LTACHs, Payers Collaborate for Better Outcomes and Reduced Costs

Audra Early, senior vice president of strategy and network development, Kindred Hospitals, discusses the role of long-term acute care hospitals (LTACHs) in patient recovery, how LTACHs alleviated burden during the COVID-19 pandemic, and how successful partnerships with payers can result in better outcomes and lower costs of care.

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Welcome back to PopHealth 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 Audra Early, senior vice president of strategy and network development at Kindred Healthcare. She discusses the role of long-term acute care hospitals in patient recovery, how LTACHs alleviated burden during the COVID-19 pandemic, and how successful partnerships with payers can result in better outcomes and lower costs of care. Audra?

Hi, I'm Audra Early, senior vice president of strategy and network development for Kindred Healthcare's hospital division. I lead our teams, who have responsibility for our managed care payer relations and contracting and have responsibility for Kindred's value-based initiatives with payers.

Can you please share where long-term acute care hospitals (LTACHs) fit in the health care ecosystem?

Yeah. In general, LTACHs specialize in the treatment of medically complex, critically ill patients that require extended care, usually after a stay in the ICU or med surg of a general acute hospital, and who are at risk for readmission.

A few things that we often get asked are how are we different as a level of care? I say that a few things that differentiate us from other postacute care settings is our ability to provide ICU, CCU-level care with daily physician oversight, and 24/7 respiratory coverage.

We also have a very high-level, unique capability to do diagnostic testing in our hospitals. Not every patient's going to need an LTACH as part of their recovery. Truly, about only one percent of all discharges from a general acute care hospital would benefit from the care we provide.

For those that will benefit from a stay in an LTACH as part of their recovery, they're typically the most difficult to treat. Those who are ventilator-dependent, have respiratory failure or septicemia, they might require dialysis or have postsurgical needs, and generally, those whose illness is complicated by chronic conditions.

These are the patients that often require that extended recovery time in a setting that combines both intensive care and specialized rehabilitation in a hospital-based setting.

Why are LTACHs important for managed care payers?

I'd say, with the rise in chronic conditions, we've generally seen that our population is becoming sicker, more acute, and even more so during the COVID pandemic. Health systems and payers are increasingly challenged, and will be, to treat more complex patients.

Therefore, the need to provide the level of care that LTACHs deliver is going to grow in importance. At the same time, there is the significant pressure for hospitals and postacute providers to deliver on better outcomes for patients, driving higher levels of quality, being more efficient about the care, and generally working to focus on reducing and managing the cost in the health care system.

For all these reasons, it's important that payers and value-based organizations continue to ensure that they're giving consideration for their networks to include LTACHs, because we can certainly provide that specialized care for these more complex patients and be a good cost-effective partner.

Regarding the partnership between LTACHs and payers, what were some of the main lessons learned during the COVID-19 pandemic?

It certainly highlighted the role that LTACHs play in the health care continuum. During each of these waves, LTACHs have served a valuable role in helping to decompress the overburdened health system, as we've seen rises in hospitalizations with each of these surges.

Throughout the COVID pandemic, our LTACHs, as well as some of the ERVs, have played a critical role in caring for patients with COVID and in postrecovery needs. Our hospitals are really equipped to care for high-acuity patients.

We have airborne isolation rooms. As mentioned, we have ICU beds that are licensed. This is what makes us more of a capable setting to care for COVID patients. As an example, during the initial wave of the pandemic, our hospitals served as a relief valve to assist acute care hospitals with their capacity challenges.

Then we've quickly pivoted to establish these COVID-designated units within our hospitals in different markets across the country. In regard to our relationships with managed care payers, the importance of transparency and communication has come to the forefront.

We've seen that happen in a few different ways. First, the federal prior authorization waivers that have been instituted by many of the health plans across the country throughout this national emergency have been extremely beneficial in ensuring that patients have timely access to the specialized care they need, and that they can transition through the continuum with much greater ease.

It's allowed our LTACHs to work directly with hospitals and health systems, both locally, nationally, in more of a real-time way, so that we can be more responsive to the needs that they have to increase capacity within their hospitals.

I'd say secondly, the pandemic disrupted a lot of the ways in which we've engaged with payers in the past. Prior to the pandemic, we would have clinical and care management teams from the health plans in our hospitals, rounding on their patients.

Restrictions, obviously, for visitation in our hospitals has created a barrier. We've had to seek new options and different ways to keep the communication at a high level with payers.

The pandemic's just made it necessary for us to have more of that real-time communication with our payer partners, particularly around coordinating care for their members in our hospitals. We do believe that patients have benefited from this.

By aligning our goals and having that better communication, we've been able to work together more collaboratively, and we're able to address some of the barriers in real time, close any gaps that we're seeing, and ensure that we can set the patient up to continue their recovery at home, with the goal to minimize risk of readmitting to the hospitals.

Can you tell us a bit about Kindred Healthcare's approach to managed care and your specific value as a partner?

I would say our vision is to be a true partner with managed care plans and care patients. In the past, our relationships with payers have been good, but they've been more transactional at best. I would say more to define payment terms on a contract and processes between us.

What we have done is taken large steps over the past three years to become a true partner. We recognize that each payer and health plan have different needs for their populations. They have unique pain points or problems they're trying to solve for.

We've just not taken this one-size-fits-all approach to building our partnerships. Just as our patient care is individualized in our LTACHs, so are our relationships and partnerships with payers. We've done a lot of listening in our engagements to understand their goals, what some of their challenges are, and what a valued partner looks like to them, and we've strived to be that.

The approach that we have taken is to seek ways in which we can collaborate better for the benefit of the patient. We've focused on ways in which we can improve access for their members to our level of care, to have higher levels of transparency between us.

Again, addressing and closing gaps in the care delivery, so that we can ensure a better experience, and all against this backdrop where we're trying to be more efficient about the cost of care. Those are the main focus points in our ability to drive better conversations with payers.

Over the three years that we've focused this way, we've changed a lot in the way that we're delivering and providing care in our setting. It's producing more value for us and for payers. For instance, we have regular meetings, what we call joint quality committee meetings, which provide a forum for us to sit down on a regular basis and talk through all the things that I mentioned.

We've also stood up care coordination calls, like I mentioned, during the pandemic, which are truly more these real-time conversations to look and focus on addressing barriers to getting patients home, but also, how can we partner together using the services of the health plan to help us achieve that goal?

Then, again, thinking about what happens after discharge, Kindred has a very unique aftercare program that is focused on when patients transition to home, that we have these touch points of communication with patients at different intervals to ensure successful transition to the home.

What we have found is that, by identifying that patients get their primary care appointments, outpatient visits, access to medications, that it does limit the potential that they could have a readmission, and it gives us a feedback loop with payers as well.

I believe that is our newer initiative on the value-based front for Kindred to work with payers. It's given us an opportunity through these value-based type arrangements, which is a higher level of partnership, but it's given us the opportunity to align our goals with payers on both cost of care and quality.

It is increasing the level of accountability to the outcomes that we're providing for care. Although this is a newer initiative, it's one that we've taken serious time to invest in. We do see and hear from our payers that this is providing value to them.

We just believe that there's always this next level to achieve in a partnership. We're in continuous pursuit of that next level with payers, because we know that when providers and payers are collaborating, and we're more aligned, our patients benefit from that. That's ultimately where we are both aligned.

Is there anything else you would like to add to the conversation today?

No, I just really appreciate the opportunity, and thank you so much for the time, Maria. It was great to be able to talk through the unique benefits of LTACHs, and also share a bit about Kindred's approach to building partnerships with managed care payers. Thank you.

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