CMS Update Suggests Possibility of Greater Provider Engagement in ACOs
For a number of years, LeadingAge as well as others have urged the Centers for Medicare and Medicaid Services (CMS) to design alternative payment models that include long term care providers in a meaningful way. That work includes partnering with other stakeholders on a recent white paper on how the CMS Center for Medicare and Medicaid Innovation (CMMI) could engage long term care and post-acute care providers more effectively with accountable care organizations (ACOs). That paper, titled “Considerations for Long Term Care Providers Participating in Value-Based Care Models” and shared with CMMI earlier this year, seems to have helped inspire ideas that may lead to greater opportunities in this realm for long term care providers.
In an update published in Health Affairs earlier this month on their vision to support value-based specialty care, CMMI suggests that it is considering new approaches that align with some of the suggestions offered in the paper. Specifically, the paper identified policy steps that CMMI could take to more appropriately align the source of nursing home resident primary care with the ACO that is working in partnership with the nursing home, as well as testing embedded bundled payment for nursing homes within the ACO.
It appears that this idea might have resonated with CMMI staff, as its April 2nd strategy update includes a similar reference. These ideas seem to be reflected in the update’s fourth strategic element – Create Financial Incentives For Specialists To Affiliate With Population-Based Models And Move To Value-Based Care. CMMI indicates that it is “exploring several options that could be embedded in future population-based models, including developing subpopulation targets that facilitate new payment approaches for high-volume or high-cost conditions.” While far from an operationalized idea, it is encouraging that CMS is taking long term care into account in their thinking on value-based care models, especially since their stated goal is to have all Medicare beneficiaries in an accountable care relationship by 2030 while utilizing ACOs as the primary vehicle to improve beneficiary outcomes and lower costs.
An article from LeadingAge with more detail is available here.