A Center of Excellence is a crucial component of a value-based approach to healthcare. In a Center of Excellence, operational delivery of services is refined and perfected so that all aspects of the Quadruple Aim are not only attested but also consistently and positively achieved. These component aims are better health outcomes, improved patient experience, improved staff experience, and lower cost of care. In the shadow of COVID-19, fulfilling the Quadruple Aim is nothing short of miraculous.
COVID-19 is providing ample testing ground for value based care (VBC), accountable care organizations, DTE pay arrangements, and Centers of Excellence. The pandemic exigencies since early 2020 have exposed VBC to challenges and opportunities. that, With its lean approach to health care and agility to assess and adapt efficiently to shifting trends and circumstances, it has have met with impressive results.
One of the challenging opportunities is the growing demand for post-acute care among COVID-19 survivors. David Grabowski, a professor of health policy at the Harvard University Medical School, prophetically coined the term “COVID-19 Centers of Excellence” in reference to dedicated post-acute care facilities for COVID-19 patients. Maintaining and improving the population health of mostly elderly COVID-19 survivors who possess multiple comorbidities calls for nothing less than a Center of Excellence.
Currently, with the continuing infectious spread of COVID-19, attention has focused on:
- increased acute-care hospital bed capacity
- decreased regulations on telemedicine to encourage its implementation
- curtailed non-urgent services and elective surgeries
- eased regulatory responsibilities
- provided stimulus funding to help struggling providers continue operations
- restricted access to residential care settings for the elderly and disabled
However, to date, there has been limited activity focused on addressing the impending need for post-acute care for the patients hospitalized with COVID-19. Not only does the post-acute care system face capacity shortages that are similar to (or worse than) those faced by acute-care hospitals, these settings, especially skilled-nursing facilities (SNFs), are currently serving long-term residents at tremendous risk for infection.
As states begin to identify the impending capacity shortage in post-acute care, they have taken a variety of steps, only some of which are also focused on reducing the risk of infection for those patients and long-term residents already residing within the SNF.
This Client Alert reviews a few of the initial state activities in this area, including the development of the “COVID-19 Centers of Excellence.”
COVID-19 and the Post-Acute Care System
Large-scale projections of post-acute care needs stemming from COVID-19 are emerging or are in process. The full picture is still somewhat malleable at this time. The overall impact of COVID-19 on the health care system offers conflicting interpretations. Some hospitals in hard-hit areas are at capacity and will need to adapt to the long-term post-acute care the surviving COVID-19 patients will need. Hospitals in less-affected regions are operating at below capacity due to the suspension of non-essential or elective services to accommodate social distancing and to prepare for a possible shortage of beds.
Nevertheless, policymakers at the federal and state levels are beginning to prepare for a large number of COVID-19 patients requiring admission to post-acute care facilities by reducing or waiving restrictions to facilitate the patient flow from the hospital to post-acute care. States are being given greater liberty to make decisions that navigate around federal requirements. The few states that have exercised this authority to prepare for the post-acute care surge have embraced dramatically divergent approaches. Several states have reserved entire nursing facilities exclusively for COVID-19 patients.
Authorities in another state issued a directive that all nursing facilities must receive patients who have been treated in hospitals and are now needing post-acute care. COVID-19 testing is prohibited as a prerequisite for admission. Complicated isolation measures are required for incoming patients in tandem with existing isolation requirements to deal with current patients with COVID-19 symptoms.
The divergent approaches regarding the provision of post-acute care generated a host of responses from the general public and from the health policy orbit. David Grabowksi, drawing focus upon the upcoming need for post-acute care services, recommended reserving entire facilities as COVID-19 residential care facilities to safeguard existing patients, guarantee sufficient capacity for dedicated services, and efficiently manage staff and personal protective equipment.
Professor Grabowski employed the term “COVID-19 Centers of Excellence” (CoE) to describe these dedicated facilities. Referring to these dedicated facilities as CoE’s is highly evocative, communicating the message that the post-acute care patients receive will be of the highest quality.
Opportunities for Payers
Health plans can collaborate with states to ensure the safety of COVID-19 patients transitioning to post-acute care without putting other patients at risk. Health plans have a strong incentive to protect vulnerable patients already being served by the special needs facilities.
A challenge facing states and nursing facilities is arranging payment to address the high costs of the post-acute services required for COVID-19 patients. By offering a wide range of payment strategies, health plans can facilitate the providers in the development of COVID-19 post-acute care Centers of Excellence.
Conclusion and Next Steps for States, Plans, and Providers
States, health plans, and care providers are having to prepare and care for the inevitable flood of COVID-19 patients into post-acute care facilities. Stakeholders at every level have no option but to prudently weigh the risks and liabilities of the different management approaches. Monitoring the early and ongoing experiences in Massachusetts and Connecticut who have adopted models that resemble a Center of Excellence and comparing them to the divergent approach followed in New York will help states, health plans, and providers determine which approach to take.
Navigating the uncharted and turbulent waters of the COVID-19 pandemic requires a high level of knowledge, experience, skill, and aptitude. The CSuites Solutions practice consists of highly competent and experienced C-Level executives with diverse skills who serve as trusted strategic advisors to their peers in the healthcare industry. To learn more about how the health care consultancy works, visit the CSuite Solutions website at csuitesolutions.com. Contact the office by phone at (813) 866-5100 or email info@CSuiteSolutions.com.