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 a few 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 centered on this inhabitants for six years. “Since proving that there’s important alternative, there at the moment are six ACOs which have long-term care populations as larger than 60% of their whole assigned lives, and it continues to broaden. In 2024 these six ACOs generated over $300 million in financial savings,” she mentioned. “There’s quite a lot of alternative, and we’re blissful 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 12 months. “We additionally expanded in 2025 to incorporate the assisted residing facility inhabitants. That was one thing new for us,” she mentioned. “A whole lot of our suppliers on this house have been serving each populations, so it was vital to broaden. With that enlargement we’re one of many ACOs which have generated a few 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 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 every year. 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 must go to the hospital except that is absolutely the proper place for them to be. However within the nursing house setting, if the first care is not obtainable and the power workers 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 can sometimes lead to a hospitalization and create quite a lot of threat. We see that as an adversarial high quality final result, so our taking part suppliers are centered on stopping these hospitalizations, and now that they are accountable for the full value of care, they’re actually engaged in attempting to attenuate that threat. We work with predictive analytics fashions to establish who’s at best threat 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 very best, highest threat.”
LTC ACO suppliers are providing intensified main care to these of us who’re at best threat. “We’re additionally centered on transitions of care. Whereas we attempt to forestall hospitalizations, we will not forestall all of them,” Krzyzewski mentioned. “They do go to the hospital, and once they return to their house within the nursing facility, they’re at larger threat, like all of our populations, for readmission. So there is a ramp-up in depth of the first care delivered.”
One other attention-grabbing element is the complexity of pharmacy and Half D and the utilization of medication. “We now have initiatives to to de-prescribe, and that is vital to assist of us stay steady within the facility,” she mentioned. “We are also actually centered on mortality threat. It’s an end-of-life inhabitants. Who’s at best threat for short-term demise? We’re very centered on superior care planning, working with the households and the beneficiaries to grasp what their targets of care are, with our main care clinicians documenting that in order that these needs are honored on the time that there’s stress and choices must 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 generally 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 always what’s the suitable use of hospice care, and might palliative care be provided to offer a few of the identical advantages?”
LTC ACO additionally faces challenges in attribution and satisfying the doctor go to. “Despite the fact that we have now quite a lot of nurse practitioners who’re the first clinicians, they’ll’t achieve attribution except there is a doctor go to, Krzyzewski defined. “So there are quite a 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 vary 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 an obstacle. She additionally mentioned CMS goes within the fallacious route with the Common Basis set of measures as a result of it contains 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 kind when you’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 can be centered on the neighborhood inhabitants.”
