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…
As the Centers for Medicare and Medicaid Services (CMS) hits reset on an important value-based care initiative popular with health care providers, including nursing homes, providers will need to make considerations this spring on whether to participate in the new model called LEAD – short for Long-term Enhanced ACO Design. Starting in 2027, the federal…
More than a decade after accountable care organizations launched, healthcare systems are still eager to bring more skilled nursing operators into the fold, according to several acute-care speakers at the National Association of ACOs Fall Conference being held in Washington, DC, this week. Financial incentives for nursing homes to sign on to ACOs not led…
Rewards tied to improved hospital readmission rates were so small and so variable from year to year that they likely contributed to a “lack of effectiveness” for a key nursing home financial incentive program. The Skilled Nursing Facility Value-Based Purchasing program is the Centers for Medicare & Medicaid Services’ largest use of financial incentives to…
As value-based care (VBC) continues to redefine reimbursement models and quality standards in skilled nursing facilities (SNFs), the Director of Nursing (DON) plays a central role — driving clinical excellence, operational efficiency and financial performance. With hospitals, health plans and VBC programs increasingly viewing SNFs as strategic partners, the DON’s influence is just as vital…
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…
What if a potent driver of value-based success isn’t found in your clinical programs but in the first few minutes your residents spend with your team? Long-term care is racing toward value-based care (VBC). You obsess over quality measures, satisfaction surveys and readmission rates. You invest in clinical pathways, technology and staff training. But when…
“Value-based care” (VBC) is one of the most frequently cited goals in U.S. healthcare reform — yet its meaning remains frustratingly vague and often contradictory. We hear that value-based care is the future. But as we navigate payment reforms, new quality programs, and evolving care models, we’re forced to ask: Whose definition of “value” are we…