This comprehensive report delves into strategies aimed at fostering greater involvement of long-term and post-acute care (LTPAC) providers within Accountable Care Organizations (ACOs). Highlighting the imperative role of these providers in achieving quality, cost-effective care, the analysis explores recommendations for policy enhancements, risk adjustment model implementation, quality metric prioritization, and bundled payment administration. Insights from key stakeholders underscore the pressing need for collaborative efforts between CMS and LTPAC providers to realize the full potential of value-based care initiatives and ensure holistic patient outcomes.
In an era marked by evolving healthcare landscapes and the pursuit of value-based care, Accountable Care Organizations (ACOs) stand as pivotal entities in orchestrating collaborative care delivery models. However, the comprehensive integration of long-term and post-acute care (LTPAC) providers remains a critical yet under-addressed aspect within ACO frameworks. Recognizing the significance of LTPAC services in holistic patient care, this report delves into strategies aimed at bolstering the participation of such providers within ACOs. By elucidating key challenges, proposing policy reforms, and advocating for collaborative approaches, this analysis seeks to catalyze efforts toward optimizing care delivery and achieving better patient outcomes.
Aisha Pittman, Senior Vice President of Government Affairs at the National Association of ACOs (NAACOS), emphasized the necessity for the Centers for Medicare & Medicaid Services (CMS) to take proactive measures in expanding the representation of provider types traditionally underrepresented in ACOs, such as skilled nursing facilities (SNFs). Pittman stressed that by including LTPAC providers more comprehensively, Medicare beneficiaries can access higher quality and more cost-effective care through value-based care initiatives.
One key proposal is the removal of long-term nursing facility populations from the MSSP and other similar models, as community-based providers often do not serve as primary care providers for these beneficiaries. Distinguishing between short-stay nursing facility populations, who typically receive care in short-term rehabilitation facilities, and long-stay populations, who are institutionalized and receive ongoing care, is essential. It’s noted that long-stay facilities primarily rely on funding from Medicaid and private insurance, while short-stay facilities receive funding from various sources including traditional Medicare, Medicare Advantage, and commercial plans.
ACOs are advocating for the adoption of the risk adjustment model tested in ACO REACH for the nursing facility population by CMS. Additionally, stakeholders urge CMS to ensure accuracy in historical references for new institutions when implementing changes to the risk adjustment model.
Regarding quality measures, stakeholders call for a greater emphasis on metrics that facilitate superior care transitions and discharge planning. They propose regular sharing of data from CMS to enable a feedback loop for updates or corrections and suggest flagging beneficiaries prospectively attributed to other ACOs or shared savings programs. Furthermore, there’s a plea for CMS to allocate funding for data infrastructure within nursing facilities.
Nisha Hammel, Vice President of Population Health Management at the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), highlights the significant opportunity for LTPAC providers to take a leading role in value-based care programs.
Participants advocate for voluntary episode-based payment models, with a recommendation for tailored approaches for skilled nursing facility (SNF) providers within ACOs based on provider type or clinical conditions to ensure effectiveness. They emphasize the importance of enhancing care coordination across settings, improving discharge planning, and applying models to various specialty provider types, including those in rural areas. Other requests include a dynamic target pricing mechanism based on live data and population-tailored benefit enhancements.
Discussions around the administration of bundled payments vary, with suggestions for both ACO-administered and CMS-administered approaches. While opinions differ, there’s a consensus that SNFs should bear the brunt of savings or losses, although ACOs should still share in the outcomes.
Despite the potential for significant savings, less than 2,000 SNFs currently participate in ACOs, with nearly 70% of ACOs lacking SNF representation. Stakeholders assert that existing ACO models do not align adequately with LTPAC providers, despite the potential benefits they offer.
A 2023 analysis by MedPAC revealed that Medicare expenditure on post-acute care amounted to nearly $57 billion, underscoring the importance of optimizing care delivery in these settings.
These recommendations stem from a roundtable convened by NAACOS, AHCA, and NCAL in August 2023, which included representation from various stakeholders such as America’s Health Insurance Plans, the American Hospital Association, Families USA, Premier, Special Needs Plan Alliance, and VillageMD.
The imperative to foster greater participation of long-term and post-acute care (LTPAC) providers within Accountable Care Organizations (ACOs) transcends mere policy considerations; it speaks to the very essence of patient-centered care delivery. As this report elucidates, the integration of LTPAC services within ACO frameworks holds immense potential to enhance care coordination, improve outcomes, and drive cost efficiencies. Through collaborative efforts, robust policy reforms, and a shared commitment to value-based care principles, stakeholders can navigate the evolving healthcare landscape with resilience, ensuring that every patient receives comprehensive, high-quality care across the continuum.