When it launched in 2016, Lengthy-Time period Care ACO was the primary ACO to deal with the inhabitants of Medicare beneficiaries who reside in long-term care nursing amenities, however now a number of different ACOs have entered that area. On the Nationwide Affiliation of ACOs (NAACOS) fall assembly, Kristen Krzyzewski, chief technique and program growth officer for LTC ACO, highlighted a number of the challenges and successes in navigating the Medicare Shared Financial savings Program with a long-term care focus.
Krzyzewski famous that after LTC ACO entered the MSSP, it was the one ACO targeted on this inhabitants for six years. “Since proving that there’s vital alternative, there are actually six ACOs which have long-term care populations as larger than 60% of their complete assigned lives, and it continues to broaden. In 2024 these six ACOs generated over $300 million in financial savings,” she stated. “There may be a whole lot of alternative, and we’re joyful to be part of it.”
LTC ACO has been within the enhanced observe of MSSP for a second settlement interval, and has entered into into a 3rd settlement interval beginning this yr. “We additionally expanded in 2025 to incorporate the assisted residing facility inhabitants. That was one thing new for us,” she stated. “Plenty of our suppliers on this area had been serving each populations, so it was vital to broaden. With that enlargement we’re one of many ACOs which have generated a number of the highest financial savings on a per-beneficiary foundation.”
She offered a fast snapshot of how her ACO’s inhabitants differs from a typical MSSP ACO. About 98% of its inhabitants is in a long-term care, institutional setting, and that compares to lower than 1% in a typical ACO. Their share of twin eligibles is considerably greater. “Over 83% of our inhabitants is dually eligible, and for the everyday ACO I feel it is rather less than 7%, so there’s a large variance there,” she added. “Our inhabitants is about 81 years outdated, on common, and the portion of our inhabitants over age 85 is about 34% and for the standard MSSP ACO, that is lower than 11%.”
Additionally, a good portion of LTC ACO’s inhabitants passes away annually. The dying charge is over 22% vs. lower than 3% in the usual MSSP ACO. “That creates totally different challenges, and you’ve got a shorter window to work with the inhabitants to enhance the fee and high quality, and it represents distinctive challenges for us,” she defined.
Areas of focus
Krzyzewski defined how these affected person demographics impression the ACO’s areas of focus. “In care supply we’re actually targeted on stopping unplanned hospitalizations. We do not need our sufferers to should go to the hospital until that is absolutely the proper place for them to be. However within the nursing house setting, if the first care is not out there and the ability employees members have a query or concern, they will ship the sufferers out,” she stated. “Weekends and after hours, the affected person’s going to go to 911, to the hospital, and that may sometimes lead to a hospitalization and create a whole lot of danger. We see that as an antagonistic high quality end result, so our collaborating suppliers are targeted on stopping these hospitalizations, and now that they are accountable for the overall value of care, they’re actually engaged in making an attempt to reduce that danger. We work with predictive analytics fashions to determine who’s at biggest danger for going to the hospital for an admission, and we arm our suppliers with that info so that they know inside a high-risk inhabitants, who’s the best, highest danger.”
LTC ACO suppliers are providing intensified major care to these people who’re at biggest danger. “We’re additionally targeted on transitions of care. Whereas we attempt to forestall hospitalizations, we will not forestall all of them,” Krzyzewski stated. “They do go to the hospital, and once they return to their house within the nursing facility, they’re at larger danger, like all of our populations, for readmission. So there is a ramp-up in depth of the first care delivered.”
One other attention-grabbing part is the complexity of pharmacy and Half D and the utilization of medicine. “We now have initiatives to to de-prescribe, and that is vital to assist people stay secure within the facility,” she stated. “We are also actually targeted on mortality danger. It’s an end-of-life inhabitants. Who’s at biggest danger for short-term dying? We’re very targeted on superior care planning, working with the households and the beneficiaries to know what their objectives of care are, with our major care clinicians documenting that in order that these needs are honored on the time that there’s stress and selections should be made about whether or not they need to go to the hospital or not.”
Additionally, on this inhabitants, hospice is a key driver of prices, and LTC ACO suppliers are typically stunned to see that a few of their beneficiaries have been on hospice for 2 years. There are some incentives on the facility for hospice utilization, as a result of it helps staffing, Krzyzewski famous. “So we’re continuously taking a look at what’s the suitable use of hospice care, and might palliative care be supplied to offer a number of the similar advantages?”
LTC ACO additionally faces challenges in attribution and satisfying the doctor go to. “Regardless that we have now a whole lot of nurse practitioners who’re the first clinicians, they’ll’t acquire attribution until there is a doctor go to, Krzyzewski defined. “So there are a whole lot of gymnastics that we have now to do to be sure that our suppliers can get that doctor go to merely to fulfill the attribution standards. That actually does not make sense. ACO REACH does not have that. We now have talked about how we wish that to alter inside MSSP, definitely for our inhabitants.”
Mismatched high quality measures
Krzyzewski famous that though LTC ACO is dedicated to high quality, by the character of its inhabitants and the standard measures utilized in this system design, they’re at a drawback. She additionally stated CMS goes within the fallacious path with the Common Basis set of measures as a result of it consists of measures that are not related for his or her inhabitants. She used breast most cancers screening for example. “If these measures are going to be more and more oriented towards a neighborhood inhabitants that is not at finish of life, you could have a bonus of some type if you happen to’re treating a inhabitants at finish of life so as to add factors again in order that we will may be measured type of equally with our friends which can be targeted on the neighborhood inhabitants.”
