March/April 2023

The Last Word: Accountable Care Organizations
By Jason Feuerman
Today’s Geriatric Medicine
Vol. 16 No. 2 P. 34

Three considerations for selecting an ACO dedicated to long term care residents

In 2021, CMS set a goal that by 2030, all traditional Medicare beneficiaries are to be treated by a provider in a value-based care model such as an accountable care organization (ACO). What, exactly, does this shift mean for primary care practitioners in the long term care (LTC) setting?

For starters, the US LTC is a growing market. According to estimates from the Department of Health and Human Services, roughly 69% of the United States population is expected to use LTC services during their lifetimes. With the geriatric population in America rapidly rising due to increased life expectancy, it’s likely providers will see greater demand for these services.

ACOs are the answer to properly addressing this burgeoning need and a way to create an aligned environment in this complex setting.

An ACO is a group of providers who come together to give coordinated, high-quality care to the Medicare fee-for-service (“Original Medicare”) beneficiaries they treat. ACOs are required to have processes to coordinate care, promote evidence-based medicine and patient engagement, measure and report on quality and cost measures, and demonstrate patient-centeredness.

Permanently authorized in 2012 by the Affordable Care Act, ACOs empower physicians and other providers to work together and take responsibility for enhancing the patient experience and keeping care affordable.

To accomplish this, ACOs participate in the Medicare Shared Savings Program, designed to improve outcomes and increase both the quality and value of care delivered to Medicare fee-for-service beneficiaries.

With the US Census Bureau projecting in a March 2018 press release that by 2034 there will be 77 million people 65 years and older, compared with 73 million adults in the United States who were 65 and over in 2020, the long-term market will undoubtedly continue to expand.

The time for waking up the ACO ecosystem is now.

Participation provides financial alignment, incentives, and administrative clarity to physicians and LTC facilities, including the ability to see the entire patient experience through the health care delivery system. With ACOs providing longitudinal patient history, providers can gain an in-depth picture of a beneficiary’s health care journey, including treatments and health outcomes. This is a cornerstone of value-based care and essential for improving care management.

For providers looking to make the transition to value-based care, here are three things to consider when weighing which ACO is right for your business:

1. Choose an ACO with a proven track record of helping its members improve quality, clinical impact, and achievement of shared savings. It’s important to identify an ACO that will work with you on creating focus and solutions.

2. Understand Medicare’s Merit-based Incentive Payment System (known as MIPS) and its reporting requirements and penalties. Participation in an ACO allows physicians to focus more of their time on patient care. Providers participating in an Enhanced Advanced Alternative Payment Model are offered the opportunity for a Medicare Access and CHIP Reauthorization Act of 2015 bonus or its successor program and additional incentives to participate.

3. Ask whether the ACO analyzes and provides actionable data and insights back to its participating providers. This is key to helping drive improved quality and cost performance for patients assigned to the ACO.

ACOs are a vital tool in moving the health system toward improving quality and driving down unnecessary costs. They empower physicians, hospitals, and other providers to work together and take responsibility for enhancing the patient experience and keeping care affordable.

The list of demands placed on providers continues to grow. After a move to value-based care and membership in an ACO, the weight of those demands is distributed among a team of experts committed to helping you advance the state of health care for the more complex populations that are high-needs in your care.

— Jason Feuerman is the president and CEO of LTC ACO, the first ACO to serve Medicare beneficiaries who live in long term care facilities, partnering with physicians and facilities to transform the way health care is provided to this underserved population. Prior to starting LTC ACO, Feuerman was senior vice president and president of the Public Sector and Health Plan Divisions of Value Options, Inc. Earlier in his career, he was president of Bravo Health, a subsidiary of Cigna, Inc, and president of Senior Care Centers of America, a leading provider of adult day health services. He holds a Bachelor of Science in finance and economics from the University of Maryland.