Reform is quickly approaching and before we can enunciate “Patient Protection and Affordable Care Act”, over 30 million more Americans will have entered the U.S. healthcare system. Beyond improving access, a paramount objective of PPACA is to create integrated care and payment models that demand higher degrees of accountability and drive improved health outcomes. Today, care delivery in the U.S. is highly fragmented and is plagued with little coordination and communication across the healthcare system. Physicians are encouraged to narrow their focus and are trained to become experts in very specific medical disciplines, and many healthcare strategists argue that delivery models with greater focus and more repetitions (commonly referred to “focused factories”) improve outcomes. While this “practice makes perfect” model has shown signs of success within each silo, it undermines the importance and value of care coordination between them. CMS currently estimates unavoidable hospital readmissions at $17 billion per year, a number that is poised to escalate as more American access our disjointed care delivery system.
Without holistic, integrated care coordination models, patients bounce between multiple sites of care (home, ER, hospital) repeatedly, leaving the patient with hefty medical bills and suboptimal care regimes for a full recovery. Unnecessary admissions and readmissions are a strong indicator of our systems ability to coordinate care across the entire continuum of care. The post-acute care market represents a significant share of the care continuum and is an area of particular focus within the reform bill. Care delivered following a patient’s discharge from the hospital including, but not limited to skilled nursing, rehabilitation, home health and hospice is highly fragmented and is void of coordination and communication.
A number of companies are making significant strides in improving care coordination are reducing unnecessary admissions and readmissions. Here are innovators in the market:
- NaviHealth. Created by Select Medical and Universal American and backed by Welsh Carson, NaviHealth partners with health plans, health systems and post-acute providers to manage the entire continuum of post-acute care. In February 2012, NaviHealth purchase SeniorMetrix, which utilizes a decision-support technology to project therapy regimens, most appropriate care settings and timing of expected outcomes
- CareCentrix. Carecentrix is a provider of home health benefits management services that recently launched a Care Transitions program designed to reduce avoidable hospital admissions and other adverse medical events.
- Independent Living Systems (ILS). Backed by Oak Investment Partners, this company provides care management services to over 100,000 Special Needs individuals. ILS’ Post-Acute Support System (PASS) is a patient-centered intervention program that controls costs and improves outcomes as patient’s transition across care settings.
With or without healthcare reform, a tremendous opportunity exists for innovative solutions that strengthen the seams between healthcare settings and promote a more holistic, integrated care system. Delivery models and supporting technologies that can help patients navigate our rapidly transforming healthcare system and eliminate waste in an emerging $50 billion post-acute care market place are not only integral to the sustainability of the U.S. healthcare system, but will also garner significant interest from both the strategic and financial sponsor communities.
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