How CMS’ Goal To Enroll All Medicare Beneficiaries In ACOs Could Impact Home-Based Care Providers

Home Health Care News | By Joyce Famakinwa
 
The U.S. Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030.
 
Currently, roughly 13.2 million Medicare fee-for-service beneficiaries are assigned to an ACO. 
With this in mind, there has been more activity and investment around accountable care organizations (ACOs), including for at-home care providers, which are strategically collaborating with these organizations.
 
The Walgreens Boots Alliance-backed VillageMD — a Chicago-based primary care services organization that has an at-home care arm — is one provider that is working heavily in the ACO space. The company is a participant in the ACO REACH Model, for example. 
 
Andrea Osborne, senior vice president of ACO operations and delegated services at VillageMD, pointed out that the ACO REACH model allows providers more leg room to approach CMS about various concerns and suggestions.
 
“We actually get to go to CMS and have conversations, and say, ‘Hey, the Medicare rule isn’t working for us,’” she said Tuesday during a panel discussion at the annual LeadingAge conference in Chicago. “‘We’d like to try it that way.’ We have these conversations.”
Amid the pandemic, the company approached CMS about expanding at-home care services, for instance.
 
“We said, ‘We want to be able to use home health care anywhere,’ and then they actually ended up opening that up for everyone,” Osborne said. “That’s because we had tested these models, so it’s really important that when you are in these partnerships – if there are barriers to care that are Medicare regulations – you’re speaking with your ACO partner, because we actually can get opportunities to test changing those rules.”
 
Medicare Shared Savings Program (MSSP) ACOs are an opportunity for home-based care providers to enter the space.
 
The majority of MSSP ACOs are hospital-based. As a result, these ACOs are focused on a patients’ post-acute stay after a hospitalization, according to Andy Edeburn, a consultant at Elder Dynamics, an advisory services company for aging services providers.
 
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