Abstract
Medicare accountable care organizations (ACOs), rewarded for containing Medicare costs for attributed beneficiaries, are seeking cost-savings in post-acute care (PAC). Intensified case management, focus on quality metrics, and improved transfers along the care continuum can improve patient outcomes and experience for older adults using PAC while reducing Medicare costs. But narrowing provider networks and downward pressure on length of stay may decrease access to desired care for beneficiaries and constrain resources available for long-stay residents receiving care not covered by Medicare.
We report on case studies of PAC provider interactions with ACOs in three health market areas, revealing skilled nursing facility (SNF) and home health agency (HHA) response to cost-containment strategies. Some SNFs compete to attain and keep ACO preferred status while others question whether participation costs are compensated by increased referrals. Rounding in the SNF by ACO clinicians, while a potential source of conflict, brings timelier primary care to some SNF patients. Coordination strategies aim to improve transitions and reduce rehospitalization. HHAs are pressed to see patients more quickly after hospital or SNF discharge.
Analysis of Medicare claims data for beneficiaries in 18 health market areas over three years of ACO experience examines the impact of these interventions, comparing PAC discharge destination, concentration of discharges in preferred provider networks, length of stay, and 30-day rehospitalizations for ACO and fee-for-service Medicare beneficiaries. Aligning PAC providers with ACO goals is moving Medicare toward more coordinated and integrated care for beneficiaries and saving costs. However, implementation is still a work in progress.