Long-term care providers have always played a crucial role in ensuring the health and well-being of the frail and elderly. As practitioners continue grappling with the demands of patient care and running their businesses, Accountable Care Organizations (ACOs) focused on residents of long-term care facilities offer a promising solution to enhance the quality of healthcare services offered to residents in their care while also helping to reduce costs.
Most ACOs participate in the Medicare Shared Savings Program (MSSP), which incentivizes healthcare providers to collaborate in enhancing patient outcomes and quality and decreasing healthcare expenses. ACOs were permanently authorized in 2010 by the Affordable Care Act to achieve these goals.
The MSSP aims to enhance beneficiary outcomes and increase the value of care by providing better care for individuals, promoting better health for populations and lowering growth in healthcare expenditures. The program plays a critical role in transitioning the health system toward increased quality and reduced costs, aligning with CMS’s goal of having 100% of Medicare beneficiaries in a value-based payment arrangement. To achieve these goals, there needs to be a deeper focus on driving program participation among providers serving populations that are disproportionately higher in cost. This includes long-term care residents, who often have complex medical needs and require a high level of care.
It’s well known that providers face numerous challenges in managing patient care and their businesses. By joining an ACO focused on long-term care residents, they gain the support of a team of experts committed to helping LTC providers advance the state of healthcare for residents in their care.
Participation in the MSSP has steadily increased since the program was first introduced, but there is still room for additional adoption. Involvement in an ACO can empower providers to better manage chronic conditions, reduce unnecessary hospitalizations and decrease emergency room visits. By sharing data and coordinating care, providers can improve patient outcomes, quality outcomes and cut costs. Long-term care residents benefit from more comprehensive care, including better management of chronic conditions and a reduced risk of hospitalization.
When deciding on ACO participation for the long-term care population, consider choosing one with a proven track record of quality improvement, clinical impact and achieving shared shavings. It’s important to identify an ACO that will work with you on creating focus and solutions. Second, it’s helpful to understand Medicare’s Merit-based Incentive Payment System (known as MIPS), reporting requirements and penalties, as they impact reimbursement rates based on performance in quality, cost and improvement activities.
Participation in an ACO allows physicians to focus more of their time on patient care. Providers participating in an Enhanced Advanced Alternative Payment Model (APM) are offered the opportunity for a Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) bonus or its successor program and additional incentives to participate.
Lastly, ask, “Does the ACO analyze and provide actionable data and insights back to its participating providers?” This is key to helping drive improved quality and cost performance for patients assigned to the ACO.
In my extensive experience working with long-term care providers to highlight successful strategies for implementing value-based care, I believe there are many benefits of collaborating with other providers in the healthcare ecosystem. These include hospitals and primary care physicians, to develop integrated care models that deliver high-quality, patient-centered care across the continuum. This can help increase participation in the program and create a more extensive network of providers working together to improve care.
As healthcare costs continue to rise, it is increasingly important for long-term care providers to focus on value-based care systems that prioritize quality outcomes for patients while simultaneously reducing unnecessary spending. Together, we can transform the long-term care landscape and ensure the healthiest lives of residents.
Jason Feuerman is the president and CEO of LTC ACO, the first Accountable Care Organization (ACO) in the United States dedicated to long-term care facility residents. Prior to starting LTC ACO, Feuerman served as senior vice president and president of the Public Sector and Health Plan Divisions of Value Options, Inc.; president of Bravo Health, a subsidiary of Cigna, Inc.; and as president of Senior Care Centers of America, a leading provider of adult day health services. He holds a bachelor of science in finance and economics from the University of Maryland.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
