Priority Intervention Targets · System-Wide
Top 15 SNF Partners by Hospitalization Leverage
1988 FFS patients · 81% of total downstream hospitalization volume
1Sante SNF Op Co, LLC
2Cottesmore Of Life Care
3Garden Terrace Healthcare Center of Federal Way
Life Care Center of Port Orchard
Life Care Center of South Hill
Avamere Rehabilitation at Ridgemont
The Oaks at Lakewood
Olympic Marmot Healthcare LLC
Judson Park Health Center
Agility Health and Rehabilitation
Birch Creek Post Acute & Rehabilitation
Avalon Care Center - Federal Way Llc
Gig Harbor Health & Rehabilitation
Martha and Mary Health Services
Avamere Transitional Care of Puget Sound
Across the 8-hospital VMFH network, a focused cluster of 15 SNF partners drives 81% of attributable downstream hospitalization volume system-wide. The first three anchors — Sante SNF Op Co, LLC, Cottesmore Of Life Care, and Garden Terrace Healthcare Center of Federal Way — together account for over 30% of the total leverage. Structured care-transition engagement, embedded post-acute support, and shared escalation protocols across this cluster is the most direct lever to reduce facility hospitalization rate (FSHR) across the VMFH system — a market-level group of 15 SNF partners is a meaningful build-out footprint, not a one-off pilot.
Critical Findings
1
Washington Odd Fellows Home: Fac Risk 11.78 — Highest in VMFH System
Virginia Mason Medical Center sends patients to Washington Odd Fellows Home (Walla Walla), which carries a facility-specific risk score of 11.78 — the highest in the entire VMFH post-acute network. Avamere Heritage Rehabilitation of Tacoma (fac risk 9.56 at Virginia Mason) and St. Anthony (8.24) represent the next-highest concerns. Immediate preferred network review required for both facilities.
2
St. Michael: 46.4% of All SNF Volume Flows to a Single Facility
Sante SNF Op Co (Silverdale) receives 420 of St. Michael Medical Center's 906 FFS SNF patients — 46.4% concentration in a single partner. This is the most extreme single-facility dependency in the VMFH system and creates systemic risk if Sante's performance deteriorates. Columbia Lutheran Home carries a fac risk of 7.98 in St. Michael's network, the highest for that hospital. Immediate concentration risk review is warranted.
3
Avalon Care Center Federal Way: Very High Fac Risk at 7 of 8 Hospitals
Avalon Care Center Federal Way appears at 7 of 8 VMFH hospitals with Very High facility risk scores at Virginia Mason (6.22), St. Anthony (5.45), St. Michael (4.33), and St. Francis (4.32). St. Francis is the largest sender (31 patients, 40.5% hospitalization rate). The Bristol Hospice parent network and consistent Very High risk pattern across 7 hospitals warrants immediate system-level preferred network exclusion review.
4
Extreme SNF Concentration Across Multiple Hospitals
St. Francis: 41.9% to Garden Terrace Federal Way (129 patients). St. Anthony: 59.5% in top 2 facilities (Cottesmore 36.2% + Life Care Port Orchard 23.3%). St. Anne: 50.4% in top 2 (Judson Park 25.9% + Wesley Homes 24.5%). St. Elizabeth: 64.5% in top 2. High concentration creates dependency risk, limits quality leverage, and concentrates readmission exposure in a handful of partners.
5
Life Care Center of South Hill: Only SNF Appearing at All 8 Hospitals
Life Care Center of South Hill (Puyallup) is the single most widely-referred SNF in the VMFH system — all 8 hospitals discharge patients there. St. Joseph is the largest sender (68 patients, 10.5%). St. Michael's facility-specific risk score for this SNF is 5.06 (Very High). A system-level preferred network conversation anchored at Life Care South Hill has immediate leverage across the entire VMFH network.
Hospital Portfolio
St. Michael
Silverdale, WA · 248 beds
SNF Patients
906
Facility Hosp Rate (FSHR)29.7%
Opp. Score
59 — Immediate
Virginia Mason
Seattle, WA · 371 beds
SNF Patients
441
Facility Hosp Rate (FSHR)38.3%
Opp. Score
54 — Immediate
St. Joseph
Tacoma, WA · 374 beds
SNF Patients
646
Facility Hosp Rate (FSHR)33.1%
Opp. Score
51 — Immediate
St. Francis
Federal Way, WA · 152 beds
SNF Patients
308
Facility Hosp Rate (FSHR)37.7%
Opp. Score
51 — Immediate
St. Anthony
Gig Harbor, WA · 80 beds
SNF Patients
536
Facility Hosp Rate (FSHR)32.5%
Opp. Score
50 — Immediate
St. Clare
Lakewood, WA · 106 beds
SNF Patients
234
Facility Hosp Rate (FSHR)n/a
Opp. Score
45 — Near-Term
St. Elizabeth
Enumclaw, WA · 25 beds
SNF Patients
76
Facility Hosp Rate (FSHR)n/a
Opp. Score
40 — Near-Term
St. Anne
Burien, WA · 133 beds
SNF Patients
216
Facility Hosp Rate (FSHR)30.8%
Opp. Score
34 — Near-Term
Strategic Recommendations
1
Launch System-Level Preferred SNF Network Beginning at St. Michael
St. Michael's 46.4% concentration in Sante SNF Op Co (906 total patients, 44-facility network) makes it the highest-priority engagement. A compact 44-destination footprint is immediately actionable. Start with Sante relationship formalization and introduce Puzzle's monitoring platform to surface Columbia Lutheran (fac risk 7.98) and Bridgeview Care (4.58) as departure candidates.
