Accountable Care Organizations (ACOs) have been round for almost a decade, however ongoing adjustments to the mannequin might be onerous to maintain up with. Consequently, there’s 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, study 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 enhancing affected person outcomes and lowering prices. They do that by offering a seamless continuum of care targeted on preventive well being and high quality outcomes. ACOs additionally present help for taking part physicians with interoperability, Digital Healthcare Information (EHR), the Benefit-based Incentive Fee System (MIPS) bonus eligibility and reporting know-how.
Along with this eligibility for MIPS value-based fee changes, ACO suppliers are rewarded financially by sharing in the associated fee financial savings achieved. CMS has offered waiver safety for ACOs to allow financial savings to be shared, and for post-acute supplier community utilization administration with the target of enhancing care. These waivers permit suppliers to coordinate care enchancment, whereas remaining compliant with Stark Legislation.
Evolving ACOs and Advantages to Suppliers
The ACO mannequin has developed since regulation debut in 2009, and it seems 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, in accordance with CMS1.
Development is nice, however what in regards to the adjustments that mandate migrating extra of the danger to ACO members? Beforehand, ACOs have been solely rewarded for high quality and value 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 danger within the type of paying CMS again after they miss their cost-savings targets. In trade for sharing within the danger, ACOs will likely be rewarded with “increased ranges of shared financial savings and higher regulatory flexibility,” in accordance with Well being Affairs.
ACOs are permitted to shift to the brand new program over quite a few years, however almost half of recent ACOs beginning on July 1, 2019, had opted for the draw back danger program. And early knowledge 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 take into account their community companions fastidiously.
Three Keys to a Profitable ACO
Profitable ACOs profit suppliers, sufferers and tax payers. There are three keys to creating an ACO profitable:
- Prevention. With metrics primarily based on high quality and affected person outcomes, working with sufferers to assist them keep effectively is the crux of every little thing ACOs do. This, in fact, is reliant on sustaining good connections with sufferers in addition to being proactive and per 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.
- At-risk affected person identification. Excessive-risk sufferers are the most expensive to deal with. About 20% of all healthcare expenditures come from the highest 1% of the nation’s neediest sufferers, in accordance with the Nationwide Academy of Drugs3. So with the intention to management prices, ACOs want to have the ability to determine 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.
- Care transitions. Each time sufferers transition from one care setting to a different there’s 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 via such transitions to maintain sufferers actively taking part within the preventive care loop and sustaining wellness.
It can be crucial for all members of an ACO to concentrate on — and to execute — these success elements for optimum affected person and supplier profit, together with the acute and post-acute setting individuals.
The Position of Publish-Acute Care in an ACO
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 best danger for readmission, undergo 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 via placement in essentially the most clinically acceptable settings additionally has the best alternative to have an effect on outcomes and value of care.
Releasing chronically, critically sick sufferers from acute care settings on to a talented nursing facility (the place care is nurse-led fairly than physician-led) can pose substantial danger to sufferers’ well being and is due to this fact misaligned with the aim of an ACO. And but, maintaining sufferers in acute care settings long-term is expensive. LTAC hospitals present intensive care whereas actively getting ready sufferers to transition residence, enhancing outcomes and lowering pricey readmissions.
CMS knowledge persistently 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 “nearly 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, in accordance with 2012 knowledge, which is the newest out there, matched sufferers handled in LTAC hospitals have been readmitted 44% much less usually than comparable sufferers who have been handled in different post-acute settings5.
Selecting a LTAC Hospital Associate 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 sick sufferers want. Kindred Hospitals specialize within the post-intensive care therapy of sufferers with complicated medical instances requiring continued intensive care and specialised rehabilitation in an acute hospital setting. With every day doctor oversight, ICU- and CCU-level staffing and specifically skilled caregivers, we work to enhance outcomes, cut back pricey readmissions and assist sufferers transition residence or to a decrease stage of care.
We’re dedicated to pursuing improvements in care supply and fee 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 now we have the glory to supply care and play completely into the three key elements 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 residence from Kindred. Our Registered Nurses contact sufferers by telephone within the first 24-48 hours put up discharge after which one week, two weeks and 30 days post-discharge to evaluate their progress and determine any post-discharge wants, resembling explaining their medicine and getting an appointment scheduled with their PCP inside 7-14 days. The AfterCare program has confirmed profitable in lowering rehospitalization charges and eradicating gaps/limitations in care on the affected person’s residence, 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 now we have confirmed success in treating these sufferers, the altering affected person panorama of older sufferers with extra persistent situations encourages the continued scientific progress and experience this inhabitants will demand.
Case Examine: Kindred’s Lengthy-Time ACO Expertise
Kindred is the LTAC hospital associate of alternative for a lot of well being methods 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 associate ACOs and payers is behind that success.
In 2014, Kindred turned the bulk proprietor of Silver State Accountable Care Group. This strategic partnership created the most important ACO out there 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 alternative, however we’ve additionally dealt with all community and care administration for the ACO for the previous 5 years, serving to Silver State ACO persistently generate financial savings to share with CMS:
- $6.3 million in 2015
- $15 million in 2016
- $15 million in 2017
To study extra about how Kindred can assist your ACO obtain comparable shared financial savings, Contact Us.
2: Extra ACOs Taking Accountability Beneath MSSP By ‘Pathways To Success’
4: 2017 MEDPAR Last File
5: Publish-Acute Care Fee Reform Demonstration: Last Report