Worked with both Hartford and Bristol Hospital to develop a preferred provider network, referring patients to specific skilled nursing facilities which meet select criteria and high quality standards.

Challenge:

Hospitals, faced with financial pressure from Medicare to improve readmissions, have developed a strategy to use their influence to refer patients to preferred skilled nursing facilities which meet select criteria.  Convincing patients to use these preferred providers that meet standards of quality can lead to shorter lengths of stay in the nursing facilities and reduced hospital readmission rates.

Solution:

Qualidigm analysts studied Hartford Hospital’s patterns of referral to long term facilities and then developed a process to request information from nursing home facilities to assist in determining the facility’s eligibility to be part of their preferred provider network.  Qualidigm also worked with Hartford Healthcare to place nursing homes in tiers based on scores assigned to the facility.

Similarly, Qualidigm worked with Bristol Hospital to assess both long term care and home health care facilities in their referral area to determine their suitability for inclusion in their preferred provider network.  Work included review and assessment of current performance, a quality reporting metric, and establishment of other requirements to be part of the network.

Benefit:

With the information gained from Qualidigm’s research and analysis, Hartford Hospital, one of the larger healthcare providers in the State of Connecticut, was able to make data-driven decisions to develop their preferred provider network.  Bristol Hospital also benefited from the quality reporting network and efforts to establish preferred provider network requirements in developing its selection of nursing home providers.