Contract Assistance

  • Negotiation of standard contracts (ability to accept something other than Plan’s contract)
  • Attractive to MCO’s since they only have to negotiate with one organization. It fills their network up with little effort
  • Facilities may be able to carve out specific items based upon their individual strengths/clinical capabilities
  • IPA’s cannot negotiate in a “take it or leave it” manner or bind it’s members.

Financial/Other Integration

  • Electronic Medical Record Systems
  • Health Information Technology
    • Provides infrastructure to support care coordination
    • Data reporting (assessment, outcomes)
  • Risk contracting
  • Group Purchasing
  • Recruitment/Employment services
  • Call coverage
  • Marketing
  • Accounts receivable/Billing support
  • Clinical consulting (CMI for now)

Clinical Integration

  • Staffing standards
    • Turnover, use of agencies
    • Nursing supervisor on site (24/7)
    • Primary care RN
  • Clinical specialization provided through one or more members
  • Quality improvement programs
    • Share resources to improve quality
    • Training/assistance with quality measures, mock surveys, QAPI
    • Resident satisfaction (i.e. My Innerview)
    • Sharing of best practices
    • Gain/Risk sharing opportunities with insurers
  • Admission processes
    • screening/acceptance within a minimum timeframe
    • 24 hour, 7 days a week
    • Collaboration weekend/nights
    • Agree to admit hard to place residents (share)
    • Possibly work with preferred medical group
    • Standard “welcome” process
  • Facility standards
    • Clean, comfortable setting

Clinical Integration (Continued)

  • Clinical processes
    • Therapy – 7 days/week, assessment/evaluation performed within a prescribed time.
    • Hospital Re-Admission prevention – utilize INTERACT or other protocol
    • Prescription formulary
    • Diagnostic testing follow up within prescribed times
    • Care plan meeting standards (timing, outcomes, communication, IDT)
    • PCP/NP on site access
    • Clinical pathways
    • Evidence based care practices
    • Palliative Care
    • Tele-Health Medicine
    • Point person for MCO Contact regarding assessment/change in condition.
  • Discharge
    • Medication reconciliation education
    • Advance directives sent with patient
    • Discharge paperwork sent to receiving facility
    • Standard discharge planning checklist
    • Follow up with patient within prescribed time after discharge (within 3 days?)

Key Phrases

Preserve individual autonomy

Change the way SNF’s deliver health care

Level the playing field

Change how healthcare is provided

Admission and discharge processes

Financial viability through efficiency

Transparent and cost-effective

Patient satisfaction and clinical outcomes

Improving quality will result in efficiency

Social responsibility

Facilities should be able to carve out specific items based on individual strengths/clinical capabilities

Change the basis for referrals from price and geography to how healthcare is provided

Financial/other integration, such as EMR, health information technology, risk contracting and group purchasing