2
Address Avalon Care Center Federal Way Across All 7 Sending Hospitals
Avalon Federal Way's Very High fac risk at Virginia Mason (6.22), St. Anthony (5.45), and four additional hospitals signals a systemic quality concern. Coordinate a cross-hospital preferred network exclusion conversation through VMFH's post-acute leadership. Puzzle can provide real-time monitoring to quantify readmission risk and inform the decision.
3
Use Life Care Center of South Hill as the System-Wide Network Anchor
With all 8 hospitals sending patients to Life Care South Hill, this facility represents the single highest-leverage relationship in the VMFH network. Formalizing a preferred partnership here — with Puzzle's performance monitoring — creates immediate cross-system visibility and an accountability framework scalable to the other 70+ cross-system SNFs.
4
Reduce the 123-SNF Virginia Mason Footprint to a Monitored Core
Virginia Mason's 123-destination network is the most fragmented in the system and operationally impossible to monitor without infrastructure. Washington Odd Fellows (fac risk 11.78) and Avamere Heritage (9.56) should be immediate exit candidates. Puzzle's preferred network tools can compress this to a curated 20–30 facility list with real-time performance data, reducing both readmission exposure and monitoring burden.
5
Pilot Puzzle Healthcare at St. Michael or St. Joseph as the System Entry Point
St. Michael's above-state readmission rate (16.6%), extreme concentration risk, and compact 44-facility network make it the fastest path to demonstrable ROI. St. Joseph's 14.57% above-state readmission rate (vs. 12.81% WA avg) and 80-destination network provide strong complementary data. A dual-hospital pilot — with Puzzle's preferred network framework, SNF scorecards, and readmission monitoring — positions VMFH for system-wide rollout within 6–12 months.
Hospital Drill-Down
Opportunity Index
Hospital Engagement Priority Ranking
Composite score (0–100) based on volume, utilization vs. WA state avg (18.30%), readmission rate, network fragmentation, concentration risk, and Very High risk facility count.
| Hospital | Location | SNF Patients | SNF Dests | SNF Util % | 30d Readmit | Score | Priority |
|---|---|---|---|---|---|---|---|
| St. Michael Medical Center | Silverdale, WA | 906 | 44 | 16.60% | 16.60% | 59 | Immediate |
| Virginia Mason Medical Center | Seattle, WA | 441 | 123 | — | — | 54 | Immediate |
| St. Joseph Medical Center | Tacoma, WA | 646 | 80 | 16.97% | 14.57% | 51 | Immediate |
| St. Francis Hospital | Federal Way, WA | 308 | 50 | 18.84% | 15.63% | 51 | Immediate |
| St. Anthony Hospital | Gig Harbor, WA | 536 | 41 | — | — | 50 | Immediate |
| St. Clare Hospital | Lakewood, WA | 234 | 43 | 19.45% | 15.63% | 45 | Near-Term |
| St. Elizabeth Hospital | Enumclaw, WA | 76 | 10 | 22.65% | 14.46% | 40 | Near-Term |
| St. Anne Hospital | Burien, WA | 216 | 28 | — | — | 34 | Near-Term |
Scores are relative within the Virginia Mason Franciscan Health system. Higher score = higher engagement priority for Puzzle Healthcare. Score blends FFS volume, SNF destination breadth, and SNF utilization (CMS Medicare FFS claims). WA state SNF utilization avg: 18.30%.
Cross-System SNF Analysis
SNFs Appearing at 3+ VMFH Hospitals
These 11 facilities represent system-level preferred network opportunities or risk concerns. 70 SNFs total appear at 3+ hospitals across the VMFH network. Sorted by priority, then hospital count.
