The Importance of Post-Acute Care Within ACOs

Accountable Care Organizations (ACOs) have been round for almost a decade, however ongoing adjustments to the mannequin may be arduous to maintain up with. In consequence, there may be usually a false impression that solely short-term acute care hospitals are included in ACOs. In actuality, long-term acute care hospitals play an important function as effectively.

On this white paper, be taught the most recent adjustments and tendencies in ACOs in addition to methods wanted in post-acute care to achieve the altering value-based panorama.

What Is an ACO?

ACOs are authorized entities voluntarily assembled by suppliers for the aim of bettering affected person outcomes and lowering prices. They do that by offering a seamless continuum of care centered on preventive well being and high quality outcomes. ACOs additionally present assist for taking part physicians with interoperability, Digital Healthcare Data (EHR), the Benefit-based Incentive Cost System (MIPS) bonus eligibility and reporting expertise.

Along with this eligibility for MIPS value-based cost changes, ACO suppliers are rewarded financially by sharing in the fee financial savings achieved. CMS has supplied waiver safety for ACOs to allow financial savings to be shared, and for post-acute supplier community utilization administration with the target of bettering care. These waivers enable suppliers to coordinate care enchancment, whereas remaining compliant with Stark Legislation.

Evolving ACOs and Advantages to Suppliers

The ACO mannequin has advanced since regulation debut in 2009, and it seems to be as if ACOs are right here to remain. Sufferers lined by Medicare ACOs rose from 10.5 million in 2018 to 10.9 million in 2019, based on CMS1.

Progress is nice, however what concerning the adjustments that mandate migrating extra of the danger to ACO members? Beforehand, ACOs had been solely rewarded for high quality and price financial savings, and weren’t held chargeable for lacking such targets. However a January 2020 redesign of the federal Shared Financial savings Program requires ACOs to tackle extra threat within the type of paying CMS again after they miss their cost-savings targets. In change for sharing within the threat, ACOs shall be rewarded with “increased ranges of shared financial savings and larger regulatory flexibility,” based on Well being Affairs.

ACOs are permitted to shift to the brand new program over a lot of years, however almost half of latest ACOs beginning on July 1, 2019, had opted for the draw back threat program. And early information suggests the mannequin isn’t as dangerous because it sounds. ACOs which have taken accountability for lacking cost-savings targets carry out higher than ACOs nonetheless in shared savings-only applications2.

With the approaching ACO adjustments, suppliers ought to think about their community companions rigorously.

Three Keys to a Profitable ACO

Profitable ACOs profit suppliers, sufferers and tax payers. There are three keys to creating an ACO profitable:

  1. Prevention. With metrics based mostly on high quality and affected person outcomes, working with sufferers to assist them keep effectively is the crux of all the things ACOs do. This, in fact, is reliant on sustaining good connections with sufferers in addition to being proactive and in keeping with PCP and specialist visits. These efforts and good post-acute companions assist make sure that when an acute episode of care happens, the ACO affected person is steered again into preventive pathways by the post-acute setting.
  2. At-risk affected person identification. Excessive-risk sufferers are the costliest to deal with. About 20% of all healthcare expenditures come from the highest 1% of the nation’s neediest sufferers, based on the Nationwide Academy of Drugs3. So as a way to management prices, ACOs want to have the ability to establish their highest-risk sufferers. They then should help them with preventive care and provide chronic-disease administration to maintain them from requiring extra pricey acute care.
  3. Care transitions. Each time sufferers transition from one care setting to a different there may be the potential that they’ll disengage from the healthcare system or there’s a hole in care, placing them in danger for additional well being issues and rehospitalizations. ACOs should shepherd sufferers by means of such transitions to maintain sufferers actively taking part within the preventive care loop and sustaining wellness.

It’s important for all members of an ACO to concentrate on — and to execute — these success components for optimum affected person and supplier profit, together with the acute and post-acute setting individuals.

The Position of Submit-Acute Care in an ACO

Only 0.03% to 3.3% of all discharging hospital patients require care in an LTAC hospital

Constructing a clinically strong continuum of care consists of long-term acute care (LTAC) hospitals. Whereas solely a small proportion of sufferers — between 0.3% and three.3% — require care in an LTAC hospital4, they’re among the sickest sufferers. That means they’re the very best threat for readmission, endure from a number of persistent situations and have the best want to attach with PCPs and specialists on an ongoing foundation. Additional, caring for this inhabitants by means of placement in probably the most clinically applicable settings additionally has the best alternative to have an effect on outcomes and price of care.

