WASHINGTON, D.C. – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) today released a
whitepaper titled, “Advancing Accountable Care for Long Term Care Residents," which was recently shared with the Centers for Medicare & Medicaid Services (CMS). Developed by AHCA/NCAL's Accountable Care Organization (ACO) workgroup, the whitepaper refines and deepens 2024
recommendations focused on value-based care model alignment policies within long term care (LTC).
Key among the new recommendations, encompassing both nursing facilities and assisted living communities, is that CMS develop a model focused on the LTC population. Current ACO models do not fully support LTC residents because they were designed primarily for seniors living in the broader community and are centered around clinician-driven care. This structural misalignment leaves many LTC providers without a clear pathway for meaningful participation in ACOs and value-based care. As a result, fewer than 10 percent of skilled nursing facilities currently participate in ACOs. Tailoring a model that explicitly addresses the unique needs of the LTC population would unlock substantial opportunities for increased participation, improved outcomes, and Medicare savings.
AHCA/NCAL also has specific recommendations for CMS in the development of a LTC ACO specific model, including:
- A specific attribution methodology to improve participation and accountability.
- Financial incentives and flexible risk-sharing options.
- Streamlining quality measurement.
- Incentivizing interoperable technology adoption.
- Promoting wellness and chronic disease management, especially in the assisted living setting.
- Prioritizing underserved LTC populations and facilities with limited resources or infrastructure.
“Our recommendations aim to solve the vulnerabilities in existing ACO models and leverage the expertise of our providers in support of CMS' goal to align financial incentives with improved health outcomes for all Medicare beneficiaries,"
said Nisha Hammel, AHCA/NCAL Vice President of Population Health Management. “This is an opportunity to address the realities of long term care settings and advance coordinated, quality care. We look forward to working with CMS on advancing these value-based solutions."
Recent analysis by ATI Advisory found that Medicare fee-for-service (FFS) spending for LTC residents aligned to an ACO is significantly lower than spending for residents who are not aligned. In 2023, Medicare FFS spending on the average nursing facility and assisted living resident aligned to an ACO was 11 percent and 19 percent less, respectively, than unaligned residents. ATI Advisory also estimates that adopting the recommended model could generate more than $2 billion in savings to Medicare each year.
“The benefits to residents and the Medicare program are clear,"
said John Kane, AHCA/NCAL Senior Vice President of Reimbursement Policy. “CMS should recognize the unique value proposition long term care offers this medically complex population and address current barriers to ACO participation. AHCA/NCAL remains focused on improving these value-based care models and preparing providers for this evolving reimbursement landscape."
The whitepaper with analysis and full recommendations is available
HERE.