The State of Value-Based Care in PALTC

Important changes to value-based care are on the way for post-acute and long-term care (PALTC) providers. 

Historically, the Centers for Medicare and Medicaid Services (CMS) has not designed its Accountable Care Organization (ACO) models to serve the specific operational needs of PALTC providers. Instead, value-based care treated providers caring for frail, high-cost populations as cost center rather than strategic partners. But that is about to change. 

CMS is rolling out the Long-term Enhanced ACO Design (LEAD) model for value-based care, bringing with it a renewed focus on geriatric and long-term care providers. Understanding how LEAD works will be essential for organizations to succeed in the next phase of value-based care in PALTC.

What is Different About the CMS LEAD Model?

Arriving at the start of 2027, the LEAD model places greater emphasis on the needs of high-needs Medicare beneficiaries such as those found in PALTC care. Improvements to care coordination, hospital utilization and outcomes for post-acute and long-term care patients are expected as a result of the new value-based care framework.

Elevated Focus on High-Needs Patients

The new model bucks the old trend of separating high-needs beneficiaries into multiple distinct tracks. Instead, the LEAD model integrates support for medically complex patients. The result is a system that makes participation easier for organizations that care for both general and high-needs Medicare populations. 

10-Year Model Duration

The LEAD model offers longer stability than its predecessor. Its ten-year model duration, lasting 2027-2036, allows participating organizations to invest in care coordination, technology and workflow redesign with more confidence. 

Shift Away from Benchmark Rebasing

In previous ACO models, benchmarks would periodically reset to reflect successful performances. This rebasing process could make it more difficult for organizations to achieve savings in the future. By contrast, the new LEAD model will dispense with benchmark rebasing entirely, allowing PALTC providers to focus on improvements without being penalized for success. 

Preparing for LEAD Model Participation in PALTC

The impending arrival of the new LEAD model offers PALTC providers an exciting opportunity to get involved with value-based care. To prepare properly, these organizations must take proactive steps with technology and operations. To start, providers should invest in a certified electronic health record (EHR) platform equipped with electronic clinical quality measures (eCQMs) and interoperability features. 

Ready to make the first move toward leveraging the LEAD model within your organization? Contact Netsmart to schedule a GEHRIMED® demo and see how an EHR designed for PALTC providers can help you prepare for value-based care operations. You can also view our Webinar, The State of Value-Based Care in PALTC: Market Trends, ACO Adoption and What LEAD Means for You, for more details.