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Plans must be able to deploy these five tactics, whether using internal resources or collaborating with a vendor.
The time is now for health plans to focus on post-acute care (PAC). Improving PAC management offers the rare opportunity to simultaneously improve quality, save money, and enhance patient experience. Until recently, many plans have focused on more traditional areas for improving quality and achieving savings (such as expanding utilization management or negotiating lower provider rates), despite the fact that up to 25% of a Medicare Advantage plan’s total costs of care pay for PAC services and 20% to 25% of those costs may be waste. Commercial and Medicaid plans traditionally have lower per capita PAC costs, but there are potential savings on a smaller scale for those plans as well.
There are five key elements to a successful PAC plan:
All health plans should review their current approach to PAC management, and ensure that it includes the five strategies discussed above. Plan development should also include analysis of market-specific PAC spending data to identify and measure opportunities for savings and determine how to best allocate resources. Now is the time to improve post-acute care.
Michael Cantor, MD, JD, is a geriatrician and attorney with 20 years’ experience in designing and implementing population health and quality improvement programs for health plans and healthcare providers. He is currently chief medical officer (CMO) for CareCentrix, a post-acute benefits management company, and prior to that served as CMO for the New England Quality Care Alliance, the 1,800-physician network for Tufts Medical Center in Boston, where he managed network-wide population health and quality improvement programs.