Kenyon Connects

We are beginning to hear a great deal about ACOs these days, and many in the home health industry are trying to find ways to be included.  Of concern is the emerging potential that ACOs will try to create their own home care agencies and bypass the existing agencies in their areas. Now, as never before, home health has the opportunity to step front and center in the health care delivery system.  To prepare for this opportunity, home health agencies must understand the guidelines and focus of the demonstration projects. Knowing this will help agencies prepare to partner with any ACO that may be developed in their area, or, in an ideal world, be part of one that a strong home health agency has developed themselves.

The money to fund the demonstration grants was in the Affordable Care Act passed in 2010.  On March 31^st, CMS published the rules defining what an ACO should look and act like, but in very general terms. Following are the requirements and goals as published by CMS:

* Test a more rapid transition for providers from volume-based FFS payment to payment for coordination and outcomes.

*  Promote diversity of successful ACOs, including physician-led ACOs and those serving indigent or rural populations.

*  This model will test the effectiveness of a combination of the following:

1. Payment arrangements that place a group of providers at joint risk for quality performance and financial performance for the majority of their patients and revenues (including non-Medicare). Such payment arrangements will require participants to transition from fee-for-service to population-based payment by the third performance year. We believe the payment arrangements being tested will provide more opportunities for rapid escalation of shared savings and risk compared to the Medicare Shared Savings Program.
2. Technical support in the form of rapid data feedback and shared learning activities.
3. Size and scope of testing: We expect to partner with approximately 30 organizations in the model, with a minimum of 15,000 Medicare beneficiaries each (5,000 for rural ACOs). The application process and selection criteria are described in Section IV of the Request for Application but in general, applications will be prioritized based on the strength of their care improvement plans, leadership, and commitment to outcomes-based contracts with non-Medicare purchasers. Final selection will be based on the strength of the application and interviews of finalists, together with other factors, to representation of diverse geographic areas, types of organizations, and types of Medicare populations served.
4. Population: ACOs will be accountable for all fee-for-service Medicare beneficiaries that CMS determines are aligned with them, and who have continuous enrollment in Parts A and B during baseline and performance periods, with emphasis on encouraging care of underserved populations and dual eligibles.
5. Duration: Between 5 and 6 years (start third or fourth quarter of 2011 and end December 2016, which includes two 1-year optional periods).

Given the above directions issued by CMS, there are great opportunities for home health.  CMS made it clear in the requirements that they are looking for a diversity of models to be created and implemented.  We already have a successful model of hospice-based services.  Hospice receives a daily rate and is responsible for providing all services and products the patient needs for care of their terminal condition.  That includes pharmaceuticals, DME, skilled nursing facility care if needed, hospital care if needed, and any and all home health services, including nursing, aide, therapy, social work, bereavement and chaplain services.

Hospices around the country are living proof of home care’s ability to successfully manage care and resources to the betterment of the patient and at a reduced cost to Medicare and independent insurance carriers. Why not have several ACO demonstrations modeled after this archetype organization?  Why not have home health agencies be the leader of some of the ACOs?

Home care has a very short window to pull this together.  Many groups are already putting together their networks.  Unfortunately, some are not including home health as a partner.  Others, such as chronic care management companies, are attempting to fill that role. This is our success story. Home health is the lowest cost of services with quality outcomes and in the place where people want to be: their homes. Now is home health’s time.

Are you ready to take action?   Is so, Kenyon HomeCare Consulting is available to assist you in positioning yourself as a potential partner and leader for this new future. Contact us today!

 

Category: Healthcare Reform

One Response to “Accountable Care Organizations (ACOs) and Home Health: What are the Opportunities?”

1. Include Care Coordination in Your Next Home Care Technology Upgrade | Kenyon HomeCare Consulting says:

   September 30, 2011 at 6:21 pm

   [...] The need for coordinated care can drive the need for a fundamental technology shift. Today we all try to coordinate care, but in the near future care coordination will be mandatory. This is due to the necessity of sharing electronic medical records, mandates to lower readmission rates, the need to communicate with family caregivers and other family members, and incentives to lower the cost of care such as Accountable Care Organizations (ACOs). [...]