How to spark post-acute growth in challenging times

Presented by the Post-Acute Care Collaborative

How to spark post-acute growth in challenging times

© 2021 Advisory Board • All rights reserved • advisory.com Advisory Board interviews and analysis.

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Presented by the Post-Acute Care Collaborative

How to spark post-acute growth in challenging times


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Longstanding trends are accelerating due to Covid-19

Interest in shifting more care to the home. New care models and

regulatory flexibilities have enabled a short-term shift to the home, but long-

term growth will likely occur outside of Medicare home health.

Fears around SNF solvency and viability. The outbreak news,

along with continued decline in occupancy, has exacerbated existing

concerns around SNF survival.

Continued need for acute/post-acute collaboration. More than ever, acute/post-

acute providers have a shared interest in supporting throughput and quality goals.

But resource limitations mean the investments must be right-sized.

Pre- and post-Covid-19 market dynamics look similar



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Source: “Long Term Care Closures Mount as Cov id-19 Exacerbates Financial Shortf alls,” AHCA/NCAL, Nov 2020,

https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Long-Term-Care-Closures-Mount-As-COVID-

19-Exacerbates-Financial-Shortf alls.aspx; 2020 Adv isory Board surv ey : Financial impact of Cov id-19 on post-acute care.

Post-acute providers facing increased financial strain

70.8%

16.7%

12.5%

Decreased

Stayed thesame

Increased

Impact of the Covid-19 on post-acute organizations’ revenues

2020 Advisory Board survey of acute/post-acute organizations The long-term care sector has long faced

financial struggles, but the pandemic has

exacerbated these severe

challenges…Coupled with the current

need to acquire more personal

protective equipment (PPE), regular

Covid testing and staffing needs

associated with the pandemic, these

facilities are being pushed to the brink.

American Health Care Association and

National Center for Assisted Living


https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Long-Term-Care-Closures-Mount-As-COVID-19-Exacerbates-Financial-Shortfalls.aspx


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Source: 2020 Adv isory Board surv ey : Financial impact of Cov id-19 on post-acute care.

Most providers predict volumes will recover by 2022

22%

26%35%

9%

9%

Timing will depend on

vaccine availability

Volumes have already returned

to pre-pandemic levels

In 1 to 2 yearsWithin the next year

I don’t expect volumes to return

to pre-pandemic levels

Post-acute provider predictions on return to pre-pandemic volumes

2020 Advisory Board survey of acute/post-acute organizations



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Don’t just stand by; growth won’t happen on its own

Even in a post-vaccine world, a slew of barriers hinder post-acute expansion

Covid-19

induced barriers

Ongoing

barriers

Consumers question quality and

security of post-acute care amid outbreaks

Adoption of home-based care

models have changed existing referral patterns

Payers and value-based

programs incentivize lowering post-acute use

Existing reimbursements

structures don’t leave adequate room for innovation

Workforce shortages limit

service and clinical expertise expansion

Patient demographics changing

due to Covid-19 fatality rate with older adults



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The basic growth formula isn’t changing

Identify market priorities

related to post-discharge care for local stakeholders

Make the right pitch

to successfully convey to stakeholders your ability to meet those priorities

Develop a service offering

to fill market gaps related to stakeholder priorities

The fundamental steps to volume growth and sustainability remain true

1 2 3



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You are what the market believes you to be

The role you play = The problems the stakeholder believes you can solve

Hospitals see us as:

A release valve for

acute care capacity

A lower-acuity

setting

Payers see us as:

An opportunity to

minimize costs

Providers who

deliver care that can

limit long-term needs

Patients and families see us as:

The next step

in recovery

A long-term housing option

for patients that families

can’t care for at home



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Hospitals’ view: you are a way to preserve bed capacity

Top priorities influencing acute/post-acute collaboration

Reducing

readmissions

Accelerating

throughput

Ensuring

downstream quality



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Payers’ view: you are an opportunity to cut costs

Top priorities influencing payer involvement in post-acute care

Right-sizing

post-acute use

Expanding home-

based options

Ensuring strong

clinical outcomes



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Patients’ and families’ view: you are a step to recovery

