Strategy & Analytics
As insurers and health systems enhance participation in risk-based and shared savings initiatives, their first order of business is often to reduce the highly variable “post-acute spend.” SNFs are pressured to mitigate avoidable re-hospitalizations and reduce “episodic” costs – thereby compromising their most financially significant pay source. The only way to compensate for this lost revenue is to “backfill” with more admissions, but doing so requires acceptance into exclusive “Narrow Networks.”
Admission to the Narrow Network club is predicated on quality – and presentation / interpretation of the data is often as important as the metrics we report. Adjustments must be made for case-mix and demographic variables, or facilities risk being unfavorably compared to providers treating less complex patients.
ZHSG’s “Advanced Healthcare Initiatives” program improves “essential outcomes” performance to maximize our clients’ profile. Data is continuously updated and benchmarked against competitors in the local market.
Like many advisory firms, ZHSG has access to, and has extensively analyzed, publicly reported Medicare claims data (everyone has access to the same data, only the interface differs). Unfortunately, these metrics are at least a year old. Our approach to outcomes management is simply better. ZHSG’s analytics platform is built on our extensive database of recent Medicare Part A UB-04s. The UB is the single most effective document to assess a SNF’s “value-profile.” In addition to revenue codes, the UB renders a complete picture of the resident, including (but not limited to) demographic and hospital admission data, physician identifiers, discharge disposition and ancillary costs. Neither the MDS nor medical record offers the same.
Once a SNF’s UB profile is fully developed, we are able to model episodic costs by dependent variable. For example, you may know your facility’s average Medicare episodic cost (it’s revenue to the SNF, but a cost to the payer) is $8,000, but can you tell your referring ACO your average Medicare episodic cost for an 83-year woman admitted post-knee replacement with diabetes after a six-day hospitalization? That is the granular level data we provide that is essential for success in a value-based world.
ZHSG’s Strategic Analytics program offers more reliable and current data than anything on the market, and is essential to support SNFs with the following initiatives:
- Managed Care Negotiations
- Bundling / ACO Participation
- Risk Tolerance and Performance Assessment
- Full Spectrum Competitor Comparison
- Quality Benchmarking
- Continuum of Care Utilization
- Risk-Based Ancillary Contracting
- Financial and Clinical Outcomes Tracking