When it launched in 2016, Lengthy-Time period Care ACO was the primary ACO to concentrate on the inhabitants of Medicare beneficiaries who reside in long-term care nursing services, however now a number of different ACOs have entered that house. On the Nationwide Affiliation of ACOs (NAACOS) fall assembly, Kristen Krzyzewski, chief technique and program growth officer for LTC ACO, highlighted among 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 centered on this inhabitants for six years. “Since proving that there’s vital alternative, there at the moment are six ACOs which have long-term care populations as better than 60% of their whole assigned lives, and it continues to increase. In 2024 these six ACOs generated over $300 million in financial savings,” she mentioned. “There may be a variety of alternative, and we’re pleased 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 mentioned. “Numerous our suppliers on this house have been serving each populations, so it was necessary to increase. With that growth we’re one of many ACOs which have generated among the highest financial savings on a per-beneficiary foundation.”
She supplied 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 proportion of twin eligibles is considerably increased. “Over 83% of our inhabitants is dually eligible, and for the standard ACO I believe it is rather less than 7%, so there’s a large variance there,” she added. “Our inhabitants is about 81 years previous, 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 demise price is over 22% vs. lower than 3% in the usual MSSP ACO. “That creates completely different challenges, and you’ve got a shorter window to work with the inhabitants to enhance the price and high quality, and it represents distinctive challenges for us,” she defined.
Areas of focus
Krzyzewski defined how these affected person demographics affect the ACO’s areas of focus. “In care supply we’re actually centered on stopping unplanned hospitalizations. We do not need our sufferers to need to go to the hospital except that is absolutely the proper place for them to be. However within the nursing residence setting, if the first care is not obtainable and the power employees members have a query or concern, they are going to ship the sufferers out,” she mentioned. “Weekends and after hours, the affected person’s going to go to 911, to the hospital, and that may sometimes end in a hospitalization and create a variety of danger. We see that as an antagonistic high quality consequence, so our taking part suppliers are centered on stopping these hospitalizations, and now that they are accountable for the overall price of care, they’re actually engaged in making an attempt to attenuate that danger. We work with predictive analytics fashions to determine who’s at best 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 best danger. “We’re additionally centered on transitions of care. Whereas we attempt to stop hospitalizations, we will not stop all of them,” Krzyzewski mentioned. “They do go to the hospital, and once they return to their residence within the nursing facility, they’re at better danger, like all of our populations, for readmission. So there is a ramp-up in depth of the first care delivered.”
One other fascinating element is the complexity of pharmacy and Half D and the utilization of medicine. “We now have initiatives to to de-prescribe, and that is necessary to assist people stay steady within the facility,” she mentioned. “We are also actually centered on mortality danger. It’s an end-of-life inhabitants. Who’s at best danger for short-term demise? We’re very centered on superior care planning, working with the households and the beneficiaries to grasp 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 choices need to 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 consistently taking a look at what’s the suitable use of hospice care, and may palliative care be provided to offer among the similar advantages?”
LTC ACO additionally faces challenges in attribution and satisfying the doctor go to. “Although we now have a variety of nurse practitioners who’re the first clinicians, they’ll’t acquire attribution except there is a doctor go to, Krzyzewski defined. “So there are a variety of gymnastics that we now have to do to make it possible for 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 want that to alter inside MSSP, actually 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 mentioned CMS goes within the mistaken 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 instance. “If these measures are going to be more and more oriented towards a neighborhood inhabitants that is not at finish of life, it is advisable to 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 are able to may be measured type of equally with our friends which might be centered on the neighborhood inhabitants.”
