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PAC Perspective: 4 ways to untangle the patient choice paradox

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The patient choice paradox of post-acute care selection is one that has steadfastly confronted patients, caregivers and providers alike. When a patient is preparing for discharge, where do they go next to continue their care? With little or no healthcare experience, information, or time to guide their choice, how best do patients and caregivers make such a critical care-related decision?

Consider the current value-based landscape: providers are assuming more risk to drive better outcomes at lower costs, payers are pressing hospitals to reduce lengths of stay while preventing costly and avoidable readmissions and patients are seeking to play a more active role in post-acute care decisions and their healthcare overall.

Interestingly enough, these complex and demanding industry dynamics, which in part serve to present and protect patient choice, have led patients and caregivers into a challenging and overwhelming post-acute care ‘gamble’ for which they are not usually prepared. Patients find themselves in a confusing and stressful situation while hospitals find themselves faced with a paradoxical challenge to drive the best outcomes for their patients.

For patients and caregivers to feel truly empowered to make smarter, more informed decisions when it comes to their care, providers, insurers and policymakers must work to establish a more ‘informed patient choice’ model to begin untangling this patient choice paradox. From robust decision-support and evidence-based tools, to clinical standardization and advance care planning, here are four critical strategies to consider:

1. Begin post-acute care discussions sooner

Care planning conversations between hospitals and patients and their caregivers are often delayed until a quick decision needs to be made – an unfortunately common approach which intensifies an already stressful and emotional situation for patients and their loved ones. Decision-making discussions must to be prompted as early as possible (preferably at hospital intake) while hospital tools such as clinically-validated assessments and predictive analytics can equip patients and caregivers with the data and information they need to develop a more longitudinal understanding of their options and needs to better prepare for what’s to come – beyond just the next step of their care journey.

2. Standardize and share quality and cost information


The significant cost and quality variation among post-acute care providers can have deep financial repercussions for a hospital’s bottom line and even more serious effects on patient satisfaction and outcomes. Considering the facts that the healthcare industry has not fully defined what quality looks like in a post-acute care setting and the Centers for Medicare and Medicaid Services (CMS) has acknowledged that standardization will take time to nail down, this is no easy task. However, providers can continue in the right direction through clinical decision support technology that provides actionable data to identify and predict a patient’s unique needs.

3. Develop robust clinical decision support technology

Quality and cost data alone will not help patients to make more informed care decisions. This information available to them must be leveraged through decision support technology and key metrics to predict patient outcomes and more effectively tell the story of which level of care is appropriate for the patient, at which stage in his or her recovery, and which high-performing provider can best serve the patient’s needs.

Through actionable data analytics, these technologies can empower providers to offer patients and caregivers the kind of credible and objective information they need to make informed care decisions for themselves or their loved ones.

4. Establish best practices to build high-performing collaborative networks

As the value-based era of healthcare emphasizes wellness, performance and coordination across settings of care, high-performing post-acute care networks have never been more essential to drive success and better care delivery.

Hospitals must be armed with the right information to identify and vet potential post-acute care partners who will engage in best practices to foster collaboration, improve care for the patient and work toward a shared vision to optimize outcomes.

Although these high-performing networks drive clinical efficiencies to reduce gaps in care, lower costs and reduce unnecessary care, they are costly and require significant change and effort within each entity to develop. Collaboration across health leaders and industry stakeholders can master these challenges by identifying and sharing best practices in high-performing network development with a shared vision to help reduce costs, offer reliable data, and equip patients to make care decisions that lead to better outcomes.

About the Authors:
Mary Naylor, Marian S. Ware Professor of Gerontology and Director of NewCourtland Center for Transitions and Health, UPenn School of Nursing
Brian Fuller, VP of Value-Based Care, naviHealth

Interested to see how your organization can tackle the patient choice paradox of
post-acute care selection? View Brian Fuller’s webinar presentation, “Tackling the Patient Choice Paradox,” to learn more.