Introduction
Post-acute care facilities are vital to patient recovery, but closed provider networks limit their ability to serve those in need. Controlled by payers and hospital systems, these networks restrict patient choice and create financial strain. To break through these barriers, facilities must expand access, build partnerships, and push for policy change.
The Problem with Closed Networks
Closed networks limit contracts, reduce referrals, and shrink financial stability. The consequences include:
- Fewer patients gaining access to post-acute services.
- Revenue loss due to restricted reimbursements.
- Disrupted care coordination, leading to inefficiencies.
Strategies to Overcome Barriers
1. Build Direct Referral Relationships
Strong ties with hospitals, physician groups, and community partners can increase referrals, bypassing restrictive networks.
- Partner with independent physician associations (IPAs) and primary care providers.
- Work closely with hospital case managers for discharge planning.
- Use outcomes data to prove superior recovery rates.
2. Tap into Value-Based Care Partnerships
Payers prioritize providers who save costs and improve outcomes.
- Join Accountable Care Organizations (ACOs) for broader contract access.
- Implement data-sharing agreements to enhance coordination.
- Use alternative payment models (APMs) focused on quality and efficiency.
3. Expand with Telehealth and Remote Monitoring
AI-driven tools keep post-acute providers engaged, reducing rehospitalizations and strengthening payer relationships.
- Offer virtual follow-ups to prevent complications post-discharge.
- Use predictive analytics to flag high-risk patients early.
4. Advocate for Policy Reform
Fighting for inclusive provider networks is key to long-term success.
- Collaborate with industry associations to push for fair policies.
- Use data-driven case studies to highlight patient access issues.
- Engage lawmakers to support legislation that expands patient choice.
5. Diversify Payer Contracts and Services
Relying on a single payer is risky. Expanding networks and service lines boosts resilience.
- Contract with Medicare Advantage, Medicaid Managed Care, and private insurers.
- Offer home-based care, outpatient therapy, and palliative care.
- Introduce direct-pay options to serve out-of-network patients.
Conclusion Breaking through closed networks requires a bold, strategic approach. By strengthening referral relationships, leveraging value-based models, expanding telehealth, advocating for reform, and diversifying revenue streams, post-acute providers can increase access, improve financial health, and serve their communities more effectively. The future belongs to those who adapt, innovate, and fight for change.