CCRCs 'ideal candidates' for ACOs, AMDA says

AMDA Executive Director Christopher Laxton, CAE
AMDA Executive Director Christopher Laxton, CAE

Following the passage of resolutions at its annual conference, AMDA – The Society for Post-Acute and Long-Term Care Medicine will advocate for continuing care retirement community participation in an accountable care organization initiative and for an integrated care model in assisted living.

One resolution passed by the AMDA House of Delegates, introduced by the Illinois Medical Directors Association, calls for AMDA to work with LeadingAge, the American Health Care Association, the American Medical Association and other interested parties to enable CCRCs and other long-term care facilities to participate in the ACO Investment Model.

The model was one of several developed under the Affordable Care Act, the resolution noted. In this model, designed for ACOs that are part of the Medicare Shared Savings Program, according to the Centers for Medicare & Medicaid Services, pre-paid shared savings are used to encourage new ACOs in rural and underserved areas and to encourage current Shared Savings Program ACOs to transition to arrangements with greater financial risk.

“Long-term care and continuing care retirement centers are ideal candidates for patient-centered medical homes and ACOs due to the congregate living arrangement for frail elderly residents and the presence of medical directors and practitioners on site,” the AMDA resolution stated, “but they lack the financial wherewithal to successfully create and implement such programs.”

The prepayment of shared savings under the ACO Investment Model, according to AMDA, alleviates the financial burden of creating new ACOs. “Any such financial support from the federal government in the form of advance payment of shared savings is impactful in allowing LTC, CCRC and practitioners in such settings to successfully implement electronic health records and data analytics programs that are essential for participation in population health programs,” the resolution stated.

The fate of various healthcare programs created under the ACA is uncertain under the new administration and Congress, but at least some government officials have expressed support for continuing pilot programs aimed at saving money and increasing efficiencies.

Integrated care in assisted living

Also at the AMDA conference, House of Delegates members passed a resolution calling for the organization to promote and advocate for an integrated care model in assisted living.

The move comes as assisted living communities increasingly find themselves “at the tenuous interface between residential and institutional settings” due to healthcare reforms, the resolution stated.

Now that the resolution has passed, AMDA will work with stakeholders to develop policy statements and white papers sharing how integrated models of care can improve the health and wellbeing of residents by making care easily accessible and available at a lower cost than in other settings.

“Over the years, the assisted living setting has seen greater and greater increases in health acuity among its residents, requiring operators of these communities to engage in a fundamental shift in perspective,” AMDA Executive Director Christopher Laxton, CAE, told McKnight's Senior Living before the conference. “Assisted living communities can no longer remain simply senior housing with light functional assistance. Their resident populations look increasingly like those in nursing homes of 30 years ago.”

If assisted living operators do not address the increasing healthcare needs of residents, he said, “the inevitable consequences are either the repetition of the cases of unconscionable neglect of our elders in under-regulated nursing homes that we saw in the 1960s or the imposition of a federal regulatory framework that does not reflect the philosophy and culture of assisted living.”

Kevin O'Neil, M.D., chairman of AMDA's Assisted Living Committee, which introduced the resolution, told McKnight's Senior Living that assisted living is “the next big frontier for geriatric care” because it may allow some older adults to bypass more expensive skilled nursing settings.

“It's an extraordinary opportunity for those assisted living providers who create that integrated care model to really thrive,” he said.

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