Leveraging Data to Optimize Value-Based Care in Skilled Nursing Facilities

Quick Review of Chapter 1 in Our VBC Series for SNFs 

In Chapter 1 of our e-book series on value-based care (VBC) in skilled nursing facilities (SNFs), we delved into the steps facilities can take to build effective, sustainable, and workable VBC programs.  

These steps include understanding the current VBC marketplace and its benefits, exploring key programs associated with VBC and their relevance for SNFs, and identifying the actions SNFs must develop and implement to succeed. These programs aren’t abstract concepts; they’re pathways to success. SNFs learn how to align their practices with these programs, ensuring their relevance in a shifting health care ecosystem. 

In this chapter, we will examine the critical role of data and analytic solutions. We will explore how they can help SNFs optimize their performance in VBC programs. Additionally, we will discuss the types of data used to establish meaningful benchmarks that drive performance. Practical applications of data for an SNF will be highlighted, demonstrating how it can assist in negotiations with payers, reporting, and other potential uses for the data generated by VBC programs. 

Value-based care programs in skilled nursing facilities are pivotal in enhancing patient outcomes and reducing unnecessary hospital readmissions, ultimately leading to improved quality of care and cost savings. – Centers for Medicare & Medicaid Services  

The Role of Data and Analytics in Optimizing VBC  

Value-based care represents a transformative shift from the traditional fee-for-service model in the modern health care landscape, emphasizing quality and outcomes over volume.  

While it may seem like a daunting task, the strategic use of data and analytics can help skilled nursing facilities optimize their performance by providing actionable insights that drive improvements in care quality, operational efficiency, and financial outcomes.  

By leveraging data, facilities can establish meaningful benchmarks, monitor key performance indicators, and identify areas needing improvement. Plus, analytics enable the identification of trends and patterns, facilitating better decision-making and strategic planning. This, in turn, enhances their ability to negotiate with payers, comply with reporting requirements, and ultimately deliver higher-value care to patients. We’ll explore these areas later in this chapter. 

The good news is that there’s no shortage of data sources. You have a lot to work with as meaningful data can come from: 

  • Your own data, including data from your electronic health record (EHR) platform 
  • Health Information Exchanges (HIE) encompassing data from other facilities that have treated the same patients 
  • Claims data, Medicare, Medicaid, private insurers, etc. 
  • Patient surveys and feedback 
  • National databases like CMS (Centers for Medicare & Medicaid Services) and NIH (National Institutes of Health) 

For example, data from patient surveys can provide direct insights into patient experiences and satisfaction levels. Analyzing this data helps identify strengths and weaknesses in care delivery, enabling facilities to target specific areas for improvement. By addressing patient-reported concerns and preferences, SNFs can improve the quality of care, a crucial component of value-based purchasing metrics.  

Surveys also address another key VBP mandate: patient engagement by showing a facility’s commitment to understanding the needs and preferences of the populations they serve. Additionally, positive patient feedback can enhance a facility’s reputation, making it more attractive to payers and increasing patient referrals.  

SNFs can also collaborate with external organizations like hospitals and health systems, universities, research institutions, associations, and manufacturers.   

By leveraging these data sources, SNFs can effectively gather the necessary information to implement and optimize value-based care programs. This data shapes and informs virtually every step and process required for an effective VBC program. However, it often takes considerable time and effort for SNFs to compile and analyze data from all sources. Analysis and support from trusted third-party experts, who often have access to other sources, are highly beneficial. 

The Real World: Practical Applications 

CMS Value-Based Purchasing Program 
One of the more crucial value-based care programs for SNFs is the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program. According to CMS, the SNF VBP Program awards incentive payments to SNFs to improve the quality of care they provide to patients. 

For the Fiscal Year (FY) 2024 Program year, performance in the SNF VBP Program is based on all-cause hospital readmissions. The SNF VBP program is also mandatory. According to CMS, “all SNFs paid under the SNF Prospective Payment System (PPS) are required to participate in the SNF VBP Program.” It’s also a program many SNFs continue to struggle with. Better data will help. It plays a crucial role in this program for several reasons:  

  • It enables SNFs to evaluate their performance on a hospital readmission measure, a key metric. 
  • Data informs both improvement and achievement assessments, allowing SNFs to track progress and identify areas for enhancement.  
  • SNFs receive quarterly confidential feedback reports based on data, providing insights into their performance.  
  • Data drives the calculation of incentive payments, encouraging SNFs to improve care quality continually.  

While issues and concerns with VBP have been voiced by some, CMS and other stakeholders are working to address them, and changes are coming. According to Skilled Nursing News, starting in fiscal year 2026, the program will expand to include additional quality measures such as health care-associated infections, total nursing staff turnover, and total nursing (hours per resident day​). 

How does the SNF VBP Program affect my SNF’s FY 2024 payments? Find out with this CMS Fact Sheet

Establishing Benchmarks Through Data and Analytics 
One of the main benefits of data is the ability to establish benchmarks to gauge facility value-based care performance compared to peers, VBC standards, and reporting.  

