Home-based Palliative Care: A Value-Based Strategy that Supports ACOs in MSSP “Pathways to Success”
The challenge from the Center for Medicare & Medicaid Services (CMS) to Accountable Care Organizations (ACOs) is very specific: take on more risk going forward and get serious about delivering value.
Some say these changes under a new federal program called “Pathways to Success” may upend the entire ACO movement, with estimates that it could drive 109 ACOs providers out of the Medicare Shared Savings Program (MSSP) by 2028.
But we believe that the introduction of home-based palliative care provides a key strategy for MSSP ACOs to succeed. Some innovative models are designed to meet the needs of seriously ill individuals and their families outside of the hospital setting, offering ACOs a reliable pathway in their road to meeting government expectations.
The proposed rule shrinks the amount of time ACOs can be in an upside-only model to two years. Currently, 82 percent of ACOs participating in the MSSP are in an upside-only model.
To meet this tight timeframe to participate in next year’s program, ACOs need to start planning now. While this will likely require many programmatic changes that may have significant ramp-up, Turn-Key’s community-based palliative care model can be rapidly deployed in any geographic area and scaled for larger populations. This enables ACOs to quickly introduce options that are proven to lower costs and improve patient outcomes, with enhanced quality of life for individuals and their caregivers.
CMS is giving ACOs some breathing room to move to the upside only model, with a one-time six-month extension for ACOs with contracts that end in 2018. Furthermore, new participants will have a special July 1, 2019, start date with a spring 2019 application period.
ACOs Expected to Lower Cost and Improve Patient Outcomes
Populations with serious or advanced illness place incredible strain on ACO resources, compromising their ability to improve care while generating shared savings under the MSSP model.
By adopting a newer approach, such as Turn-Key’s Palliative Illness Management (PIM) program, ACOs can turn this high cost population into an opportunity, improving quality and patient satisfaction while reducing cost and generating shared savings through reduced unnecessary admissions, readmissions, ICU stays and other such services that are not helpful in such situations. This type of innovation will be a necessary condition for ACOs to operate successfully under the newly proposed risk models.
CMS Expects to Save $2.24 Billion Over the Next Decade as a Result of the Changes
A systematic approach to community-based palliative care delivery can effectively manage the most vulnerable and costliest member populations. This strategy enables ACOs to improve patient quality of care and experience, decrease caregiver burden, and lower the total cost of care.
Given the new CMS requirements around risk sharing, ACOs should focus on the extraordinary healthcare needs within the growing senior and baby boomer population. Specialized palliative care programs, such as Turn-Key’s PIM model, represent the greatest opportunity for effective impact at the intersection of quality and cost.
Improve and Coordinate Care for Millions of Medicare Beneficiaries
This is precisely where Turn-Key’s structured, systematized approach to community-based palliative care brings value, integrating analytics, a proprietary platform and oversight of its extensive network of palliative care professionals – primarily nurses and social workers. By training, overseeing and deploying its network, PIM empowers its palliative care team members to act as an extension of the primary treating physician, and strengthen the medical home.
The palliative team establishes goals of care, provides supportive home-based care and assesses patient and caregiver status, reporting relevant information to the primary treating physician to fill gaps in care and better align goals with care received.
Click here to contact the Turn-Key Health team for an in-person demonstration of how an ACO can readily adopt a home-based, systematized palliative care program in any region nationwide or contact John Halsey, Vice President, Payer Development at firstname.lastname@example.org