The accountable care organization (ACO) model is shaping up to be the base that future value-based care models will be built on, with more than 50% of Medicare fee-for-service (FFS) beneficiaries being aligned with an ACO now. While there’s a lot of room for improvement in the ACO model, the Centers for Medicare and Medicaid…
As the Centers for Medicare and Medicaid Services (CMS) strives to improve and expand accountable care organization (ACO) models for the future, there’s a prime opportunity to better serve long-term care populations, including residents in nursing homes. For starters, the federal agency should consider simplifying the bureaucratic hurdles that keep more skilled nursing facilities (SNFs)…
The Medicare Advantage (MA) Star Ratings program is undergoing a fundamental shift. Instead of primarily rewarding health plans’ operational compliance and administrative performance, the focus is moving toward measurable clinical outcomes and member experience. As a result, medication management will increasingly influence both Star Ratings performance and financial outcomes, making it a critical area for…
Ari Shabat: Well, we just heard a little bit of that from Joel Theisen, founder and CEO from Lifespark, in the previous session. His concept of “choppy interactions” and the effort to build a sensible workflow really ties into admissions — because that’s where value-based care either begins or breaks. Many facilities still treat admissions as…
For organizations hoping to draw out savings from value-based care, added administrative burdens might be a source of hesitation. However, some operators are successfully turning to technology offerings that maximize reimbursement, pinpoint essential data, and include platforms already used by referral partners and managed care organizations (MAOs). AI programs can help “tease out” some of…
The future of value-based care programs will likely focus on greater integration of care, as nursing homes and other providers in the health care continuum discover the benefits of more thoughtful discharges – less focused on swiftness and more on moving patients through a continuum of care – in order to close costly gaps in…
A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of…
Skilled nursing providers are facing an extremely challenging operating environment, but they must keep adapting and innovating as the shift toward value-based care continues across the U.S. health care system. And in fact, providers have tremendous opportunities to seize. “Value-based care through the population health management model is the most exciting thing I’ve had the…
While the Centers for Medicare & Medicaid Services (CMS) proposes to make some of the most significant changes to its accountable care organization (ACO) model since it was finalized in 2011, it doesn’t appear that such updates will have a lasting impact on the broader skilled nursing industry. If anything, only operators with their own…
A leader from PACE program Summit Eldercare believes there should be at least half the number of nursing homes in the country, in order to adequately provide value-based care. Instead, prospective SNF residents would be better served in community housing options. This is coupled with a trend Summit Eldercare is seeing among the SNFs it…