4 Steps Assisted Living Can Take Toward ACO Status

Accountable care organizations (ACOs) aren’t just for physician groups and hospitals anymore. Senior living is starting to make its way into these innovative models, and there is a lot that assisted living providers can do to advance the conversation with ACOs and ultimately join these provider groups.

“Think of an ACO like buying a television,” Kevin O’Neil, MD, chief medical officer for Brookdale Senior Living (NYSE: BKD), said Tuesday during the 2016 Argentum Senior Living Executive Conference in Denver. “A company like Samsung is buying all the different components from different manufacturers and putting it together to make sure it works. Right now, the components of care for a patient do not work together. A lot of the problems we have in the health system are from not coordinating together.”

ACOs are made up of groups of doctors, hospitals and other health care providers, but have typically not involved senior living operators. Some ACOs have crumbled while others have maintained their status, and new ACO models are still being created. The basic idea is that the providers coordinate care among themselves, and share in the savings if they come in under Medicare cost thresholds while hitting quality metrics.


As big players in the care of seniors, assisted living providers don’t have to be left out of the equation. Brentwood, Tennessee-based Brookdale, the nation’s largest senior living company, tested its transitional care programs with a Centers for Medicare & Medicaid Services (CMS) Innovation Grant through the use of the Interventions to Reduce Acute Care Transfers (INTERACT) program. The project aimed to reduce hospitalizations with the University of North Texas Health Sciences Center (UNTHSC). The collaborative project aims to be a model for future ACO collaborations involving multi-site senior living providers. 

ACOs have their ups and downs, but with the potential for assisted living facilities to eventually share in the money distributed to ACOs if they achieve cost goals, and CMS exploring new alternatives, being positioned for such a partnership could put some providers at an advantage.

With that in mind, here are four things that assisted living providers should be doing to be better engaged in the ACO conversation:


1. Assess assisted living facility capabilities and alignment with hospital goals

With much to lose as a result of steep penalties for higher readmission rates, hospitals and physician groups are increasingly looking for partners that can help reduce these rates and improve both health outcomes and the patient experience. This is a good opportunity for assisted living providers, as this is an aligned goal, according to O’Neil. 

“Sometimes when residents are hospitalized, they don’t end up coming back to assisted living,” O’Neil said. 

That’s because hospitals can actually be dangerous places for seniors, resulting in higher rates of infections and delirium and leading to higher acuity needs. To be better positioned to partner with a hospital, assisted living providers should assess their capabilities and initiatives to keep residents out of the hospital. 

2. Establish care coordination programs

Lack of care coordination between care settings can lead to costly mistakes within the health system, and the consequences of miscommunication can be deadly, as the third-leading cause of death in the U.S. is medical error, according to findings recently published in the Journal of Patient Safety. ACO partners are focused on improving care coordination for a seamless transition, and assisted living providers can play a bigger role.

“We get into trouble when we have miscommunication [between providers],” O’Neil said. “It’s usually not a bad doctor or nurse or aide; it’s the bonehead errors that fall through the cracks.”

3. Build coalitions of quality post-acute and long-term care providers

While Brookdale is exploring the possibility of working with and being a part of an ACO, it all started by working with other care partners. As a senior living behemoth operating more than 1,100 communities nationwide, Brookdale executives recognize that working with other care providers is still the best way to engage in the changing health system dynamic. 

“Even with my own colleagues at Brookdale, I have said we can’t own all of this,” O’Neil said. “We might be big nationally, but in a local market, you need to work with other.”

4. Measure and maintain the partnerships

Of course, once coalitions are established, tracking improvements in health outcomes are essential. 

“Any time you work on quality improvement, the data piece is critical,” O’Neil said. “[W.] Edwards Deming said, ‘In God we trust, all others must bring data.’ Make sure you bring data.”

Assisted living providers need to be actively engaged with technology, such as measuring hospital admission rates and residents that transition after a hospital visit. The data is the most valuable tool to align with other providers.

“ACOs are responsible for coordinating the services and collecting the data,” O’Neil said. “I would urge you to start tracking your data, especially if you want to engage in this environment as we move forward.”

Written by Amy Baxter 

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