Medicare Advantage is growing at a rapid rate as more beneficiaries are opting to have their care managed by a private health plan attracted by the additional benefits, and by federal policies driving more flexibilities. In addition, value based payment models continue to garner wide support especially as COVID-19 has shone a spotlight on the vulnerabilities in the current fee-for-service structure and system of care.
Most recently, the Centers for Medicare and Medicaid (CMS) announced its goal of moving 100% of Medicare fee-for-service into an accountable care model by 2030. Given these driving forces, population health management and value- based models are expected to grow and there is a growing imperative to get ahead of the curve.
To ensure AHCA/NCAL members have the resources and information to succeed in this changing and dynamic environment, AHCA/NCAL has launched the
Population Health Management (PHM) Innovation Lab which contains free “AHCA/NCAL Member Only” foundational resources designed to introduce assisted living, nursing facility and intermediate care facility members to the wide array of PHM models available today and in the future. Information on provider-led special needs plans (SNPs) – one solution that has been gaining traction within the LTC provider space – is covered within the PHM Innovation Lab resources.
The PHM Innovation Lab Phase I contains six different subject area modules with corresponding educational components including webinars and briefs.
- Population Health Management Fundamentals -- Describes the who, what, where, and how of Population Health Management (PHM). It also introduces various PHM models including their specific characteristics, benefits, and implications.
- Accountable Care Organizations -- Provides an overview of the structure, financial model, and regulatory requirements of different ACOs. Types of ACOs covered include Medicare Shared Savings Programs and Next Generation ACOs.
- Bundled Payments -- Provides an overview of the basics of bundled payments (episode-based payments) including what are bundled payments, how they work, and their implications for LTC and PAC providers.
- Emerging Models: Direct Contracting -- Provides a detailed overview of Direct Contracting including types of participants, payment, beneficiary alignment, quality incentives, and a model timeline.
- Managed Care -- Provides an overview of Medicare Advantage/ Provider-led Special Needs Plans (SNPs) and explains how SNPs work, and discusses the implications for LTC and PAC providers.
- Provider Networks --Provides an overview of the why, what, and how of provider-owned integrated care networks and explains the benefits of provider networks.
Members will need to login with their AHCA/NCAL usernames and passwords to access
PHM Innovation Lab materials. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail
educate@ahca.org with their name and facility contact information.