Wednesday, February 01 | Human Services, EHR Solutions and Operations, Interoperability, Value-based Care

AHCA Population Health Summit Recap: Four Takeaways from Industry Experts

By Beth Reece, Vice President and General Manager, GERHIMED

Netsmart was proud to be part of the recent AHCA Population Health Summit in Washington, D.C. featuring presentations from multiple Netsmart clients and experts including Mark McClelland, MD, PhD, former administrator of the Centers for Medicaid and Medicare (CMS); and Ellen Lukins, deputy director of the CMS Innovation Center. If you were not able to attend, here are four takeaways based on the many excellent presentations and our discussions about the challenges of value-based care with long-term care executives and leaders.

It's Time for Senior Care Providers to Move up the Food Chain

The transition from fee-for-service to value-based payment is accelerating. It’s not a matter of if but when most seniors will be covered by plans based on value-based care compensation. Senior care providers need to think about how they can become payers and benefit from the value they provide.

There is no one model that will work for all post-acute organizations, but executives should be investigating how to set up and manage their own Institutional Special Needs Plan (ISNP), accountable care organization (ACO), Direct Contracting Entity (DCE) or partner with larger payers to offer such plans to their patients and residents. Bottom line: If you don’t become part of the payer structure, someone else will be profiting from the value you bring to the table.

Broaden the Focus Beyond High-Risk Individuals

To lower costs and improve outcomes, the focus is often on high-risk individuals. But beyond the “low hanging fruit” this segment represents, there are larger segments that offer opportunities to effectively manage risk. Preventing individuals in the middle/rising-risk segment from migrating to the high-risk segment can result in significant reductions in hospitalizations and emergency department visits. Organizations will need to formulate effective strategies that encompass all risk segments and plan to acquire population health management technology that supports monitoring, tracking and analyzing outcomes in order to optimize care plans.

Explore Ways to Provide High-Touch Care Cost Effectively

Containing costs while maintaining high-touch post-acute care is a delicate balancing act. Providing care in place using telehealth software and mobile technologies can help achieve that goal. They make diagnosis and treatment by specialists, such as dermatologists, cardiologists and wound care specialists, accessible to residents without traveling, which can be problematic for those with mobility challenges. Telehealth also increases the coverage area and supports more flexible scheduling for high-demand specialists, such as psychiatrists and psychologists. Additionally, a mobile EHR designed for geriatric physicians, physician assistants and nurses working in your facilities makes it easy to track MIPS progress, avoid negative payment adjustments and maximize positive adjustments.

Interoperability is Key

Interoperability gives clinicians a complete view of the individuals under their care, with easy access to lab results, notes from other providers, continuity of care documents (CCDs) and more. Providers should look for a healthcare technology partner that develops interoperability into every aspect of its systems, starting with a single, unified EHR platform that can support all service lines. Interoperability solutions should also include a single point of access that connects to the healthcare ecosystem, secure messaging and data exchange, support for referrals and more.

Ready to Start?

Post-acute and long-term care organizations are already using Netsmart technology to manage risk-sharing arrangements. Our population health management software help simplify data analysis, segment populations and stratify risk, support care coordination and improve protocols and treatment plans.

As a founding member of Carequality, we’ve been a strong proponent of interoperability for nearly a decade. The depth and functionality of our healthcare software solutions reflect that focus, simplifying transitions of care, supporting closed-loop referrals, saving hours of staff time and reducing medication errors.

Take a look at our post-acute playbook for value-based care and find out how we can help you prepare for new payment and care delivery models.


Meet the Author

Beth Reece · Vice President and General Manager, GERHIMED

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