Creating successful partnerships with Medicare accountable care organizations (ACOs) can seem like a daunting task for many skilled nursing facilities (SNFs), but with the right tools and strategic approaches, these relationships can be the cornerstone to clinical, and operational, success. Below are a few tips to assist in ACO success.
Tip #1 - Collect the Basic Information: Obtaining the basic information should be the first step to a successful ACO-SNF partnership. Some key questions that you can ask the ACO leadership team or your facility’s leadership team may include:
Is our facility a SNF affiliate for the ACO? If the answer to this question is yes, then an agreement has been executed and specific requirements have been defined, including aspects that involve a three-day waiver. Additionally, some ACOs have supplemental agreements with care delivery expectations. If the facility is not a SNF affiliate, then ensure you still obtain the basic information for collaborative care purposes.
Who is the ACO primary contact for the SNF? Most ACOs have a dedicated individual, or team, that supports the SNF with post-acute care delivery or care-continuum needs. Identifying this person or team within the ACO may assist in streamlining communication and ensuring that care delivery elements are successfully delivered to the beneficiary.
What is the communication plan? Request the specifics for the communication plan or determine the elements of the plan that are already a part of the current SNF processes.
Does the ACO have specific admission protocols? Many ACOs have strong partnerships with other providers, such as the local hospital, and there may be specific protocols in place for communicating that a hospital patient is an assigned beneficiary. The SNF should know these protocols to assist in a smooth transition.
Are there specific forms that need to be completed for the ACO? Some ACOs request that specific forms be completed, while other providers request biweekly clinical updates.
How will the ACO communicate about an assigned ACO beneficiary? One of the biggest challenges that SNFs encounter is related to obtaining information on assigned ACO beneficiaries. The SNF leadership team should engage in a positive dialogue to understand how information about the ACO beneficiaries will be communicated to the facility.
Does the ACO have an emergency department diversion program, a telehealth program, or any other supportive features that may assist in the care delivery process?
These questions should not be considered an all-inclusive list but should give an idea of the types of information that should be shared. Additionally, it is essential to obtain information such as a list of providers that are part of the ACO, as well as to determine whether the ACO has dedicated SNFists or physician extenders that will round, or support, the assigned beneficiary while care is being provided at your facility.
Tip #2 - Share Your Facility’s Capabilities and Special Features: While a facility should obtain the basics about the ACO, providing the organization with your facility’s information is also very important. Most providers are unaware of the regulations, rules, and laws associated with a SNF setting, so if a provider believes that its patient can be admitted to your facility based on inaccurate information, the partnership could be undermined. Offering insight into your facility’s capabilities can assist the ACO providers in supporting the care delivery process. Share your facility’s protocols by informing the ACO on discharge planning procedures, therapy updates, care planning processes, and capability levels. The ACO leadership team and providers should have primary contact information for SNF leadership and have contact information for various members of leadership on each shift. When the ACO has knowledge of its points of contact, then the partnership can be stronger.
Tip #3 - Focus on Care Coordination: Focus on the right care, at the right time, in the right setting! The 3-R mentality can assist in providing the best outcomes for those who are cared for at your facility. Most SNFs have a solid understanding of care coordination, as our regulations require, for robust processes and care delivery programming. However, care coordination related to ACO collaboration can be challenging. As a SNF provider, you understand that care coordination is more than providing information. It is also recognizing that care coordination efforts can be supported by having residents and patients who may be high risk or have complex comorbidities. Anticipating the beneficiaries’ care needs through strong care coordination processes may result in better interventions that are built on proactive approaches, thus allowing for situations to be addressed before an issue becomes urgent or emergent. Consider discussing the ACO’s high-risk patient protocols to determine how your facility can align best practices. Share how the facility addresses these types of situations and ask the ACO leadership if a care coordinator is part of their approach.
The current healthcare environment is challenging for all providers, and creating a collaborative approach that is focused on the ACO beneficiary is critical. Most providers elect to be in an ACO to assist in providing the best quality of care throughout the continuum, which can allow for alignment of the various stakeholders. Your facility and the ACOs share similar goals, like preventing unnecessary readmissions, delivering patient-centered care, embracing cost-control methods, reducing duplicative services, ensuring care coordination, and collaborating with all providers in the marketplace. Embracing these goals, as a team truly focused on the ACO beneficiary, can lead to enhanced outcomes. If the goals and approaches are aligned, then ACO success can be achieved!
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