Releasing chronically, critically ailing sufferers from acute care settings on to a talented nursing facility (the place care is nurse-led moderately than physician-led) can pose substantial threat to sufferers’ well being and is due to this fact misaligned with the purpose of an ACO. And but, maintaining sufferers in acute care settings long-term is dear. LTAC hospitals present intensive care whereas actively making ready sufferers to transition house, bettering outcomes and lowering pricey readmissions.

CMS information constantly exhibits that sufferers recognized as being the “sickest”— that means they spent three or extra midnights in an ICU and require ventilator administration — and transition to LTAC hospitals obtain care that’s “pretty much as good or higher” and “prices the identical or much less” as in contrast with sufferers who bypass the LTAC hospital setting and use solely short-term acute care hospitals and expert nursing services. And, based on 2012 information, which is the latest obtainable, matched sufferers handled in LTAC hospitals had been readmitted 44% much less usually than related sufferers who had been handled in different post-acute settings5.

Selecting a LTAC Hospital Companion for an ACO

Acute care suppliers and ACOs want companions that may proceed to supply physician-directed care with the prolonged restoration time that chronically, critically ailing sufferers want. Kindred Hospitals specialize within the post-intensive care remedy of sufferers with advanced medical circumstances requiring continued intensive care and specialised rehabilitation in an acute hospital setting. With day by day doctor oversight, ICU- and CCU-level staffing and specifically educated caregivers, we work to enhance outcomes, cut back pricey readmissions and assist sufferers transition house or to a decrease stage of care.

We’re dedicated to pursuing improvements in care supply and cost fashions to supply new instruments and options to our sufferers and their households in addition to our supplier companions. Many of those sources and initiatives are designed to make sure environment friendly care administration for every affected person, for whom we’ve got the honour to supply care and play completely into the three key components of an ACO talked about above.

One such service is our AfterCare program. The AfterCare program ensures a clean transition for sufferers who discharge straight house from Kindred. Our Registered Nurses contact sufferers by telephone within the first 24-48 hours publish discharge after which one week, two weeks and 30 days post-discharge to evaluate their progress and establish any post-discharge wants, reminiscent of explaining their treatment and getting an appointment scheduled with their PCP inside 7-14 days. The AfterCare program has confirmed profitable in reducing rehospitalization charges and eradicating gaps/obstacles in care on the affected person’s house, providing immense profit to upstream companions within the goal of prevention.

Moreover, with a concentrate on at-risk affected person identification, our hospitals all throughout the nation have achieved or are looking for disease-specific certification from The Joint Fee for sepsis and respiratory failure. Whereas we’ve got confirmed success in treating these sufferers, the altering affected person panorama of older sufferers with extra persistent situations encourages the continued medical progress and experience this inhabitants will demand.

Case Research: Kindred’s Lengthy-Time ACO Expertise

Kindred is the LTAC hospital companion of selection for a lot of well being programs and ACOs throughout the nation. We’re well-versed within the drivers of value-based care and are confirmed individuals in producing ACO financial savings. We consider that being collaborative and clear with our companion ACOs and payers is behind that success.

In 2014, Kindred grew to become the bulk proprietor of Silver State Accountable Care Group. This strategic partnership created the biggest ACO available in the market and within the high 20% nationally, with greater than 400 doctor companions serving roughly 42,000 sufferers6.

Kindred has been not solely Silver State ACO’s LTAC hospital of selection, however we’ve additionally dealt with all community and care administration for the ACO for the previous 5 years, serving to Silver State ACO constantly generate financial savings to share with CMS:

  • $6.3 million in 2015
  • $15 million in 2016
  • $15 million in 2017

To be taught extra about how Kindred will help your ACO obtain related shared financial savings, Contact Us.


2: Extra ACOs Taking Accountability Below MSSP By way of ‘Pathways To Success’
4: 2017 MEDPAR Last File

5: Submit-Acute Care Cost Reform Demonstration: Last Report

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