Sound’s clinical team embarked on a transformation strategy to reduce spending on post-acute care and readmissions, which vary widely across hospitals and account for over half of total episode spending. (Transitioning)

It also focused on ensuring that intensity of care aligned with patient preferences and improving end of life care.

To strengthen physician alignment and engagement, Sound disseminated scientific evidence about the clinical benefits associated with avoiding overuse of post-acute care facilities and aligning care with patient preferences, and how best to achieve those goals. Financial incentives related to quality and value based care were also implemented.

While continuing to encourage local innovation, Sound developed a standardized care model for implementation at all hospitals which were based on published best practices and its own experience. Key clinical expectations included:

  • Identification of patients for special focus, including those in VBC risk programs, at high readmission risk, or at clinical equipoise between going home and a SNF
  • Structured, reimbursable advance care planning in all 65+ and high-risk patients
  • 2-week home health protocols that are structured, frontloaded, and tailored to needs of individual patient
  • Selective referral to high-quality network among patients requiring skilled nursing facility (SNF) or home health care following discharge
  • Hospitalists see potential readmissions early in emergency department evaluations

Sound invested heavily in three technology platforms to drive success with its value‐based care model. Sound adapted SoundConnect, its proprietary IT platform, to flag BPCI and other risk program patients, provide clinical checklists based on patient diagnosis and risk, collect required quality indicator data, and identify PAC facilities in Sound’s network. Sound’s analytic platform, SoundMetrix, incorporates administrative, clinical, and claims data and then provides instantaneous, risk‐adjusted, benchmarked performance feedback to physician leaders and clinicians to ensure accountability with quality and cost metrics. And finally, Sound telemedicine allows hospitalists to extend their influence beyond hospital discharge and into Skilled Nursing Facilities (SNFs). So far, readmissions in the SNF population fell from 23 to 15 percent in the first year of the SNF telemedicine pilot at 12 different sites. Plans for home‐based telemedicine in high risk patients are also underway.

Transitioning

Source: Transitioning to Value-Based Hospital Medicine

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