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How The Supreme Court's Decision Impacts Transitional Care

U.S. Supreme Court Upholds ACAIt's settled. The Supreme Court has ruled to uphold the Patient Protection and Affordable Care Act.

As the nation absorbs and reacts to this landmark case, healthcare insurers and practitioners like you will be rolling up their sleeves and getting back to work.

You'll continue to improve the delivery of care to your patients – focusing on service quality over quantity – ensuring your patients receive safer, more appropriate healthcare.

If there was ever any doubt about the importance of managing care transitions – it's gone now.

Implementing Patient-Centered Models of Care

At the very heart of reform are patient-centered organizations like yours. Organizations that view healthcare as something that occurs across the entire continuum of care – not just during acute or chronic illness. 

You understand that being accountable for the quality of care a patient receives is the path to improved population health and financial security. Many of you will continue on this path and implement new models of care, such as Accountable Care Organizations and Patient Centered Medical Homes.

In order for these new care models to succeed, you'll be required to coordinate your patient's movement between local and national healthcare resources as their needs change. 

This means you need to have an infrastructure in place that:

  • Provides patients with 24x7 access to clinical support.
  • Coordinates clinical and administrative resources.
  • Enables continuous feedback to each patients entire care team.
  • Has relentless quality oversight; allowing for continuous improvement.

Preventing Unnecessary Use of Healthcare Resources

If you've been in a blissful state of denial, it's time to shake it off. CMS penalties are coming. 

As a result of the Affordable Care Act, the Centers for Medicare and Medicaid Services will now be withholding payments for excessive hospital readmissions. In short, hospitals are now financially at risk for patients re-hospitalized for reasons considered to be preventable.

While CMS has implemented financial penalties for hospitals with excessive readmissions, they haven’t provided any instructions on how to successfully reduce them.

This leaves many hospitals wondering what the right approach is. And while there are indeed many solutions to consider, managing how patients transition in and out of the hospital is critically important to impacting readmission rates.

This requires that you focus on improving:

Improving the Patient Experience Through Quality Care

In addition to financial incentives targeting preventable readmissions, CMS will reward hospitals that provide high-quality patient care through the hospital Value-Based Purchasing Program (VBP). 

The goal of the VBP program is to motivate hospitals to focus on the quality of care delivered, rather than the quantity of services they provide – outlined by:

  • 12 Clinical Process of Care Measures, and
  • 8 Patient Experience of Care Measures. 

Transitional care plays an important role in experience management. 

To receive appropriate care, a patient will likely require services from a variety of healthcare practitioners and settings across the healthcare system. Transitional care programs provide consistent, personally relevant guidance to patients, enabling them to successfully find and utilize these resources. 

By supporting patients as they move along the continuum of care, you reduce the likelihood a gap in care will occur – simultaneously building the patient's trust in the care they are receiving. 

The Way Forward for Building a Transitional Care Program

No transitional care program will be exactly the same.

That's because, while The Patient Protection and Affordable Care Act has created incentives for organizations like yours to focus on providing high-quality patient care, they haven't provided any instructions on how, exactly, to do that.   

What is clear is that to be successful, you'll need to create a patient-centered infrastructure that facilitates the delivery of care through customized patient interactions, guideline driven processes, clinical escalation, dynamic referrals, and real-time notifications.


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