Case Study: Guaranteeing Outcomes in an ACO/MCO World
by Ken Lund
CEO, Shea Family; CALTCM Board Member
 

Delivering care under the Affordable Care Act is changing the healthcare landscape, and requires that post-acute care providers think differently.

Few could have imagined a 50-70% cut in skilled rates, but that’s exactly what unfolded in Southern California. Today providers are contractually obliged to demonstrate measurable outcomes in exchange for volume from managed care organizations (MCO) and accountable care (ACO) partners.

At Shea Family, we re-structured to improve health care delivery and drive outcomes. The migration began four years ago, and the model has been in operation for the past two years.  Teams focused on five areas: care coordination, specialty education, strategic technologies, innovations in care delivery, and $15M+ in renovations.

Key innovations

·              Single point of entry for all post-acute services
·              Full continuum of care with skilled nursing, high-acuity assisted living, memory care,
               home health,home care, hospice, transportation, construction, and more
·              Ventilator and tracheostomy units
·              Medical home environment
·              Home and community-based medical services responding to the Affordable Care Act

 

Today our new model for care has a coordinated network with aligned values and a breadth of service lines across the full continuum. Referrals from partners flow in, because we were able to eliminate layers of management overhead the ACO/MCO would have had to absorb.  The model also aligns with acute hospitals and managed care payors.  

Results

·       75% of Shea Family skilled rehab patients go home in less than 2 weeks, compared to
         the state average of 35%
·       50% lower readmission rates, compared to peers
·       75% of Shea Family Care Centers are now rated 4 to 5 Star by CMS, compared to
         just over 33% nationwide

 

Key to making the model work is the introduction of transition coaches, who follow the patient across settings after discharge.  It’s about engaging patients over their lifetime, not just an episode of care.

Changing the way business is done has resulted in enhanced outcomes, higher satisfaction from members and dramatically reduced expenses to payors.  Change is always tough, but our survival depended on it.