| SNF Facility | # Hospitals | Hosp Rate | 30d Readmit | Max Fac Risk | Priority |
|---|---|---|---|---|---|
| Life Care Center of South Hill | 8 | 34.6% | 12.9% | 5.06 | High |
| Sante SNF Op Co, LLC | 5 | 31.1% | 11.4% | 3.02 | High |
| Cottesmore of Life Care | 5 | 43.4% | 15.0% | 3.55 | High |
| Life Care Center of Port Orchard | 5 | 35.0% | 12.3% | 3.99 | High |
| Garden Terrace Healthcare Center of Federal Way | 6 | 50.9% | 12.8% | 3.43 | High |
| Avamere Rehabilitation at Ridgemont | 5 | 44.8% | 15.3% | 3.82 | Near-Term |
| Martha and Mary Health Services | 5 | 18.0% | 9.4% | 2.96 | Near-Term |
| Enumclaw Health & Rehabilitation Center | 7 | ins | 12.0% | 4.36 | Near-Term |
| Judson Park Health Center | 4 | 41.0% | 8.6% | 3.27 | Near-Term |
| Avalon Care Center - Federal Way LLC | 7 | 40.5% | 13.8% | 6.22 | Immediate |
| Hallmark Manor | 4 | 45.2% | 16.7% | 5.42 | Immediate |
Hospitalization rate shown from the hospital with highest available data for each SNF. Max fac risk = highest facility-specific risk score across all sending hospitals. “Immediate” = system-level review required. “Near-Term” = preferred network discussion warranted. “High” = strong preferred network candidate. Data: CMS Medicare FFS Claims, Q4 2023–Q3 2025.
Data Sources & Methodology
Primary Data Source
All SNF utilization, volume, and readmission metrics are derived from CMS Medicare FFS Claims data (8Q trailing window: Q4 2023 – Q3 2025). The dataset covers fee-for-service Medicare beneficiaries discharged from acute-care hospitals to skilled nursing facilities during the analysis period. Facility metadata (bed count, NPI, CCN, ownership) is sourced from CMS Care Compare and CMS PECOS provider records.
Facility-Specific Hospitalization Rate (FSHR) — Primary Leading Indicator
FSHR is the all-cause rehospitalization rate among Medicare FFS patients discharged to a given SNF, measured at the SNF level over the 8-quarter analysis window. We lead with FSHR — rather than 30-day acute readmission — because FSHR is the metric most directly influenced by the structured SNF-level interventions Puzzle deploys (transitions of care, real-time admission/discharge visibility, in-SNF nurse practitioner coverage, and proactive complication management). The 30-day acute readmission rate sits one layer upstream and is affected by clinical complexity, discharge planning, and SNF performance combined; FSHR isolates the SNF-attributable component where intervention moves the needle.
Calculation: For each hospital, FSHR is reported as a volume-weighted average of SNF-level FSHR values across that hospital’s reportable SNF destinations, weighted by FFS patient volume. SNFs falling below the CMS minimum reporting threshold (<11 FFS patients per cell) are suppressed at source and excluded from the weighted calculation; aggregate destination counts still reflect them. System-wide weighted FSHR across the Virginia Mason Franciscan Health network: 32.2%.
Where the data lives: Raw 30-day readmission values remain stored alongside every SNF in this dashboard for analytical completeness, but FSHR is the lead metric surfaced throughout the executive narrative and per-hospital tiles.
State Benchmarks
Washington state averages are derived from the same CMS Medicare FFS Claims data window: SNF utilization rate 18.30% (share of acute discharges routed to a SNF) and 30-day all-cause readmission rate 12.81% (readmission from SNF within 30 days of discharge). These figures represent the Washington-weighted average across all reporting acute hospitals during Q4 2023–Q3 2025. 30-day readmission remains a supporting signal; FSHR (see preceding section) is the lead metric surfaced throughout the dashboard.
Opportunity Index
The Opportunity Index is a composite score (0–100) designed to surface where structured post-acute network engagement has the highest expected impact. Components:
- Volume (25 pts) — FFS SNF patient count, scaled relative to system peers
- Utilization vs. WA benchmark (20 pts) — Delta between hospital SNF utilization and WA state average
- SNF hospitalization signal (20 pts) — FSHR-weighted SNF rehospitalization rate combined with 30-day acute readmission, blended into a composite signal vs. WA state benchmark
- Destination fragmentation (15 pts) — Number of unique SNF destinations (more = more complex)
- Top-2 concentration risk (10 pts) — Share of volume in top 2 SNF partners
- Very-high-risk SNF exposure (10 pts) — Count of SNFs with elevated facility risk scores
Priority tiers: Immediate (≥50), Near-Term (≥35), Monitor (<35). The Opportunity Index is a scoring input for cross-hospital comparability; the operational lens for SNF-network intervention is FSHR.
Suppression & Coverage
SNFs with fewer than 11 FFS patients per CMS reporting cell are suppressed at source. Two VMFH facilities (St. Clare Hospital and St. Elizabeth Hospital) have all top-destination SNF-level hosp_rate cells below the minimum reporting threshold, so a facility-specific FSHR cannot be computed at those hospitals; we surface volume, concentration, utilization, and 30-day readmission as supporting signals for these sites.
Cross-System SNF Identification
A SNF is classified as “cross-system” if it appears as a discharge destination for 2 or more VMFH hospitals during the analysis period. The 88 cross-system SNFs (2+ hospitals) and 70 network-wide anchor SNFs (3+ hospitals) are identified through NPI-level matching across all VMFH hospital discharge records.
Confidentiality Notice
This report is prepared exclusively for Virginia Mason Franciscan Health by Puzzle Healthcare and is Confidential & Proprietary. It is intended solely for internal use by authorized VMFH personnel. Do not distribute externally without written authorization from Puzzle Healthcare.