Accountable Care Organizations (ACOs) continue to evolve, growing from Medicare-focused entities to ones that are deeply involved in private payer markets. Regardless of the funding source, the goals remain the same – to optimize the quality of care by using data, emphasizing prevention, closing gaps, and coordinating care. While originally focused on primary care, ACOs now involve all manner of care organizations, including private pay home care. This article looks at the relationship between ACOs and organizations like SeniorBridge, which focuses on medically directed home care for chronically ill patients.

The rise of commercial ACOs

Commercial ACOs are not held to the same standards as public ACOs that are connected to the Centers for Medicare & Medicaid Services (CMS).

For example, financial requirements, quality metrics, and reporting standards vary among commercial ACOs, and the flexibility seems to have encouraged more commercial payers to get involved.

Health Affairs (2021) reports that “While the number of Medicare ACO contracts has plateaued, commercial…ACO contracts have continued to increase steadily.”

“ACOs reported that home visits help them gain a greater understanding of a patient’s home life, including any safety issues and barriers to health, while providing an opportunity to build relationships with patients and engage them in managing their health to reduce hospital and other care use.”

The Commonwealth Fund (2019)

The role of medically directed home care in ACOs

Since the goals of ACOs (commercial and public) include cost containment, care coordination, and patient health, medically directed home care is positioned to play a significant role.

A 2019 study found that “ACOs, which take on risk for patient populations, are more likely than other health care organizations to use home visits to support complex patients, including during care transitions and times when a patient is out of contact.” This indicates a shared awareness among ACOs and medially directed home care organizations that patients are especially vulnerable during care transitions, and home-based care can safeguard their recovery and contain costs by reducing risk of hospital readmission.


Commercial ACOs are using home care visits

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A 2019 Commonwealth Fund report stated that commercial ACOs often use home visits. This points to the understanding that home care can play a central role in reducing healthcare costs. The study also reported that “ACOs used home visits for patients who were noncompliant or nonresponsive with office-based care.”

ACOs and High Need High Cost (HNHC) patients

Recent research indicates how ACOs are mobilizing to address the needs of the costliest patients – those with conditions that often result in increased utilization and require intense coordination among multiple providers.

Yet ACOs face serious challenges in addressing the needs of HNHC patients. Among them are identifying HNHC individuals, patient engagement, staffing, and IT resources.

Medically directed home care such as SeniorBridge, which uses RNs, LCSWs, LPNs, CNAs, and HHAs in a flexible, integrated model is optimally well suited to work with ACOs in caring for HNHC individuals. The range of services provided, from in-home medical procedures to psychosocial care, make medically directed home care a potentially significant player in the ongoing success of ACOs.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
Brookings Institution (2015)
Health Affairs (2019, 2021)
Commonwealth Fund (2019)

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