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Transitions of Care: The Biggest Challenge for Value-Based and Senior Care Efforts

During the keynote of the ninth annual SUMMIT, PointClickCare co-founder and president, Dave Wessinger announced plans to supply over 20,000 senior care providers with access to the Carequality Interoperability Framework. The purpose of this move is to enable interoperability and sharing of critical data between healthcare settings as a patient moves through the care continuum, with the underlying goal of reducing readmissions that most often occur during a care transition.

Audible gasps and applause echoed throughout the conference center during the announcement and the functionality was demonstrated. Post-acute and senior care providers are hungry for tools to enhance partnerships with acute care partners as value-based arrangements begin to change patient care and focus more on care transitions and readmissions reduction.

Collective Medical, a PointClickCare Marketplace member and partner, is uniquely positioned to support these efforts in improving care transitions via our national network of hospitals, post-acute facilities, accountable care organizations (ACOs), health plans, primary care and behavioral health providers. Collective’s care collaboration platform and real-time, risk-adjusted encounter notifications help providers gain a 360-degree view of the patient at the point of care. Collective is now also participating bidirectionally in national CCD networks to further support care teams in efficiently accessing critical information and optimizing care transitions.

SUMMIT was a great forum to meet with our post-acute customers who have joined the Collective network through our Marketplace partnership with PointClickCare. We wholly expected the hot topic to be the recent reimbursement change to the Patient Driven Payment Model (PDPM). In listening to our customers, it was a pleasant surprise to understand that PDPM was viewed as a regulatory item to comply with rather than an industry innovation and that the key innovation and change is arriving in the form of value-based care. Our skilled nursing partners shared their need for clinical data sharing to address this change. These partners are utilizing the Collective platform to enhance their relationships and coordination efforts with acute hospital partners.

Collective has long been working toward its mission to prevent the nation’s most vulnerable patients from slipping through the cracks of the healthcare system. We’re well positioned to help care teams achieve this aim as the post-acute and senior care markets make strides to align with value-based care initiatives and do the right thing for the most complex and at-risk patients.

Ryan Snow
Account Executive, Post-Acute Care