Medicare’s Shared Savings Program should be amended to allow more provider types — including assisted living providers — to lead its accountable care organizations, Nicole Fallon, LeadingAge vice president of integrated services and managed care, said in a recent letter to the chairman of the House Budget Committee Health Care Task Force.
Currently, the Shared Savings Program ACO model only allows hospitals, health systems and physicians to lead the model.
“We have seen examples of LeadingAge members who have successfully led risk-based or accountable care models in residential settings, such as nursing homes and assisted living communities,” Fallon wrote to Rep. Michael C. Burgess, MD (R-TX) on Oct. 15. “Models should test whether an ACO model could work in these settings where the residential facility coordinates services with primary and specialty care and other support services to avoid unnecessary hospitalizations and other high-cost settings and manage conditions.”
The association argued that residential-based settings have the benefit of daily interactions with older adults they serve, as well as addressing nutritional and transportation needs. The “more comprehensive view of the older adult” positions assisted living and residential care settings to identify changes in condition earlier and intervene sooner to avoid higher cost settings, Fallon wrote.
“Appropriate interventions like treating in place can reduce Medicare spending,” Fallon wrote.
Assisted living can be innovative
The advocacy organization also provided recommendations related to innovative care models that could include assisted living.
Exploring ways to reimburse providers — particularly in rural and underserved areas — for effective interventions could provide the funding and flexibility necessary to bring community partners together to promote innovative practices, Fallon said.
She pointed to the Connected Communities Grant Project from LeadingAge Minnesota as an example of a successful innovation model. Each Connected Community pilot includes assisted living providers, home- and community-based service providers, nursing homes, home health agencies, area hospitals and/or health systems, local area agencies on aging and tribal agencies, social services, physicians, local public health and area health plans.
LeadingAge called the project a “whole system, person-centered approach” that addresses community planning, care coordination, quality improvement and social engagement.
The project has resulted in shared problem-solving and resources to meet community needs, improved identification and interaction with individuals before they need care, and a comprehensive inventory of available services and supports in the community, Fallon said
“This type of approach is local, but there are aspects that are replicable, including creating a local coalition to lead this community-based work and break down barriers across sectors, completing a comprehensive review, taking a population health approach, engaging older adults in healthy aging, and building a community-specific care management model that can address needs unique to that geographic area, especially in rural areas,” she wrote.
In addition to sharing recommendations related to increased access and reimbursements to assisted living, LeadingAge also used the letter to reiterate its support for establishing a White House Office on Aging and to address issues related to affordable senior housing and value-based care.
