Post Acute Care Networks Case Study


Historically, Post Acute Care Providers also known as Long Term Services and Supports (LTSS) providers have been reimbursed under the traditional Fee-For-Service (FFS) model for both Medicaid and Medicare. FFS pays for volume and doesn’t reward providers for producing good health outcomes for the older adults they serve. Over the past several years, there has been a movement away from FFS in LTSS as providers are transitioning to more managed care models of reimbursement. Medicare Advantage has seen significant growth in many states across the Country. Moreover over 36 states have moved to Managed LTSS (MLTSS) in an effort to reward providers for producing good outcomes, paying for value versus volume and incorporating Alternative Payment Models (APM) to LTSS.

However many LTSS providers have not worked in the managed care or APM environment and have found themselves vulnerable to the nuances of contract negotiations, transitioning to different payment models and even getting the attention of managed care plans.

The Need

LTSS providers may need help as they way they get paid for providing services changes and making sure the new payors (Medicare Advantage, MLTSS, Managed Care Plans) recognize them in the markets they provide services. In the FFS environment, there was no need for providers to come together, however in a managed care marketplace providers will need to come together to show market presence and the value they bring to payors.

The Solution

Strategic Health Care has successfully developed post acute care networks in Ohio, Indiana, Iowa and Illinois that bring the full continuum of long term care services together to negotiate manage care contracts with both commercial and government payors leveraging a strong quality program that collects data on 21 outcome measures that shows value to payors and hospital partners. These networks have leverage themselves to negotiate Pay-for=Performance (P4P) contracts based on outcomes achieved. Our network management includes contract negotiation, credentialing of providers with the payors, data collection of quality measures and development of dashboards to show value to payors and hospital partners. Our work has lead to significant increases in reimbursement (one payor $25.bed day increase) and reduction of administrative burden (Prior Authorization, Timely Filing of Claims, Prompt-pay) through our contract negotiations. The end result is a group of providers with a presence in their market developing a working relationship with payors to achieve great outcomes and sustainability.

Is your organization considering forming or joining a post-acute care network? Do you need help with contract negotiations and transitioning to a new payment model? The next move is yours — contact us today for a consultation.

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