ACOs want increased participation of long-term and post-acute care providers

Fierce Healthcare | February 21, 2024

Accountable care organizations are calling on the feds to increase participation of long-term and post-acute care providers in ACOs and to better incorporate episodic-based payments. The recently released white paper highlights ways the ACO REACH Model and Medicare Shared Savings Program (MSSP) can be utilized to grow participation. “If CMS is to achieve its goal of having all Medicare beneficiaries in an accountable care relationship by 2030, then it must take steps to better include provider types less represented in ACOs, including SNFs,” said National Association of ACOs (NAACOS) Senior Vice President of Government Affairs Aisha Pittman. “We hope our recommendations spark attention to this area, because patients served by LTPAC providers deserve the higher quality, lower cost care we know value-based care delivers.”

SUD Treatment Providers Embrace Alternative Payment Models, Ditch Fee-For-Service

Behavioral Health Business | February 20, 2024

Fee-for-service reimbursement models have contributed to a fragmented behavioral health industry. Substance use disorder (SUD) providers are set to evolve current reimbursement models to alternative payment systems in 2024. Alternative payment models, which include risk-bearing, bundled payments and shared savings, offer a brighter future for the industry. But taking on risk and working with payers to develop alternative payment models requires strategizing and careful discussion with payer partners, industry insiders told Behavioral Health Business.

Inside Steps CMS Could Take to Increase Nursing Home Participation in ACOs

Skilled Nursing News | February 21, 2024

The nursing home sector’s minimal participation in Accountable Care Organizations (ACOs) – largely because they have not found it lucrative to be in ACOs or have been sidelined within ACOs by other provider types – has resulted in a push for change. In a joint effort aimed at enhancing the integration of long-term and post-acute care (LTPAC) providers into ACOs, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of ACOs (NAACOS) have released a set of recommendations, which if implemented could result in cost savings and quality improvements for nursing homes. These recommendations, recently shared with the Centers for Medicare & Medicaid Services (CMS), target policies to increase participation of LTPAC providers in ACOs, fostering improved patient outcomes and reduced Medicare costs.

Contract Management in a Value-Based Care Environment

Managed Healthcare Executive | February 19, 2024

For operational efficiency, value-based initiatives need a scalable digital infrastructure that can handle multiple reimbursement models, including fee for service. Value-based care (VBC) models are designed to improve patient outcomes and reduce healthcare costs by proactively focusing on patient wellness. This preventive approach to individual and population care requires collaboration between patients, providers, payers, and other stakeholders, such as community-based organizations (CBOs) that offer wellness-related services. Payers benefit from VBC models because their emphasis on preventive care results in a healthier overall population and better management of chronic conditions, which reduces claims for prolonged and expensive treatments. Heart disease, diabetes, cancer, Alzheimer’s disease, and other chronic illnesses combined account for 90% of healthcare costs in the U.S., according to the Centers for Disease Control and Prevention.