Data and analytics provide a robust foundation for establishing these benchmarks. By aggregating and analyzing data on patient outcomes, readmission rates, patient satisfaction, and cost of care, SNFs can comprehensively understand their performance. 

For instance, facilities can use historical data to identify patterns and trends in patient care outcomes. By comparing these outcomes with industry standards and peer performance, SNFs can set realistic and achievable benchmarks. Advanced analytics can refine this process by identifying areas where a facility excels or lags. For example, predictive analytics can forecast patient outcomes on wound or UTI healing, pressure injuries, and falls, allowing facilities to adjust their care protocols proactively. These same areas—and others identified as relevant for a facility—can also be used to develop meaningful benchmarks. 

Benchmarking through data analytics is not a static process. It requires continuous monitoring and updating to reflect changes in patient demographics, medical practices, and regulatory requirements. SNFs can leverage real-time data analytics to keep their benchmarks relevant and challenging. This dynamic benchmarking process ensures that facilities are constantly striving for improvement and aligning with the goals of VBC, which focuses on delivering high-quality, efficient, and patient-centered care. 

Net Health’s Value-Based Care Solutions for Skilled Nursing provides a deeper perspective on the metrics, offering a time-saving tool that allows facilities to drill down to the resident level from a single dashboard. This granular level of detail supports improved patient care and outcomes. 

Ensuring Timely Reimbursement Through Compliance 
One of the key challenges SNFs are facing as they seek to build out value-based programs is slow reimbursement, which is often due to inaccurate coding or adherence to other guidelines. With nearly 55% of the payer mix for SNFs coming through Medicaid, it’s crucial to ensure billing is accurate the first time it’s submitted. But where are the errors occurring? What’s happening operationally? Once again, data analytics can help pinpoint problem areas and provide guidance on solutions.   

One of the primary reasons for slow Medicaid reimbursement is improper coding. Data analytics can help SNFs analyze their coding practices by comparing submitted claims against standardized coding guidelines. Through this comparison, facilities can identify coding errors, such as incorrect or incomplete codes, which often result in claim rejections or delays. Analytics tools can also track and flag common coding mistakes, enabling staff to receive targeted training to improve their accuracy and efficiency in future submissions. 

Need more help with proper coding? 

Last year, CMS launched a Skilled Nursing Facility (SNF) 5-Claim Probe and Education Review program to help facilities avoid future claim denials and adjustments. Visit this link and ensure your EHR provider is up to date with the latest guidelines. 

Non-compliance with Medicaid’s stringent regulatory requirements is another significant factor that can delay reimbursements. Data analytics can assist SNFs in monitoring compliance by evaluating claim submissions for adherence to Medicaid’s rules and regulations. For instance, analytics platforms can automatically check whether all necessary documentation is included with each claim, whether patient eligibility criteria are met, and whether the services billed are medically necessary. By ensuring that all claims meet these requirements before submission, SNFs can reduce the likelihood of denials and expedite the reimbursement process. 

Additionally, data analytics can provide insights into the performance of the billing process itself. By analyzing the time taken at each stage of the billing cycle, from claim submission to payment receipt, SNFs can identify bottlenecks and inefficiencies. For example, if the data reveals that a significant number of claims are being delayed due to issues in the initial submission phase, the facility can implement process improvements or additional training for billing staff to address these issues promptly. 

There’s another important area where analytics can help SNFs, and it is one you may not have considered. It can help SNFs understand the impact of policy changes on reimbursement timelines. By tracking and analyzing claims data over time, facilities can detect trends and shifts in payment patterns that may be associated with changes in Medicaid policies or procedures. This proactive approach allows SNFs to adjust their billing practices in response to policy updates, ensuring continued compliance and minimizing disruptions to their cash flow. 

Enhancing Negotiations with Payers 
Negotiating with payers is a critical aspect of operating under a VBC model. Payers, including insurance companies and Medicare, are increasingly tying reimbursements to performance metrics such as patient outcomes and cost efficiency. Data and analytics play a pivotal role in these negotiations by providing SNFs with the evidence they need to demonstrate their value. 

As noted, the key metric measured under the CMS Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program is hospital readmissions. With detailed data on their readmission rates, SNFs can show payers how their services lead to better health results and lower costs. Data on reduced hospital readmissions can be a powerful negotiating tool, demonstrating effective care coordination and management. Additionally, analytics can highlight the facility’s adherence to best practices and clinical guidelines, strengthening its negotiation position. 

Furthermore, data analytics can help SNFs tailor their negotiations to different payers’ specific interests and priorities. By understanding what metrics are most important to each payer, facilities can present their data in a way that aligns with those priorities. This targeted approach can lead to more favorable contract terms and reimbursement rates. 

Advanced analytics can also help SNFs identify new opportunities for value-based contracts. By analyzing market trends and payer strategies, facilities can proactively seek partnerships aligning with their strengths and goals. This strategic use of data ensures that SNFs are reacting to payer demands and shaping the landscape of their contractual relationships. 

