Highmark has initiated a three-year partnership with naviHealth, a national post-acute care management company, to bring a personalized approach to support its Medicare Advantage members across Pennsylvania.  According to patient needs, naviHealth will utilize decision support technology and its post-acute analytics capabilities to coordinate long-term acute care, inpatient rehabilitation and skilled nursing utilization and will oversee proper care transitions to and from these facilities.  The goal of the partnership is to increase member satisfaction, lower readmission rates and improve clinical outcomes.

Now I think it would be reasonable to assume that this initiative will occur in other states and regions and as I see it, this is a game changer for skilled nursing facilities who care for a large population of Medicare Advantage residents.  Highmark acknowledges that it is a reasonable and appropriate expectation that the overall utilization of post-acute care services will decrease following the naviHealth implementation. As decisions are better informed and patient focused, variation from best-practice recommendations will decrease. Delivering services that are focused on the best possible outcome for the patient typically does result in reduced utilization as more efficient and effective approaches are implemented.

More than ever, we are going to be challenged to look at how we do business—particularly as it relates to our hospital readmission rates, our Medicare lengths of stay, our clinical outcomes, and our partnerships and relationships with our primary referral sources.  The gauntlet has been cast my friends!!