NaviHealth program combines information from outcomes database and case manager followup to help plans and providers reduce post-acute care costs by up to 30%.
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NaviHealth, a company that uses health IT and case managers to manage post-acute care for health plans and healthcare systems, is working with healthcare systems on Medicare bundled payment pilots that involve hospital care and post-acute-care for up 90 days after discharge.
Signaling the new importance of post-acute-care in the industry, the company recently received investments from Blue Cross Blue Venture Partners, an offshoot of the Blue Cross Blue Shield Association, and Ascension Health Ventures, a fund controlled by Ascension Health and several other healthcare organizations.
NaviHealth uses a proprietary, evidence-based analytics technology to identify the best treatment regimens for patients and to help reduce variations in care. The technology relies on algorithms and a database of 750,000 patient outcomes that have been tracked over 10 years, said Carter Paine, senior VP of business development for NaviHealth, in an interview with InformationWeek Healthcare.
This database was created by SeniorMetrix, a firm that NaviHealth acquired shortly after its formation. SeniorMetrix has been selling its technology to Medicare Advantage plans for 14 years, and has worked with Kaiser Permanente for a decade.
NaviHealth uses this technology to do functional assessments of patients while they're still in the hospital, focusing on three areas: lower body, upper body, and cognitive ability.
"Those are the primary drivers of what kind of post-acute therapy someone should be receiving," Paine said. "It's not diagnosis alone. Function is the core driver of how post-acute therapy regimens should be structured. Function is the key variable we use in our database to do a patient assessment and predict what that post-acute protocol should look like."
Applying its algorithm to the functional findings and the outcomes of similar patients drawn from its database, NaviHealth creates a protocol that determines both the recommended treatment regimen and the right type of care setting for that patient. It provides this information to patients and caregivers to help them make good decisions, and also gives it to post-acute-care facilities.
In addition, Paine said, NaviHealth measures the performance of post-acute providers in each market it enters. Within three to six months, he noted, the firm knows which providers are the most efficient and deliver the highest quality care.
"There's a lot of variation, and the tool allows us to educate patients on who the quality providers are, not just the ones who will pick them up the fastest or who are closest to home," he said.
After discharge, NaviHealth nurse case managers "round" in post-acute-care facilities once a week to reassess patients and adjust their therapy protocols, he added. They also guide transitions of care to ensure that patients get their discharge medications and see their primary care doctor if they're discharged to home. Regardless of whether patients have a doctor, the nurses perform most of the care management, including teaching patients how to manage their own care.
Although it's too early to say NaviHealth reduces readmissions, the company has been able to reduce customers' spending on post-acute care by 15% to 30% without having an adverse effect on outcomes, Paine said.
Because the information systems in post-acute-care facilities are generally limited, NaviHealth collects its own data without connecting to those providers' systems. However, it does integrate with hospital EHRs to download key clinical data about its patients, Paine said.
Post-acute care has always been important to health plans, because it accounts for 20% to 25% of their total medical spending, he said. With the advent of healthcare reform, it has also become a matter of concern to hospitals, which are being penalized by Medicare for excessive readmissions and which are also starting to take bundled payments for acute and post-acute care.
Post-acute-care providers have been receptive to NaviHealth's approach, Paine said. This is partly because they want to remain in health plans' networks, and also because hospitals are their biggest source of referrals.