WellSky® Survey Reveals Key Post-Acute Care Challenges for Health Plans, Need for More Visibility and Influence Into Post-Acute Care Management

July 17, 2024 at 09:00 AM EDT

Majority of respondents feel only moderately confident their members are receiving the appropriate level of care after discharge from acute care settings

WellSky, a leading health and community care technology and services company, today shared the results of a recent survey of health plans regarding challenges they face with post-acute care (PAC) management. The findings reveal that only 37% of respondents manage members in a post-acute setting after discharge from acute care, with the majority attempting to manage this care internally rather than partnering with external vendors and providers.

Additionally, just one-third of respondents reported the majority of their members are discharged to high-performing post-acute care facilities, while 43% of respondents expressed only moderate confidence that their members receive the appropriate level of care post-discharge. The survey included responses from health plans with Medicare Advantage (MA) enrollments ranging from 115,000 to over 7 million members.

“These findings reinforce what we continue to hear from payers regarding how important it is for Medicare Advantage plans to have greater visibility and proactive influence into their members’ discharges to ensure they are being sent to not only the right level of care, but to high-performing post-acute providers for a member’s specific conditions. This will help plans achieve lower total cost, enhanced quality of care, and improved member outcomes,” said Andy Eilert, president of payer and emerging markets at WellSky. “With this being a relatively unmanaged area, MA plans are now realizing the significant opportunity to improve in this area and are looking for next-generation solutions that generate better outcomes across the entire episode, including readmissions.”

U.S. healthcare costs are rising, and there are many factors that contribute to the cost of post-acute care episodes. The largest driver of cost identified in the survey was readmission rates, followed by extended lengths of stay, high utilization of PAC facilities, unnecessary care, and general lack of data visibility.

Health plans also see the need to manage acute care hospital expense, because inpatient stays are another significant cost driver. Analysis of WellSky’s claims data shows that 25% to 30% of these stays are avoidable. Nearly 43% of respondents said they do not have a diversion program for members arriving at the emergency department. Having such a program incorporated into an organization’s workflow could help identify appropriate diversion options that include home health, skilled nursing facilities, or a primary care physician (PCP) referral.

“There are many challenges when it comes to managing post-acute care, and we can no longer attempt to solve them in silos,” said Eilert. “We need solutions that bring care providers together in an integrated, value-based model to proactively manage these patients from acute to post-acute care to home, including avoiding readmissions back into the hospital. WellSky provides a unique hybrid solution, including technology and clinical managed services, that enables end-to-end management to help ensure members receive the right care, in the right setting, by the right provider.”

WellSky PAC Advance is a next-generation post-acute management program for health plans, focused on facilitating high-quality, end-to-end post-acute care management. The industry-leading acute and post-acute technology, analytics, and services help health plans optimize the member’s journey, enabling more effective and timely access to appropriate and high-quality post-acute services for each member.

To see more insights from the post-acute care survey, visit wellsky.com.

About WellSky^®

WellSky is one of America’s largest and most innovative healthcare technology companies leading the movement for intelligent, coordinated care. Our proven software, analytics, and services power better outcomes and lower costs for stakeholders across the health and community care continuum. In today’s value-based care environment, WellSky helps providers, payers, health systems, and community organizations scale processes, improve collaboration for growth, harness the power of data analytics, and achieve better outcomes by further connecting clinical and social care. WellSky serves more than 20,000 client sites — including the largest hospital systems, blood banks, cell therapy labs, home health and hospice franchises, post-acute providers, government agencies, and human services organizations. Informed by more than 40 years of providing software and expertise, WellSky anticipates clients’ needs and innovates relentlessly to build healthy, thriving communities. For more information, visit wellsky.com.