Five Factors Changing the Delivery of Care across the Healthcare Continuum: Article

April 1, 2021
April 1, 2021

This blog post is the first in a series excerpting our HealthStream article of the same title.

Not so long ago, hospitals built relationships with nursing homes to achieve inpatient growth objectives. The hospital business development staff regularly called on nursing home administrators and medical directors in pursuit of becoming the hospital of choice for their residents. All of this was done in the name of growing inpatient volume. How times have changed! Today, these relationships are more important than ever, but for very different reasons. The entire care continuum, from home health to skilled nursing facilities (SNFs), plays a critical role in controlling healthcare costs and avoiding hospital admissions.

This healthcare continuum includes rehabilitation or palliative services that a patient receives after, or in some cases instead of, a stay in an acute care hospital. Non-hospital services are provided in a variety of settings, including skilled nursing, inpatient rehabilitation, long-term acute care, hospice, senior care housing, non-medical home care, adult day care, assisted living, continuing care retirement communities, and home health.

The demand for senior living continues to rise as the senior population grows at substantial rates. By 2020, the United States Census Bureau projects a population of 56 million seniors, with 74 million by 2030. Seniors become eligible for Medicare at a rate of 10,000 per day.

Seniors Aren’t What They Used to Be

With the rise of consumerism, younger seniors have higher expectations and are more likely to consider price in their healthcare decision-making. In recent remarks, Secretary of Health and Human Services Alex Azar discussed the next generation of older Americans. “They have much more experience interacting with healthcare technology [than older seniors]. We’ve probably all been impressed by an older relative who’s mastered Google Photos or Skyping with an iPad, but think about the next generation of older Americans: They’ll have mastered technology much earlier in their lives.” Seniors already use patient portals and online scheduling, and they view the Internet as an instant source of medical information.

Oxford Economics, in a briefing paper for AARP, claims that longer lifespans are “upending conventional wisdom about how aging affects the overall U.S. economy and the country. Rather than lengthening extreme old age, the 30 years added to lifespans in the 20th century have resulted in a longer middle age—extending the period when workers are at their most productive and creative, and representing a major, often untapped resource.”

According to the National Investment Center for Senior Housing & Care, nursing home occupancy declined from 86% in 2012 to 82% in Q1 2018. Length of stay is also declining. Downward pressure is exerted by the value-based payment system (VBP), risk-based health plans, and consumers’ preference for alternate healthcare delivery channels, such as telemedicine and home health.

As a result, care across the continuum must evolve— adapting services to changing needs and technology, and developing new vehicles for care delivery.

This article includes discussion of five factors helping to spur this evolution:

1.       More partnerships between acute and care continuum providers

2.       Value-based payment

3.       Changing payer models

4.       Medicalization of senior living

5.       The internet of caring things

Access the full article here.