Top priorities influencing post-acute selection

Facility-based

care avoidance

Setting

reputation

Lifestyle and

visitation policies



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Enhance virtual relationships with hospitals

01



16

With hospitals, same challenges but added difficulty

Challenges

Optimize virtual

relationships

Competition with other

post-acute providers

Lack of hospital interest in

collaboration

Lack of hospital bandwidth

for collaboration

Lack of in-person

communication

Action step



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Covid-19 has changed how we reach hospital partners

Traditional marketing channels New marketing methods due to Covid-19

More focus on clinical

quality and safety

Pros of changes

Harder to change pre-existing

discharge patterns

Harder to build relationships with partners

Cons of changes

• Liaisons

• Meetings

• Website

• Tours

• Factsheets

• Community outreach

• Remote meetings

• Virtual tours

• Virtual community events



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1. Hospital Readmission Reduction Penalty .

Translate data into value for hospitals

Hospitals view you as:

• Readmission rates for HRRP1 penalty

conditions, bundled conditions

• Throughput for bundled conditions

• Episodic cost for bundled conditions

Don’t make this common mistake: Sending a data dump.

A capacity release valve

A low-acuity setting

Key data points to share:



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Prove your value to payers

02



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With payers, the same challenges but new opportunities

Challenges

Lack of payer interest

Challenging to prove ROI to payers

seeking demonstrable cost reduction

Take advantage of the

opportunity Covid-19 has

created to prove value to payers

Action step

Insufficient concentration of beneficiaries of

one specific payer in each provider’s patient pool



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1. Managed Care Organization.

Getting the chance to prove your value

Consider the plan’s

Chief Operating Officer a contact for strategic inquiries

Go straight to the top Work your way up Partner with a provider Partner with the state

Test new service ideas

on a case basis with MCO1 clinical leaders and use evidence to

request strategic discussions

Host voluntary meetings

regarding new program ideas following mandatory meetings

between the MCOs and state

Ask affiliated providers with

clout for introductions, joint meetings



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Translate data into value for payers

Payers view you as:

Don’t make this common mistake: Only focusing on immediate, or short-term, costs of care.


• Provider share of MA1 volumes in

relevant markets

• Total cost of care for top diagnoses

• Healthcare days for top diagnoses

An opportunity to

minimize costs

Enhanced care to

limit long-term needs



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Rebuild trust with consumers

03



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Challenges of appealing to consumers are exacerbated

Challenges

Lack of consumer faith in the safety of

post-acute and long-term care settings

Lack of consumer understanding of

what post-acute and long-term care is

Rebuild

consumer trust

Action step



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“Reputational restoration for the industry will be ongoing.

We’ll need to come together to remind consumers, media

and lawmakers of the innumerable benefits of living in a

senior living community and to not only reassure them that

communities are safe, but to truly live up to that promise.”

James Balda, President and CEO, Argentum

Source: “Recovering from emotional, economic effects of pandemic will dominate senior living in 2021,”

McKnight’s Senior Living, January 2021, https://www.mcknightsseniorliving.com/home/news/recovering -

from-emotional-economic-effects-of-pandemic-will-dominate-senior-living-in-2021/.



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Source: Konetzka RT et al., “Use Of Nursing Home Compare Website Appears Limited By Lack Of Awareness And

Initial Mistrust Of The Data,”Health Affairs, https://www.healthaf f airs.org/doi/full/10.1377/hlthaff.2015.1377?related-

urls=y es&cited-by =y es&legid=healthaf f%3B35%2F4%2F706&sid=a3df e968-bf 85-4b8c-9b94-1b172dccb6b8

Quality is extremely difficult for families to gauge

Cleanliness

Friendliness and number of staff

Activities

Visible specialization

When trying to evaluate

quality, families rely on:

“Cleanliness I would tie into the

competency of the staff. ‘Cause,

you know, if they’re not taking

care of the place, what else aren’t

they doing?

Interviewee selecting nursing

home for a loved one



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Translate data into value for consumers

Consumers view you as:

Don’t make this common mistake: Using referrer-centric terms when sharing metrics with consumers.


A step to recovery

Long-term housing

• Average length of stay

• Services and certifications held by staff

• Functional improvement metrics for relevant

diagnoses


How to spark post-acute growth in challenging times

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