With real-time interventional analytics, care management teams can monitor member data and respond to changes in status immediately. In nursing homes and skilled nursing facilities (SNF), historically challenging settings for health plan monitoring and care management, immediate data analysis is a better solution than relying on past data to predict future problems.
"Individuals in these facilities are a special population, one that health systems and health plans often lose sight of from a care management and data perspective. But the adoption of real-time data analytics driven by value-based care models provides a way to improve care coordination and outcomes in these settings," says Margaret Latrella, MSN, APN-C, vice president of clinical and network quality for Real Time Medical Systems.
The timing of this adoption could not be better given the push by the Centers for Medicare & Medicaid Services (CMS) to shift beneficiaries to value-based care as part of Medicare Advantage and an aging population.
"Now, this population is receiving continuous monitoring due to Accountable Care Organizations becoming part of this space," Latrella notes. It is a tremendous benefit to have another set of eyes helping to impact health outcomes."
Value-based care models demand that health plans improve member outcomes while decreasing costs. Real Time's analytics technology is a key to success.
"It's not just valuable. It's critical. It's part of our ability to take on risk and care for these members," reports Keith Persinger, chief operating officer for Provider Partners Health Plans, a multistate payer specializing in tech-enabled value-based care models in Medicare Advantage for members in skilled nursing, assisted living and other long-term care facilities.
Provider Partners uses Real Time's Interventional Analytics solution to support its onsite and offsite care management teams. "If we did not have real-time data, we would be taking on the risk of coverage blindly. With interventional data and a human element, we can take a real, true care management approach with our members, Persinger emphasizes.
Impact on direct care management
Nursing Homes and SNFs have faced a myriad of challenges in tracking subtle changes in member health status. Even under the new CMS minimum staffing rule, they may have the capacity for routine care and not much else. "Basic stuff can get missed because people are busy. There's not enough staff," Persinger notes.
Real Time's analytics technology mines the electronic health record (EHR) for relevant data, identifying clinical changes and concerning trends. Then, a care coordinator analyzes the data. "It's not just a skilled nurse, but a skilled nurse with a long-term care background who knows how to maximize the software. It makes a difference in the member’s care," says Persinger.
The care coordinator alerts onsite staff to subtle changes in condition, such as weight gain and edema in a member with heart failure. "The software analyzes the post-acute EHR documentation, 24/7, using both structured data, like weight or pulse, and unstructured data, like keywords in nursing notes," explains Latrella. "We present live clinical alerts and insights to care teams. With this level of communication, everyone knows what is happening with the member and the physicians can intervene early before an adverse event occurs. It's data, plus the human element."
Staying ahead of subtle changes in member conditions helps care teams react in the moment, potentially avoiding complications and (re)hospitalizations. "It reduces unnecessary trips to the hospital," Latrella states. "If you can intervene sooner, you can stop members from declining."
As physicians build trust with care coordinators and act on alerts, they can see how early intervention leads to successful member outcomes. "The knee-jerk response is to send a member to the hospital, but LTPACs have come a long way. When you intervene early, a lot can be done in the facility," asserts Latrella.
Cost savings and economic benefits
According to CMS, 15% of patients are readmitted to the hospital within 90 days of discharge, costing the healthcare industry over 20 billion dollars annually. The post-acute care population is especially vulnerable. "Transitions are rocky periods. Having data to back up care coordination efforts means you can really make a difference in member outcomes," says Latrella. "It decreases utilization, but most importantly, you're doing what is best for the member. And, when you do that, the cost savings naturally follow."
Beyond reducing readmissions, accessing real-time data can improve a wide array of financial metrics and guide appropriate utilization. "Medicare Part A covers 100 days of skilled nursing time, and then there has to be a 60-day break before members qualify for more. It is important that the member receives the appropriate level of care so Medicare days are available when members need them," Latrella comments.
Health plans are seeing the financial impact in other ways. "You want a lower length of stay in a hospital, but in LTPAC care settings, a longer stay means you are managing members better," explains Persinger. "We are hearing from facilities that our members stay much longer. It also makes a difference for the facility financially. For the member, it means a longer and better quality of life."
Staff benefits of real-time analytics tools
In healthcare, digital tools must avoid adding more work for direct care staff, which is crucial when they're short on time and resources. Beyond that, real-time technology can also improve workflows.
"As a provider, having your members' risk stratified helps you manage your day appropriately, identifying those at highest risk. Rather than going through every member to discover who needs your attention first, care can be prioritized based on level of risk for (re) admission and current clinical alerts," Latrella observes.
Real-time data analytics can also reduce repetitive work, alleviating administrative burden on care teams. "We have an infection control dashboard that tracks the type of infection, antibiotic ordered and whether it's hospital-acquired versus community-acquired. It saves staff hours of manual entry for required reporting," says Latrella.
Real-time analytics in the future of healthcare
The utilization of real-time analytics is destined to grow. With CMS' goal of having 100% Medicare Beneficiaries in a value-based contract by the end of the decade, the need for real-time data analytics will become more crucial than ever before. "There's a push from Medicare to move the fee-for-service population into value-based care," Persinger highlights. He reports that this population includes millions of beneficiaries.
CMS may not immediately mandate moves into value-based care programs, but Persinger predicts CMS will continue to "strongly encourage movement to VBC with incentives for providers, and this includes the LTPAC space, often overlooked."
"This is going to transform the level of care. It's clearly benefiting everyone who is using it now. Everyone wants to reduce healthcare costs, and these programs help achieve those goals," concludes Persinger. Early adopters of real-time analytics technology will be prepared for value-based care shifts and tangibly improve member outcomes for populations in short- and long-term facilities.
