LONG-TERM CARE (LTC) FACILITIES

Get Rewarded for Improving the Quality & Cost of Medicare Services Provided to Your LTC Residents

As the first and only ACO focused solely on residents of LTC facilities, LTC ACO and its participating long-term care facilities and physicians are able to participate in the savings that accrue to the Medicare program that result from their efforts to reduce preventable hospital and emergency room admissions for the long-stay residents in many of its facilities. Studies show that hospital expenses account for nearly 40% of Medicare spending on patients who live in long-term care facilities¹ and that a significant portion (30-67%)² of those hospital admissions are avoidable.

Why Work With Us

In 2014³,there were 15,600 nursing homes with 1.4 million residents and occupancy rate of 82.4%. According to the most recent Medicare Current Beneficiary Survey, 2013 Characteristics and Perceptions of the Medicare Population, residents in long-term care facilities had Medicare benefit payments of over $40.3 billion. But Medicare does NOT cover the cost of long-term stays in a nursing home, such as room and board.  Those costs are typically covered by Medicaid or are paid privately by individuals. As a result, long-term care facilities have historically had limited opportunities to participate in Medicare program savings for its long-stay residents, despite long-term care facility residents costing the Medicare program twice the average of other Medicare beneficiaries.

Participation in LTC ACO creates a new and effective opportunity for long-term care facilities to be financially rewarded for improving the quality and cost of care delivered to their Medicare fee-for-service, long-term care residents, even when such care is provided outside of the facility! LTC ACO participating long-term care facilities have access to comprehensive Medicare claims data for ACO-assigned beneficiaries and are therefore able to understand and address the Medicare needs for their long-stay residents in a way they weren’t able to do so previously.

KEY BENEFITS

Up to 25% of Shared Savings Earning Potential
Participation in the LTC ACO entitles long-term care facilities to earn 25% of the savings generated based on your specific patient population (assuming the ACO in total produces shared savings, with quality and participation criteria satisfied). In case there are no savings, participating long-term care facilities face no financial risk whatsoever.
No Financial, Capital, or Marketing Risk
Unlike other managed Medicare programs, such as Medicare Advantage Institutional Special Needs Plans (I-SNPs), LTC ACO participating long-term care facilities have:
  • NO Downside Risk
    You share in gains based on performance, but you will NOT share in losses to the ACO.
  • NO Capital ContributionMany Medicare Advantage I-SNPs require facilities to contribute large sums of capital to fund regulatory licensure requirements and/or operational start up.  LTC ACO does NOT require any capital contribution.
  • NO Onerous Marketing or Enrollment Requirements
    Since LTC ACO is not a health plan, patients are not enrolled in the ACO rather they are assigned to the ACO if their primary care clinician participates in the ACO.  That means all of the I-SNP marketing and enrollment requirements DO NOT APPLY to LTC ACO.
Get the Full Picture of Your LTC Patients' Health with Access to All of Their Medicare Claims Data
Today, you only have access to the Medicare-covered services you provide to your LTC Medicare fee-for-service patients.  By participating in LTC ACO, you will have access to Medicare claims data for all Original Medicare services provided to your LTC ACO patients, including those services delivered by other providers outside of the LTC facility. The ACO will provide reports to you to help you interpret the quality and cost of care provided to your patient, so that we can find ways to improve outcomes together.

Note: Medicare Beneficiaries may elect to opt out of data sharing.

Want to Learn More About Participation with LTC ACO?