Eroding the payer/provider divide

It used to be, coffee was coffee. It came in a coffee cup from a coffee shop. Now it’s a mocha latte macchiato (with caramel drizzle, please), bought with a loyalty points-earning card at a drive-through window.

During October’s inspiring crush of conference sessions and workshops, I heard a fascinating financial market trends session by Jared Landis, senior consultant for the Post-Acute Care Collaborative within The Advisory Board Company, Washington, D.C., on the massive redefining of healthcare’s pieces-parts. It seems that everyone is trying to capture more and more of the total healthcare dollar—because it’s a very shiny prize, indeed.

Many of the game-changing market movements Landis discussed have happened in just the past two or three years. For example, many skilled nursing facilities have either partnered with or purchased rehabilitation companies, assisted living communities and/or home health agencies to increase the range of care services they can provide.

Some continuing care retirement communities are becoming providers not only of multilevel care, but also of the insurance that pays for it—via becoming sort-of brokers of Medicare Advantage plans.

Walgreens purchased three accountable care organizations this year—yes, Walgreens the drugstore. Walmart apparently isn’t far behind, and let’s think about the power of that retail footprint.

Landis calls it “the eroding of the payer/provider divide.”

But as care management and the shared cost of care become greater parts of everyone’s business, the most lucrative prize will be harnessing healthcare’s cost-laden sister component: post-acute care. As hospitals transfer patients to post-acute care, they have a natural (and federally mandated) interest in monitoring the 30-day episode of care. But it’s the 60, 90 or 120+ days of skilled nursing care that could end up costing more than the hip replacement surgery did.

Like it or not, Landis says, post-acute care has a target on its back for much more than hospital readmissions now. Reducing length of stay, analyzing care episodes for the cost-drain culprits, developing deep and integrated ways to capture and share care documentation, and developing best practices and improved care protocols to reduce costs will be just some of the initiatives required of post-acute care down the road. Everyone’s eyes are on the prize.

As the market plays out, we’ll see whether the mixing of these traditionally separate gene pools will create a stronger, better health system, especially for those who participate in Medicare and Medicaid.

Meanwhile, I won’t need an appointment to get my flu shot this weekend—I’ll be getting it at Walmart. Along with a cappuccino.

Topics: Accountable Care Organizations (ACOs) , Advocacy , Executive Leadership , Medicare/Medicaid , Regulatory Compliance