Managing Patients, Costs in Postacute Care Settings

Kaleb Kuhl, vice president of sales, Olio Health, discusses the cost variations associated with postacute care, the role of value-based care strategies, and what payers and accountable care organizations should know about managing patients who require this type of care.

Read the full transcript:

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 Kaleb Kuhl, VP of Sales at Olio Health. He discusses the cost variations associated with postacute care, the role of value-based care strategies, and what payers and ACOs should know about managing patients who require this type of care. Kaleb?

Thanks, Julie. My name's Kaleb Kuhl. I’m the VP of Sales here at Olio Health. I've been with the organization since December. Prior to that, I was with naviHealth.

I've spent the past, I don't know, probably five or six years talking with health systems, ACOs, payers about strategies for managing costs in the postacute environment. I'm looking forward to the conversation today.

Can you talk a little bit about the cost associated with postacute care?

Your listening audience is probably familiar with cost from a technical perspective, but what they might not know is how much variability exists in the space. There was an industry report published a few years back that stated 70+% of variation in Medicare spending comes just from the postacute space.

This is why a better understanding of postacute spend and how to manage cost is such a hot topic in the industry right now.

What role does value-based care play in the postacute care space?

I tend to think of this question from the reverse angle of, what role does postacute care play into value-based care? When you look at successful value-based care programs, you'll likely find a direct correlation to successful management of postacute care.

What that means is they're getting patients to the right first level of care, appropriate utilization, reducing readmissions, etc. Probably, the most critical role postacute care plays is getting visibility into a patient's care journey.

The biggest challenge for most payers and health systems is losing track of a patient and, ultimately, their progress once they leave the four walls of a hospital.

Now, we're starting to see the impact of transitional care management programs getting patients connected back to their PCP. That lack of visibility is a huge area for improvement for most.

What should payers, ACOs, and other stakeholders know about covering patients requiring time in a postacute care hospital?

The biggest thing they need to understand is we, as an industry, have created a very complex environment for postacute care providers.

What I mean by that is every payer, ACO, health system has a team of folks that have built very complex strategies for how to manage and drive the best outcomes for patients once they get into postacute care. The problem is most postacute providers, they don't have the same budget, technology, or resources to execute those strategies.

That's further compounded by the fact that for every postacute location, they're going to have three payers, two ACOs, four health systems, all with their own unique strategy. Calling, leaving message, showing up on-site every single day, wanting to know how their individual patients are progressing.

Postacute providers are overwhelmed with requests right now. The end result is payers, health systems, they keep investing more to try to fix the problem, but the full potential improvement hasn't been reached yet.

What is the next phase of postacute care management? Where do you see the future going?

To understand what the future looks like, it helps level set where we are now and how we got there. Today, PAC management has essentially gone through three phases, starting probably back in early 2010s.

Phase one was developing PAC scorecards, so using claims or performance data to try to rank providers. Phase two then took those scorecards and tried to develop these narrow networks, drive more patient volume to those that are perceived to be delivering better outcomes.

Phase three, which is what I would call the current phase—there's a lot of folks that are either here or trending in this direction—is all about developing care coordinators or patient navigation strategies. Essentially, building teams that are in the market, they're going to show up on-site. They're calling on these PAC providers, trying to manage patient outcomes.

In terms of the future and what I'm seeing for phase four, it goes back to my earlier comments about complexity. To date, none of the strategies that we've rolled out so far have involved postacute providers at all.

Again, as an industry, we've made it a point to hand out gold stars for doing a good job, or possibly a slap on the wrist for poor performance, but that's about it. This next phase needs to focus on making it much easier for postacute providers to execute these complex strategies and modernize how they're able to communicate.

With that, we're seeing much more emphasis on managing home health. It's that next phase as well. To effectively do that, you've got to have a much easier method of communication and work with those postacute providers to maintain visibility.

Overall, is there anything else you would like to add to this conversation?

The last thing I'll add is any payer or ACO that's focused on postacute management needs to consider three things.

How can I make it easier for postacute providers to communicate with me? How can I scale my strategy as our risk population grows? How do I work with the PAC community to get visibility into the patient's care journey so I can connect them with TCM programs or get them connected back to their PCP?

At Olio, I've seen from our clients how doing these three things, simplifying communication with PAC providers, effectively involving them more in the process, has generated tremendous results, not only for the payer or the system but most importantly, for the patients.

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