New Access Payment Model Could Be ‘golden Opportunity’ For Senior Living Operators

A new CMS model is an opportunity for senior living operators to add revenue and improve their clinical capabilities, but it will take new infrastructure and partners.

The Advancing Chronic Care with Effective Scalable Solutions (ACCESS) model will test a new payment model for Medicare to increase access to technology-supported care options, such as virtual visits, patient education and integrating remote patient monitoring devices, that could help improve overall health while preventing or managing chronic diseases.

The 10-year program will address common conditions affecting more than two-thirds of people using Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain and depression.

Medicare has historically lacked a payment model that includes technology-supported care. As it stands, fee-for-service models pay for a defined set of activities but do not always align with the way technology-supported care is delivered. The ACCESS model is meant to fill that void by creating an Outcome-Aligned Payments (OAPs) model.

Organizations that participate in ACCESS will receive recurring payments for managing qualifying conditions, with full payments directly linked to “achieving measurable health outcomes,” according to CMS.

“ACCESS can be a means to an end, but it is not a solution in and of itself,” Chris Dawe, president of Health Services at Curana, told Senior Housing News. “What residents need is a robust, true primary care clinical model.”

That model must also include behavioral health, advanced illness management, care coordination and a mix of on-site, virtual and technology-enabled services, Dawe said.

ACCESS a ‘pure technology play’

Senior living providers have taken steps to deepen value-based care arrangements to capitalize on the care they provide daily to older adults. At the same time, operators have infused more technology into daily operations to support better care coordination and revenue management strategies.

The ACCESS model is a “pure technology play,” not for traditional care providers that rely heavily on clinicians, Dawe said. The model is more focused on data, artificial intelligence (AI) and digital health interventions, making ACCESS an infrastructure and payment model for senior living providers.

In establishing partnerships with care providers, Dawe said senior living providers must emphasize the tech-forward nature of ACCESS and commit to implementing new technology to support resident care management.

Senior living providers seeking to use the new payment option should establish strong clinical partnerships while also using remote patient monitoring technology to identify changes in the condition of senior living residents. Baseline needs for ACCESS participation include having an electronic health record (EHR) system with application programming interface capabilities to allow for the smooth flow of data, according to Will Sellheim, managing director in the provider strategy and care transformation practice at ATI Advisory.

“The goal of the program is to bring these non-traditional, digital-first technologies into traditional care settings,” Sellheim said. “This is a great opportunity to receive information from clinical sources that they aren’t receiving today and a great opportunity to be paid for coordinating additional services for which they are only being paid in a clinical event.”

The ACCESS model will require participants to adopt remote patient monitoring devices, mobile and telehealth options while also tracking and managing older adults’ chronic conditions between primary care appointments, according to CMS guidelines.

This comes as “everyone is adopting something” when it comes to improving technology capabilities in clinical care management and care coordination in senior living, Sellheim said. Use of and access to remote patient monitoring technology, which is becoming more common in senior living, is infrastructure that could soon become a baseline in assisted living and memory care settings, Sellheim added.

ACCESS is ‘golden opportunity’ for senior living

Sellheim sees ACCESS as being ripe for assisted living- and memory care-focused senior living providers to benefit from stronger clinical capabilities led by more in-depth technology platforms.

“I do think it’s a golden opportunity for senior living,” Sellheim said.

BMO Managing Director Imran Javaid also wrote in an open letter to senior living providers that there was “limited downside financial risk” as operators receive incremental revenue if they meet the required CMS benchmarks for participating in ACCESS. By delivering “outcome-based care,” senior living providers are “well-positioned” to participate in the program since it closely mirrors what operators provide in their communities on a daily basis.

Making improvements to and tracking the required health conditions of older adults is an area in which Sellheim sees an opportunity for senior living providers to excel given their established clinical care capabilities. But where work needs to be done is in creating the technology platform needed to track outcomes and building stronger relationships with primary care providers.

‘Wait and see’ about impact on senior living

But it may be too early to tell if ACCESS will be a viable solution for senior living providers to capture more revenue for the care they provide on a daily basis.

While ACCESS doesn’t have a “heavy risk component” that CMS is shifting to the ACCESS contract holder, Dawe views ACCESS in part as a “pay-for-performance” arrangement compared to actuarial risk associated with Medicare Advantage plans.

“I think it’s too early to say definitively that there could be limited risk,” Dawe added.

What is promising is the number of providers that are tracking and measuring health outcomes and integrating technology like remote patient monitoring. At the same time, Dawe sees a “noticeable uptick” in senior living providers “thinking about measuring risk areas” including resident falls or polypharmacy.

Finding partners within ACCESS will be critical to success, Dawe said, and operators must ensure that physician partners meet program requirements while also having the technology and staff in place to improve the lives of older adults.

With operators having the ability to “vet the solution and decide who to partner with,” Sellheim said this flexibility in which health outcomes to track could ultimately benefit senior living providers.

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