Would Preferred Provider Relationships Work for You?

Think collaboration and redesign your way of doing business.

By Joyce Ryan Boin, PT, MA

The creation of a preferred provider partnership is an innovative strategic response to the significant impact that changes in reimbursement are exerting on all segments of the health care continuum.

Several programs have been initiated that will challenge traditional reimbursement. MedPac, a unified payment system for post-acute care with payment based on patient characteristics instead of site of service, continues to move to a 2021 implementation. Bundled payment programs will continue to increase. Value- and outcome-based payment models will continue to drive reimbursement. Other factors contributing to the need to coordinate care delivery include the Medicare Hospital Readmissions Reduction Program, with penalties up to 3 percent for re-hospitalization being imposed. Accountable Care Organizations (ACOs) and other hospital systems seek to impact cost and improve outcomes through the establishment of post-acute care networks.

These changes in the landscape demand the re-design of how all segments of the patient care team do business within the health care continuum. Strategic preferred provider partnerships offer an effective approach to integrating and coordinating the patient’s journey across the continuum, resulting in improved patient outcomes and lower costs.

What Is a Preferred Provider Partnership?

The movement away from fee for service and volume-driven reimbursement models requires providers to reexamine the clinical operations delivered. A partnership established with key, valued referral sources allows the therapy provider the opportunity to develop a dedicated, comprehensive relationship with its partners. This re-design includes:

• Enhanced integration and coordination of the patient through each transition of care
• Removal of the silos of information among providers
• Focus on patient-centered care model
• Transformation of a patient’s experience through integration of all interventions
• Establishment of communication tools and processes unique to the needs of our partners to facilitate improved outcomes
• Demonstration of a shared accountability and engagement to patient, physician, families
• Supporting the outcome measures of partners to achieve a 5 star rating and maximal reimbursement

What Differentiates a Partnership from Ordinary Business?

The development of a successful partnership requires a mutual commitment to the development process. Identifying shared values and culture allows for the basis of a strong relationship. In this climate of consolidation, a single provider will find it increasingly difficult to maintain a market share. Alliances already create the framework for improved transitional care as hospitals connect with skilled nursing facilities, and home care agencies partner with outpatient providers. In some markets, these collaborative arrangements have even moved to shared professional staff. Who wins in these collaborative arrangements? That would be the patient! With facilitated communication giving access to documentation from early stage interventions through discharge to independence, it is the patient who benefits. While a strategic partner may celebrate the financial impact of keeping the patient from a hospital readmission, it is the patient who benefits from a potential decline in their status with another hospital stay.

I have participated in the development of several post-acute network partnerships. I believe strongly that in creating unique provider alliances among segments of the care continuum the rehab professions will not only survive reimbursement challenges but also can lead the way to demonstrating a new and improved business model. There are key components to consider as a development plan is initiated.

• Establish clear, specific communication expectations. This might include meeting schedules, reporting mechanisms, information technology (IT) interoperability.
• Develop transitional hand-off criteria and processes to ensure smooth transitions between continuum partners.
• Adopt clinical guidelines and quality performance standards supportive of a consistent, comprehensive care plan.
• Regularly assess the effectiveness of clinical interventions to promote continuous improvement in the quality of care against mutually agreed upon performance targets.
• Develop performance-reporting tools shared among all providers displaying key data points, such as patient satisfaction, utilization data, or financial targets if appropriate.
• Develop shared patient education materials.
• Complete market assessments with current and potential market share identified.
• Create an advisory board to review and evaluate processes and measures supportive of the customer need. This team may include physician, referral source, professional and patient representatives.

My most recent experience in creating a preferred provider alliance has afforded me the opportunity to network home care providers and outpatient facilities with a unique twist. We are incorporating the use of outpatient therapists into home care. This is not a new concept. However, we are implementing a variance to the typical model, which ensures that appropriate orientation and training is provided to every therapist as they move between specialty areas. Good outcomes are hampered if each therapist is not familiar with the rules and regulations governing each area in which they provide care. While I was the director of a large home care agency in the Chicago area, I was responsible for the provision of thorough and accurate education to therapists new to the home care environment. As you might expect, this had a positive impact on patient outcomes and decreased levels of stress for the therapists.

In summary, successful preferred partnership arrangements can offer exciting and professionally rewarding opportunities for the future of rehab. My best advice is to plan them carefully, educate appropriately, and reap the benefits!

Joyce Ryan Boin, PT, MA, is the administrator of LifeCare Home Health in Northbrook, Illinois. She can be reached at jboin@lifecareus.com.