Partnership strategies to boost skilled nursing referrals and occupancies 

The days are quickly vanishing when the hospital discharge planner made a referral based on a personal relationship with a skilled nursing administrator. The realities of value-based care with its penalties and shared savings programs are creating a new referral system with narrowed networks that rely on accurate data and positive patient outcomes. 

Faced with occupancy challenges, skilled nursing operators have the opportunity to capture additional market share by understanding how to partner with referral sources and what they seek in their skilled care providers. The details were discussed recently at the 2019 NIC Spring Conference.  

The session, “A Post-Acute Survival Guide: Real Strategies and Real Results for Increased Occupancy,” was led by Joseph Kiernan, chief strategy officer/senior vice president, network development, Ocean Healthcare, a network of skilled nursing facilities and services based in New Jersey. 

Taking an innovative approach, Kiernan brought together executives from his own referral network: a hospital system, RWJ University Hospital/Barnabas Health; bundled payments managerRemedy Partners; and a care transitions company, naviHealth. “We are all working together,” said Kiernan.  

The panel walked through their relationships, providing insights into their different roles, how they work together, and what is expected from a skilled nursing provider. Several requirements stood out. Stakeholders want some form of continuum of care, clinical excellence and a compatible technology platform to ease/facilitate communication 

Panelist Nicole Berner discussed the role of the hospital system. She is director, medical administration at RWJ/Barnabas Health. The system has 11 hospitals and serves 3 million patients annually.  

Skilled facilities join the RWJ/Barnabas network by invitation only, noted Berner. Criteria include patient requests, staffing, claims data and physician referrals. Other factors include technological capabilities, and how many skilled beds the hospital needs. 

Berner described how she works with the other stakeholders represented on the panel. They share data to help determine which skilled providers have the best outcomes, and which ones perform well in specific specialties such as psychiatric care, or joint replacement. 

“We are narrowing our network,” said Berner.  

A good understanding of the role, and requirements, of bundled payments programs can impact occupancy, according to panelist William Shatraw, senior operations director, Remedy Partners, a bundled payments program manager. 

Remedy Partners works with hospitals, including RWJ/Barnabas, to build skilled care networks. Both quantitative and qualitative factors at the skilled facility are considered. “We take a quantitative approach but qualitative factors are just as important,” said Shatraw. “We see where we can make improvements.” 

Remedy Partners collects quantitative data, such as length of stay and readmissions. Also, a post-acute representative from Remedy evaluates each skilled nursing facility using a 70-question survey. The results, along with the quantitative data, are used to rate the facilities, show where improvements can be made, and pick partners.  

The payor’s role was addressed by Shawn Super, director, network engagement & operations, naviHealth, which represents large payors.  

For many years, payors thought it was better to have more providers. “That’s no longer the case,” said Super. Payors want to work with the highest quality providers. “Less is more,” she added.  

Super’s team uses a high-tech, high-touch model to make sure the patient is discharged at the right time to the right place. Data from 4 million records is used to create a dashboard for each patient to show what they can expect in terms of length of stay and treatment based on their condition. The information is shared with upstream and downstream providers. “We set a consistent message across the board,” said Super.  

Skilled nursing facilities receive a score card of how theyre doing and how they can improve their results. “We want the best providers in the network in order to keep costs down,” said Super.  

Panelists agreed that sharing performance information among the stakeholders is a paradigm shift. “Everyone used to hold their strategies close to the vest,” said Kiernan. “The dynamic of the business approach has changed.” 

The collaborative approach is working for Ocean Healthcare. Occupancy at its skilled facilities averaged 92.5 percent in the last two quarters of 2018.  That compares to a state-wide average of 84.8 percent in New Jersey where Ocean’s facilities are located.  

Where to start? Drive quality, focus on partner relationships, share data, and be transparent. “High performing providers will rise to the top,” said Kiernan.  “You have to be engaged. Start listening to what your partners want.”  


For more ideas on how to partner with healthcare referral sources to boost occupancies, access the entire session’s audio and PowerPoint presentation here.


March 28, 2019