Improving Reporting Capabilities 
Accurate and comprehensive reporting is a cornerstone of value-based care. SNFs must report on a wide range of metrics to comply with regulatory requirements, demonstrate quality of care, and secure reimbursements. Data and analytics enhance SNFs’ reporting capabilities by automating data collection, analysis, and presentation. 

Analytics tools can integrate data from various sources, including EHRs, patient satisfaction surveys, and financial systems, to provide a holistic view of the facility’s performance. This integration simplifies the reporting process, reducing the administrative burden on staff and minimizing the risk of errors. 

Moreover, advanced analytics can generate insights that go beyond basic reporting requirements. For instance, predictive analytics can identify potential risks and areas for improvement, allowing SNFs to address issues proactively. This capability is particularly valuable in VBC models, where preventing adverse events and improving patient outcomes are paramount. 

Data visualization tools further enhance reporting by presenting complex data in an easily understandable format. Dashboards and interactive reports enable stakeholders to understand critical metrics and trends quickly, facilitating informed decision-making. These tools also support transparency, as clinicians can share relevant information with patients, families, and payers to demonstrate the facility’s commitment to quality and accountability. 

Top 5 Ways to Use Analytics to Improve Value-Based Care

  1. Prevent adverse events and improve care planning. 
  2. Streamline workflow and operations. 
  3. Improve health outcomes and quality of life. 
  4. Develop data-based partnerships. 
  5. Measure ROI. 
For more information, see 5 Ways Skilled Nursing Facilities Use Analytics 

Leveraging Data for Comprehensive Improvements 

Beyond benchmarking, negotiations, and reporting, clinicians and administrators can use the data generated by VBC programs to make a myriad of other improvements in SNFs. One significant area is clinical decision support. SNFs can develop evidence-based care protocols and guidelines that improve patient outcomes by analyzing patient data. For example, analytics can identify the most effective interventions for managing chronic conditions commonly seen in SNFs, such as diabetes or heart disease. 

Data can also drive operational efficiencies. By analyzing workflows, resource utilization, and staffing levels, SNFs can identify inefficiencies and areas for cost savings. For instance, data analytics can reveal patient admissions and discharge patterns, enabling better staff scheduling and resource allocation.   

This optimization ensures that SNFs are not only providing high-quality care but also operating in a financially sustainable manner. 

Patient engagement is another area where data can have a significant impact. By leveraging patient interactions and feedback data, SNFs can tailor their services to meet their patient’s specific needs and preferences. For example, analytics can identify trends in patient satisfaction and pinpoint areas where improvements are needed. It can also help pinpoint when patients and families might need to be contacted and encouraged to discuss end-of-life planning. This patient-centered approach aligns with the principles of VBC, which emphasize the importance of delivering care responsive to patients’ needs. 

More ways to use analytics to tackle SNF challenges include:  

  • Human Resource Management – To discover why employees choose to stay or leave.
  • Staff Deployment – To identify which areas need more or less staffing on a given day or time. 
  • Revenue Enhancement – To find new ways to generate more patient volume.
  • Decrease Denials – To pinpoint factors leading to claim denials. 

Moreover, data analytics can help SNFs comply with regulatory requirements and accreditation standards. By maintaining comprehensive and accurate data records, facilities can ensure they meet all necessary criteria and are prepared for audits and inspections. This compliance protects the facility from potential penalties and enhances its reputation and credibility in the health care community. 

In addition to these benefits, clinicians and administrators can use the data generated by VBC programs for research and innovation. SNFs can collaborate with academic institutions, health care organizations, and technology companies to conduct studies and pilot new approaches to care. This collaborative approach fosters a culture of continuous improvement and innovation, positioning SNFs at the forefront of advancements in post-acute care. 

Analyzing the Analytics 

Simply having data isn’t enough in the complex and dynamic environment in which SNFs operate today. You need help analyzing your analytics—finding out what is relevant, what’s a priority, and what’s attainable and most beneficial to the organization. 

Post-acute analytics refers to using data-driven insights in the post-acute care setting to improve clinical outcomes, enhance revenue, and ensure compliance.  

A review of the data also assists in identifying risk factors and predicting potential issues that might lead to hospital readmissions and adverse events. This enables health care providers to implement preventive measures and improve patient outcomes. Providers and payers use these advances to inform clinical and operational decision-making and succeed in value-based care.  

Does your current approach to analytics help you? 

  • Increase compliant reimbursements 
  • Decrease readmissions and hospitalizations 
  • Improve quality measures and facility rating 
  • Use staff resources more efficiently 

Ask VBC experts, and they’ll tell you that data and analytics are indispensable tools for SNFs operating under value-based care models.  

By establishing benchmarks, enhancing negotiations with payers, improving reporting capabilities, and leveraging data for comprehensive improvements, SNFs can optimize their performance and thrive in the evolving health care landscape.  

The insights gained from data analytics support better patient outcomes and operational efficiencies and empower SNFs to shape their future in value-based care proactively. As the health care industry continues to prioritize quality and value, the strategic use of data and analytics will be crucial for SNFs to achieve their goals and fulfill the mission of providing exceptional patient care.