Lee Kilmer

Transitioning to a value-based care model: 4 considerations for LTC providers

The valued-based care model is set to become the norm in reimbursement for long-term care (LTC) facilities by the year 2030. For providers who aren’t yet fully prepared — or unsure of even where to begin — here are the most important considerations about transitioning to value-based care.

Why is reimbursement changing to a value-based care model?

In the past, LTC providers have operated on a traditional fee-for-service model, where reimbursement was based on services provided — whether or not the patient or resident experienced positive health outcomes. In recent years, however, the Centers for Medicare & Medicaid Services (CMS) has worked to replace fee-for-service with value-based care, a model of performance-based reimbursement that rewards providers for achieving results.

This emphasis on quality over quantity is being made for a number of reasons. First of all, there’s the upcoming “senior tsunami.” About 10,000 Americans reach retirement age every day, and by the year 2030, every member of the Baby Boomer generation will be at least 65.

What’s more, these new and future retirees are looking for different things than previous generations. For instance, there’s a strong preference to age in place (i.e., at home), and to live independently for as long as possible. And when they do enter LTC facilities, these seniors are also looking for more community-based services, amenities, and social elements.

Not only is the number of retirees increasing, but these folks tend to have more serious health issues, as well. The number of seniors with multiple chronic conditions grows each year. For instance, the number with dementia almost doubles every 20 years. And by 2050, the number of Americans with Alzheimer’s is projected to reach nearly 13 million — more than double its current prevalence.

What value-based care means for LTC providers

Value-based care is being implemented to help meet these challenges. To that end, the goal is for all Medicare beneficiaries to be in some kind of value-based model by 2030.

Along with value-based care comes a new emphasis on wellness, prevention, and population health. In addition, CMS is seeking to improve SNF utilization to drive down length of stay and help relieve some of the financial pressures on the system. On top of optimizing reimbursement, these initiatives also align with resident preferences for more types of programs, and the option to age in place.

That means LTC providers will soon be paid based on positive outcomes, and on new types of services that they may not currently provide. By the same token, they could be penalized if someone declines while in their care, and consequently lose reimbursement dollars. As a result, LTC providers may need to diversify their service offerings to add more wellness, at-home services, and amenities in general.

Certainly, some LTC providers are ready for this change. But most aren’t quite there, as of yet. Many are at different stages of the preparedness spectrum. Maybe they have already joined a risk-sharing provider network, or participate in a program like PACE or ACO REACH, for instance.

For other providers, maybe they’ve been successful with fee-for-service care, and simply haven’t prioritized the change to a value-based care model. But regardless of that success, or comfort with or preference for the current model, the change is coming — 2030 isn’t far away, after all.

In other words, transitioning to value-based care needs to become a priority for all LTC providers. And those seeking guidance on this important goal can begin by considering four important questions.

4 questions for LTC providers transitioning to value-based care

#1: How to manage risk. First and foremost, providers need to figure out how to best manage risk. The system is moving toward driving down the cost of healthcare while improving outcomes. So, the question is how to manage risk, and how to understand who’s most at risk. How do you provide the interventions, care plans or services that will best prevent those individuals from having an adverse event?

#2: How to stay ahead. Secondly, LTC providers should be thinking about how to innovate and stay ahead of this broader shift. Especially for facility-based providers with skilled nursing or assisted living facilities, the question should be how to improve performance in other services and settings, particularly in-home care.

#3: How to diversify and expand. Closely related to this is the question of how to diversify services. How do you provide differentiation in the care you provide? Of course, there will always be a need for skilled nursing facilities. But as we’ve seen, more seniors prefer to be in settings with lower-care levels. So, how should LTC providers approach diversifying services to better meet these expectations?

Another way to frame this question may be, how can providers focus on the whole person — not only physical health, but mental and behavioral health, chronic disease management, social well-being and wellness, and prevention?

#4: How to leverage technology. Finally, how can technology be used to help achieve these goals? The value-based care model is very much focused on organizations working together to help improve care and drive down costs. So, how can providers leverage technology to provide integration between different care partners — whether they’re ancillary care services or physician care services, post-acute care, acute care services, and even integrating the family more in the care of the individual?

Especially today, care teams aren’t always within the same four walls. So, how can technology be used to coordinate care and insights across that entire team, including the resident and family, connecting everybody in a meaningful way?

Transitioning to value-based care: What to do next

No matter what a provider’s current level of preparedness may be, there are solutions available to address each of these questions. And leveraging them means not only meeting value-based care requirements, but also embracing the opportunity to offer the benefits and features that new residents want. The result could be a chance to be more competitive in an increasingly challenging market.

At MatrixCare, we’ve worked to pioneer new innovations in technology to help LTC providers not only take their first steps toward transitioning to value-based care, but also realize greater value from doing so. That includes implementing the necessary infrastructure to enable risk-sharing and at-home care. It also includes applying analytics, artificial intelligence and machine learning to gain important insights from data to improve population health management and other performance-based goals.

MatrixCare can help provide the technology, tools and guidance to help your organization more fully transition to a value-based care model. Request a demo today to learn more.

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Lee Kilmer

Lee Kilmer serves as the Vice President, Product Management at MatrixCare. Lee started at MatrixCare in June of 2016 and has over 24 years of experience leading global software development and product management teams with a proven track record for setting product strategy and delivering new innovative software solutions to market. Lee currently resides in the Greater Minneapolis-St. Paul Area.

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