The role of Skilled Nursing Facilities (SNFs) is frequently maligned in the market (and unloved by Venture Capitalists), but they play a critical role in the care continuum. While staffing is currently the most significant challenge faced by SNFs, the care transition from SNF to home is crucial. Approximately 25% of Medicare patients hospitalized for acute medical illness are discharged to a SNF, but only 48.6% of patients successfully returned to their home or community following a short stay in a SNF. Evidence suggests that older adults with multiple chronic conditions are particularly vulnerable to breakdowns in care and therefore have the greatest need for transitional care services. Poor “handoff” of these older adults and their family caregivers has been linked to adverse events, low satisfaction with care, and high rehospitalization rates. Let's look at why this unpopular path is both important to our healthcare ecosystem and a key initial focus for HealthHive.
About the SNF to Home Market Need:
In 2013 the Centers for Medicare & Medicaid Services (CMS) created a bonus and penalty system designed to reduce the 2.6 million seniors who are readmitted to hospitals within 30 days, at a cost of over $26 billion every year. Approximately 25% of Medicare patients hospitalized for acute medical illness are discharged to a SNF. And while the transition from SNF to home is critically important, most of the new patient coordination solutions are solely focused on the transition from the hospital.
According to CMS, only 48.6% of patients successfully returned to their home or community following a short stay in a SNF, highlighting a sizeable gap for targeting quality improvement efforts. The measure of success was defined as patients that returned to home or community from the SNF and remained alive without any unplanned hospitalizations in the 31 days following discharge from the SNF.
“High-quality transitional care is especially important for older adults with multiple chronic conditions and complex therapeutic regimens, as well as for their family caregivers. These patients typically receive care from many providers and frequently move within health care settings. A growing body of evidence suggests that they are particularly vulnerable to breakdowns in care and thus have the greatest need for transitional care services. Poor “handoff” of these older adults and their family caregivers from hospital-to-home has been linked to adverse events, low satisfaction with care, and high rehospitalization rates.
These patients typically receive care from many providers and frequently move within health care settings. Based on this data, the need is great, and the financial impact significant.
About the SNF to Home Market Opportunity:
We view the SNF as the most important “orphan” within the care transition world. According to a survey published in August 2020, prior to the pandemic, only 10% of responding health systems were exploring partnerships with SNFs, 38% had partnerships without financial risk, 8% partnerships with financial risk, and 23% owned a SNF. In other words, as the market moves towards value-based care, the SNFs tend to be excluded.
Another recent survey identified that while 90 percent of patients indicated that they had felt prepared to go home from a SNF, responses to specific questions indicated serious gaps in transition planning.
You’ve Told Me About the Market, But Why Focus There?
There are three core reasons we chose to begin building HealthHive within this market:
Data, Resources, Information & Communication Gap:
HealthHive addresses these issues by holistically looking at the health system. A key challenge is bringing together data, resources, information & communication into a central place and integrating it with other solutions. These challenges have been addressed outside of healthcare, but they haven’t yet been brought to healthcare. We created our Hive and Portal structure to do this.
HealthHive centralizes this in a patient-centered Hive that integrates into existing clinical systems. Importantly, this means that any individual with an interest in the patient can see what is going on with that individual. We enable authorized parties to participate regardless of their organization and minimize or eliminate changes in the clinical workflow. We’re early, but we’ve already proven we can do this by taking the first steps in each area.
Creating a technology that solves a problem is just a small step in the success of a health tech company. The biggest challenge is engagement which is addressed by providing value to the user, based on what they need. This value differs based on role and individual in the complex healthcare environment.
Starting with care transition, we know that it is a time when the required features to deliver value are more defined than in other use cases. Therefore, we have allowed this use case to guide our initial feature set, developed a long list of features that are needed to meet our long-term goal, and we will allow our users to direct the prioritization of many of these features.
Market Entry Challenges:
Building the first version of a broad-based health tech solution is difficult. While every health tech solution requires HIPAA compliance, a secure infrastructure, and solving a problem that matters, the most important element is understanding the range of users and building for them. Despite all of the interviews and conversations, nothing speaks louder than actual behavior.
The SNF care transition provides the most significant opportunity to learn. Let’s highlight how.
Throughout this process, HealthHive has the opportunity to learn about the behaviors of the parties and what we should do to provide increased value and engagement in other environments.
We have a long way to go, but we’ve learned a lot. While we know that the lifetime value of a single SNF is low, it has served as a great place to better understand the needs and behaviors of a broad range of users. These lessons allow us to position ourselves with confidence as we move forward. Here are some key learnings:
The learnings in the SNF space have informed our product plans as we move toward our goal to create something that makes healthcare better for all participants — starting with the patient and their families while integrating into the health system.
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