Population Health Management (PHM) is a term that describes the application of various interventions and strategies aimed at improving the health outcomes and managing the costs of a targeted group of individuals.  PHM models vary based on the degree of risk, degree to which payment is tied to quality, reliance on data analytics, and level of care coordination. 

Historically population health models have been led by hospitals, health systems, physician groups and large insurance organizations.  More recently long-term care (LTC) and post-acute care (PAC) providers have been assuming a leadership role in developing and employing some PHM models.

This module is made up of two components:

Population Health Management Fundamentals Webinar: 42 minutes

This webinar describes the who, what, where, and how of Population Health Management (PHM). It also introduces various PHM models including their specific characteristics, benefits, and implications.

Population Health Management Brief: three pages, PDF

• Provides an overview of population health management
• Comparison of PHM and FFS
• Outlines some of the major models and the level of risk categorization

© 2022 American Health Care Association. All rights reserved. 

All Population Health Management Fundamentals materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Accountable Care Organizations (ACOs) are one of the largest alternative payment models in Medicare, and they also exist in Medicaid and commercial payors.

ACOs are networks of physicians, hospitals, and other healthcare providers that voluntarily come together to coordinate care and manage the total costs of a defined population, sharing in the financial risks and rewards of performance against benchmarks and on patient outcomes. 

This module is made up of two components:

Accountable Care Organizations (ACOs) Webinar: 41 minutes

Provides an overview of the structure, financial model, and regulatory requirements of different ACOs. Types of ACOs covered include Medicare Shared Savings Programs and Next Generation ACOs. Upon completion of this webinar, you will gain an understanding of how ACOs work and appreciate the role and opportunity for long term care facilities and post-acute care providers in the ACO model.

Medicare Accountable Care Organizations Brief: three pages, pdf

• Introduces and explains Medicare ACOs
• Explains and compares different ACO programs
• Outlines opportunities for SNFs

© 2022 American Health Care Association. All rights reserved. 

All Accountable Care Organizations materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Bundled payments are a type of alternative payment model designed to incentivize high quality, cost-effective care. Bundled payments, also known as episode-based payments, are single payments for all care and services provided, which could include multiple settings, for a single condition over a defined period of time (episode of care).

This module consists of two components.

Bundled Payments 101 Webinar: 23 minutes

Provides an overview of the basics of bundled payments including what are bundled payments, how do they work, and implications for LTC and PAC providers.

Bundled Payments Brief: Three pages, pdf

• Defines and explains bundled payments at a high level including bundled Payments for Care Improvement (BPCI) Initiative, Comprehensive Care for Joint Replacement (CJR), and Bundled Payments for Care Improvement Advanced (BPCI-A).
• Highlights opportunities for SNFs

© 2022 American Health Care Association. All rights reserved. 

All Bundled Payments materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Direct Contracting (DC) is part of The Center for Medicare and Medicaid Innovation’s (CMMI) Primary Cares Initiative and was released in April 2019. It is one of the newest Medicare fee-for-service (FFS) risk sharing models built on lessons learned from the Medicare Shared Savings Program (MSSP) and Next Generation ACOs (NGACOs) and leverages innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements. The design is intended to broaden participation beyond current participants in Medicare FFS risk models by attracting traditional providers new to risk as well as other innovative partnerships/organizations looking to take risk for Medicare FFS beneficiaries.

This module consists of four components: 

Direct Contracting Brief: three pages, pdf

Highlights key components of CMS’ Direct Contracting Model options noting opportunities for SNFs

Direct Contracting Overview: six pages, pdf

Provides a detailed overview of Direct Contracting including types of participants, payment, beneficiary alignment, quality incentives, and a model timeline.

Geographic Direct Contracting Brief: Three pages, pdf

Presents key features of the Geographic Direct Contracting model that requires Geographic DCEs (Geo DCEs) to assume total cost of care risk for beneficiaries residing in defined geographic regions. Eligible beneficiaries are required to participate in the model if residing in designated regions.

Medicaid Managed Care Organization (MCO) - Based Direct Contracting: Two pages, pdf

Provides an overview of the Direct Contracting track designed for Medicaid Managed Care Organizations (MCOs) to serve enrollees who are dually eligible for Medicare and Medicaid including potential implications for SNF and AL providers.

Direct Contracting 101: Opportunity for SNF/PAC to Lead Webinar : 60 mins

Direct Contracting is one of the newest, voluntary Medicare fee-for-service (FFS) risk sharing models aimed at transforming care delivery and moving providers from volume to value. Direct Contracting is based on lessons learned from ACOs and features of Medicare Advantage and encourages participation by organizations serving  dually eligible and complex needs populations. It provides a potential path for innovative SNF/PAC providers to lead in managing risk.  Join this webinar to learn more about Direct Contracting -- key features, participation options, beneficiary criteria, payment and quality, model waivers, and opportunity for SNF/PAC.

 Direct Contracting 201 “Office Hours” Webinar: 60 mins

This session succeeds the Direct Contracting 101 webinar and offers attendees a brief overview of Direct Contracting including the recently released MCO-based DCE model and a comparison of Institutional Special Needs Plans (I-SNPs) and Direct Contracting. The session is designed to give attendees a greater opportunity to ask questions and receive answers regarding some of the more detailed pieces of the model. 

Meet the Speakers:

Tyler Cromer, Principal, ATI Advisory

Nisha Hammel, Senior Director, Population Health Management, AHCA

© 2022 American Health Care Association. All rights reserved. 

All Emerging Models: Direct Contracting materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Managed care involves a healthcare delivery system that encompasses care, services, and payment and seeks to control costs and enhance quality through the establishment of provider networks and employment of utilization management strategies.

This module consists of four components:

Medicare Advantage/Provider-led Special Needs Plans (SNPs) Webinar: 48 minutes

Provides an overview of Medicare Advantage/ Provider-led SNPs, explains how it works, and discusses the implications for LTC and PAC providers.

Provider-Led Special Needs Plans Case Study Analysis and Report: Twenty-six pages, pdf

An Idea That’s Growing: Long-Term Care Providers Taking Charge in Managed Care 

• Provides the results of the analysis of Medicare Advantage data on provider-led plans 
• Provides a summary of findings on case studies of three provider-led plans including key themes 
• Offers a six-component framework for successful operation of an LTC provider-led I-SNP including critical competencies and challenges 
• Advances policy implications and considerations

Medicare Advantage Brief: Two pages, pdf

Provides a high level overview of Medicare Advantage (MA) including MA growth, opportunities for value based contracts under MA, supplemental benefits and types of MA plans. 

Medicaid Managed Long Term Services & Supports (MLTSS) Brief: Two pages, pdf

States are shifting away from traditional fee-for-service Medicaid, often using § 1115 waivers to provide capitated MLTSS programs in efforts to streamline program administration, improve care coordination, and expand access to home and community-based services (HCBS).

This brief covers:

• The Basics of MLTSS
• Opportunities in MLTSS
• Optimizing MLTSS in Your State

© 2022 American Health Care Association. All rights reserved. 

All Managed Care materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Provider networks are a joint venture of independent providers that come together to focus on the benefits for the residents, enhance quality outcomes, and work on value-based reimbursement.

This module has two components:

Provider-Owned Networks 101 Webinar: 29 minutes

Provides an overview of the why, what, and how of provider-owned integrated care networks and explains the benefits of provider networks.

Provider-Owned Integrated Care Networks Brief: One page, pdf

This brief gives you a better understanding of Provider-Owned Integrated Care Networks and includes:

• Overview
• Focus on Quality
• Benefits and Services

© 2022 American Health Care Association. All rights reserved. 

All Provider Networks materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.