AHCA/NCAL launched the first phase of its
Population Health Management (PHM) Innovation Lab earlier this year. Phase I contains free “AHCA/NCAL Member Only” foundational resources designed to introduce AHCA/NCAL assisted living, nursing facility and intermediate care facility members and their staff to the wide array of PHM models available today and in the future.
Phase I PHM Innovation Lab resources are ideal for familiarizing owners, operators, administrators and LTC managers about the fundamentals of various PHM models and how these models can better serve LTC organizations, residents and families. Members can also access the PHM Innovation Lab resources at:
PHMInnovationLab.com.
CMS continues to drive the healthcare system to one of value by shifting financial risk to providers through a range of fee-for-service (FFS) and managed care models. PHM is the application of interventions and strategies to improve the health outcomes and manage the costs of a targeted group. PHM models vary based on the degree of risk, degree to which payments are tied to quality, reliance on data analytics and level of care coordination. Understanding these models is vital in today’s operating environment.
Historically, PHM models have been led by hospitals, health systems, physician groups and large insurance organizations. In recent years, LTC providers (including assisted living) and PAC providers have assumed leadership roles in developing and employing several PHM models. The new environment demands new models, and PHM helps LTC/PAC providers understand and integrate new strategies into SNF and AL buildings by integrating SNF/AL and primary care, enhancing care transitions, and using robust care management models.
PHM models have evolved to address targeted groups of individuals (SNF and AL residents in our case), to improve their health outcomes, and providers can use these models to drive better outcomes, strategies and interventions for handling the COVID-19 crisis. A PHM model, provider led Special Needs Plans (SNPs) can be an important solution in the current COVID-19 environment. With the deployment of on-site nurse practitioners providing primary care at the long term care bedside, costly and potentially dangerous hospital transfers can be avoided.
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.