Network Integrity: Implementation and Referral Patterns

A Research Brief By: Dalton Akeim George


In the "Western" World, reverence for the older portion of the population has been lost. They are often cast aside when they are no longer able to work, and the wisdom and value that they hold from long lives is neglected in favor of younger people for their value to the country's productivity. However, at Trinity Health Senior Communities, they are seeking to change the narrative around seniors and improve the care framework surrounding the geriatric population. THSC has recently turned its focus to Network Integrity—ensuring that when a patient leaves a Trinity Health hospital they are more likely to remain with a Trinity Health skilled nursing facility. By keeping these patients in-network, Trinity Health can ensure that the culture surrounding the patient remains the same and that the stress of a care transition is mitigated for the patient and their family.

There are several factors that influence Network Integrity for a health system: Distance, Ease of Access, Familiarity, and Quality1. Of these factors, Ease of Access, Familiarity, and Quality are metrics that THSC believes the most improvement can be made in order to better serve the geriatric population. Improvements in Ease of Access are manifested in the ways and timeliness with which the nursing communities respond to referrals from the hospital. When discussing the nursing home admissions process with Carla Momongan, the Clinical Liaison at Marycrest Manor, she said that they try to respond to referrals within 15 minutes because families often choose a facility that expresses the most interest in caring for their loved one2. However, the speed of the response isn't all that matters. The new marketing team is seeking to implement a "census culture" around the referral process.

Census Culture was defined as "a refocusing of the referral process on finding ways to take as many of the patients as we can" by the new Director of Census, Teri Robinson. This means accepting more of the patients who would normally be turned away because they were "unfavorable" to a facility. Patients with high medication costs, behavioral issues that could indications of unreported3 mental health disabilities, or uncontracted insurances would be looked at more closely than before. Reasons for rejecting patients would be addressed under a census culture: contracts would be negotiated for uncommon payer sources, "riskier" patients would be allowed into the facility, and overall costs of a patient would be considered4 instead of the upfront costs of intake for a resident. Shifting towards census culture means that previously underserved elders will have greater opportunity to be accepted into nursing homes. This is important to both the providers and the patients and their families. Increasing census culture stands to benefit the health system financially by maintaining high occupancy rates for Trinity Health in the face of declining occupancy rates nationally. More importantly, placement in a nursing home is important for families5 because many of the emotional and physical care needs will be taken care of and support for their elder will be the focus of the care providers at the nursing home.