitals are known in the community as long-term acute care hospitals or LTACHs. You might also hear us referred to as specialty hospitals. We’re licensed as an acute care hospital, and we typically provide a longer-term acute care treatment plan.

We offer physician-centered care plans, not nurse- or therapist-centered care plans like some of our lower level of care like skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs). Most patients are post-ICU, but with greater flexibility for MCOs, managed care companies, to better control length of stay and total cost of care.

When complex patients leaving the hospital get this level of care from the outset, instead of immediately going to a subacute level of care, they are more likely to have an efficient recovery and less likely to readmit to the hospital, which ultimately translates into cost savings.

Improving recovery and reducing readmissions are, of course, important goals for everyone in the health care continuum. Are there specific strategies or programs at Kindred that help with these goals?

Mr Alinur: Yes, there is. At Kindred we have a number of programs that are focused on improving patient outcomes and satisfaction. As a hospital system, we're certified by the Joint Commission in respiratory failure and sepsis, which ensures that we are providing consistent, quality care. We also have what we call our “Move Early Program,” in which our rehabilitation specialists help patients get up and start moving even when they are on a ventilator, which helps with the recovery process.

Mr Alinur: Another initiative is our interdisciplinary care team bedside meetings, in which physicians and other caregivers gather at the patient's bedside every day to discuss progress and answer questions, which has the benefit of increasing patient satisfaction and adherence to treatment plans. Another important initiative, finally, is the care coordination meetings that we work with our managed care partners on.

Care coordination can mean a lot of things. What do these care coordination meetings look like at Kindred?

Ms Lee: You're certainly right, they can mean a lot of things, but in this case, we're specifically talking about regular clinical meetings between us and our payer partners that usually have a lot of high volume of admissions at Kindred. We started having these meetings back in 2018 with just 2 plans, and now we have 30 different plans because payers have seen the value in these proactive and collaborative discussions.

During these meetings, the medical directors and utilization management nurses from the payer side and case managers from the Kindred side come together to discuss each patient, which has several benefits for payers and patients. One of those benefits that the payers really like—it really reduces the administrative burden. Our case managers are in the hospital with the eyes on the patient and they can explain what's going on with the patient and what might be holding them back from a discharge.

Also, payers can ask questions in real time with the case managers or even the attending physician. This increases efficiency for payers because the live question and answer opportunity cuts down on a lot of back-and-forth phone calls and paperwork.

Another big benefit is that it it really helps both parties with overcoming barriers to discharge. In some cases, patients may clinically be ready to discharge to a lower level of care, but are unable to do so because they require special accommodations or because the next level of care doesn't have the capacity. When providers and payers get together, we find solutions to these barriers and help move patients officially through the continuum, which is always what Kindred is striving to do.

And then finally, a third benefit is that the coordination meetings help us align medical necessity and the care setting appropriately. Particularly challenging, medically complex patients may benefit from remaining in a more specialized acute care setting. If the payers and case managers are talking regularly, they can better understand the patients’ needs, including their social determinants of health that may impact outcomes post-discharge, and they can make sure they have access to the appropriate level of care—ultimately reducing readmissions and the total cost of overall care.

Thank you, Sharon, and thank you so much for this thorough explanation. Is there anything else that you would like to tell our audience?

Ms Lee: Yeah, I think I would just like to reiterate that there are so many benefits in a partnership between Kindred and our payers. These types of discussions help promote that quality of care Kindred aims for with every patient we see at our hospitals.

Great. Thank you, Sharon. And thank you, Saleem, for joining us today. Thanks for tuning into another episode of Pop Health Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.

This transcript has been edited for clarity.