Continued from page 10 “We made ourselves more available to admission, not


just Monday through Friday, 9 to 5,” Paulk said. “We expanded our assessment period of time. We became really connected as part of the discharge plan. …“The overall impact is that we have been able to get better referrals from hospitals and physicians because they better understand what we do,” Paulk said. They’re also turning down referrals who don’t fit their


resident profile. “We wanted this to be part of our busi- ness, but we didn’t want this to be all of our business,” Paulk said. “We’re looking for full-time residents.” The relationships have generated a modest 1 percent


to 5 percent increase in the number of residents, and has helped Arbor establish more community relation- ships and create another referral network. The company also pitched its post-acute care services


at community events, giving families and future hospital patients the opportunity to choose the Arbor Company to recover after hospital discharges. “We created a group of people who had one voice and


one message to bring to the marketplace,” Paulk said. Fred Bentley is the vice president for payment and


delivery innovation at Avalere, a consulting firm based in Washington, D.C. The consultancy is helping a client take an approach much like The Arbor Company’s. That client has tabulated statistics to pitch to medical providers, showing hospital emergency room use and hospital readmission rates, among other data. They’re also comparing their stats with that of Medicare patients, another way of showing their potential to be a good partner for medical providers. He also recom- mends to clients to partner with multiple ACOs to foster multiple business opportunities.


Highlight Industry Expertise Like Memory Care Referring patients to senior living gives ACOs the oppor- tunity to take advantage of the industry’s expertise with memory care residents, which can be a complex cohort for hospitals to treat. Emergency rooms, for example, are in the business of treating and releasing people as quickly and efficiently as possible. This becomes more complicated when patients, such as those with dementia, are unable to communicate their symptoms especially when they have multiple chronic conditions. Jeff Frum, senior vice president of strategic alliances at Silverado, noted emergency room staff may be more likely to treat physical ailments, rather than mental. Even when they’re diagnosed correctly, dementia patients may need help following doctors’ orders, especially post-operative care. “We get a lot of referrals directly from hospitals and health care systems,” Frum said. “It’s simply, ‘Can you help this family.’ Many times we can and we do emergency hospital admissions 24 hours a day, seven days a week.”


Some ACOs and hospitals are using social workers to help determine the best environment for patients after they’re released from hospitals, Muhlestein said, noting that senior living could form relationships with this group of experts too. As ACOs become more practiced,


they could


become more amenable to working with assisted liv- ing communities, a sector that has built-in assistance for carrying out doctors’ orders. They'll be drawn to senior living communities that are already helping them avoid readmissions or other unnecessary visits. Before reaching out to hospitals to outline their services, Paulk’s communities made sure the properties were performing well in the areas medical providers would find helpful. “We didn’t want to go to the hospital and say, ‘We can help you solve your problem,’ and have them say, ‘You’re part of the problem.’” Pitching partnerships with medical providers will give


senior living communities the opportunity to review their practices. O’Neil also suggested training front-line staff to recognize changes in residents and report them. "We’re not asking them to diagnose, but their obser-


vations are important,” he said. The frontline support was an important part of the


$7.3 million Health Innovations Challenge grant the Centers for Medicaid and Medicare Services awarded Brookdale. They ran the program, Interventions to Reduce Acute Care Transfers, or INTERACT, with two academic partners: the University of North Texas Health Science Center and Florida Atlantic University. They adapted a quality control program in 46


assisted living communities and 26 skilled nursing communities. During the three-year pilot, hospital admissions decreased 17 percent among assisted liv- ing residents and 16 percent among skilled nursing patients. And in skilled nursing, they reduced the cost of care 13 percent. O’Neil also suggests senior living companies form


partnerships with their senior living peers in their geo- graphic areas, creating a group to which patients can be referred, sharing the business while giving medical providers multiple options. “None of us can be every- thing to everybody,” he said. “The quality providers will rise to the top and work to improve patient outcomes.” Brent Holman-Gomez is a senior vice president at Cambridge Realty Capital a company that makes loans for senior housing projects. He said about 10 percent of skilled nursing communities identify those referrals as potential income sources. He doesn't see the same trend with independent or assisted living. Those relationships aren’t common enough to make or break a deal, but opportunities exist. “If there’s a hot ACO in your area, you need to


make sure you’re coordinating with them,” Holman- Gomez said.


12 SENIOR LIVING EXECUTIVE / JULY/AUGUST 2016


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