The U.S. Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030.
Currently, roughly 13.2 million Medicare fee-for-service beneficiaries are assigned to an ACO.
With this in mind, there has been more activity and investment around accountable care organizations (ACOs), including for at-home care providers, which are strategically collaborating with these organizations.
The Walgreens Boots Alliance-backed VillageMD — a Chicago-based primary care services organization that has an at-home care arm — is one provider that is working heavily in the ACO space. The company is a participant in the ACO REACH Model, for example.
Andrea Osborne, senior vice president of ACO operations and delegated services at VillageMD, pointed out that the ACO REACH model allows providers more leg room to approach CMS about various concerns and suggestions.
“We actually get to go to CMS and have conversations, and say, ‘Hey, the Medicare rule isn’t working for us,’” she said Tuesday during a panel discussion at the annual LeadingAge conference in Chicago. “‘We’d like to try it that way.’ We have these conversations.”
Amid the pandemic, the company approached CMS about expanding at-home care services, for instance.
“We said, ‘We want to be able to use home health care anywhere,’ and then they actually ended up opening that up for everyone,” Osborne said. “That’s because we had tested these models, so it’s really important that when you are in these partnerships – if there are barriers to care that are Medicare regulations – you’re speaking with your ACO partner, because we actually can get opportunities to test changing those rules.”
Medicare Shared Savings Program (MSSP) ACOs are an opportunity for home-based care providers to enter the space.
The majority of MSSP ACOs are hospital-based. As a result, these ACOs are focused on a patients’ post-acute stay after a hospitalization, according to Andy Edeburn, a consultant at Elder Dynamics, an advisory services company for aging services providers.
“A lot of SSP ACOs have built preferred provider networks,” he said during the panel discussion. “They go out and try to aggregate nursing homes, or home health organizations that they can work with in a much tighter knit way.”
This is because many hospitals are juggling somewhere between 30 and 40 post-acute relationships, Edeburn noted.
“The span of control for that is a nightmare, so they build networks, they try and build a smaller group,” he said. “If you’re working with an SSP ACO, you want to be in that network because it’s the first step in making sure you’re getting some degree of volume in that space.”
That said, Edeburn believes that the ACO REACH model is a better partner for post-acute aging services providers because of its emphasis on aging in place, and keeping patients out of the hospital.
As CMS strives to reach its overall goal, mandatory participation could be on the table in the future.
“Some of us are jumping in, some people will be pulled along,” Osborne said.
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