1. What Is Value-Based Care?
Value-based care is fundamentally a shared vision - senior living communities collaborating with care providers like physicians and therapists to improve quality of life for residents.
In practice, this looks like:
- Using data to drive proactive care. Predict who is going to fall or suffer a serious incident before it happens, and taking steps - things like arranging therapy, working with physicians to change medications, re-arranging furniture, or updated scheduling of toileting checks - to prevent them.
- Partnering with third-parties (like physician groups) that help your residents. Identifying which providers and provider-groups result in the best outcomes (e.g. longest length of stay) for residents.
- Find patterns behind adverse clinical outcomes so they can be addressed - are there certain shifts, certain med passers, certain wings, certain days of the week, etc, that are resulting in better or worse med-error outcomes, or more or fewer incidents?
2. What Is The Role of Senior Living?
Senior living communities and care teams know more about residents than anyone else - they know who is showing up to activities and who is sitting out, who is cracking jokes and who isn’t quite themselves.
They also have all of the data - senior living communities are the source of truth for tracking what meds residents take, what cares are provided, what activities they attend, and more. Capturing this data accurately, identifying KPIs, monitoring them, taking action based on those KPIs, and sharing that data with other key stakeholders (e.g. a resident’s PCP) is key to value-based care in senior living.
3. What about reimbursement?
VBC payments primarily go to Medicare-reimbursed providers (e.g. not senior living communities). However, senior living communities can be indirectly reimbursed by VBC providers (more on that later).
There are a number of different reimbursement programs - mostly piloted by the Center for Medicare and Medicaid Services (CMS) - that create financial incentives for Medicare-reimbursed providers like doctors and therapists to provide high quality care. The idea is that instead of “fee for service”, where providers are reimbursed for the services they provide, providers are instead paid for “value”, e.g. outcomes.
Examples of these programs include:
- ACO REACH (Accountable Care Organizations Realizing Equity, Access, and Community Health) and Medicare Shared Savings Program ACOs - provider groups (including primary care and specialty physicians) come together to form an ACO. CMS provides risk-sharing payments (or deductions) for ACOs and participating providers that come in below (or above) per-resident cost estimates.
- GUIDE (Guiding an Improved Dementia Experience) - a coordinated care program for individuals with dementia. CMS will pay providers a monthly per-individual fee for providing this coordinated care program.
4. Can senior living providers get paid?
Yes, they can. Senior living providers can enter into risk-sharing agreements with ACOs and other value-based care providers. Under these arrangements, senior living operators can share in savings (and receive payments) where they are successful in reducing the overall cost of care for covered residents.
5. What is ECP’s role in Value-Based Care?
ECP provides the clean data backbone value-based care depends on: assessments, care plans, medication safety, incidents, dashboards, and trend analytics. We help operators prove outcomes without adding work for their staff.
The crux of this is:
- Easy-to-use software, so that residents are accurately assessed, and all relevant data is captured (e.g., if a care is missed or refused, it needs to be tracked to drive KPIs). If a community cannot demonstrate what care was delivered and how it impacted resident health, they simply cannot participate in VBC programs.
- Powerful, customizable analytics. ECP offers industry-leading BI and analytics capabilities, where providers can build customizable dashboards reporting on the KPIs that they and their value-based care partners care about.
- AI-powered risk predictors. ECP has built a first-in-the-industry, research-driven machine learning model to identify which residents are at hightened risk (of falls, other serious incidents, or end of length of stay), and what is driving that risk, before those negative events occur, so that senior living operators can respond specifically and proactively
About ECP
ECP is the leading all-in-one software provider for senior living communities, offering eMAR, EHR, CRM, Move-Ins, Billing and business intelligence solutions. Designed to enhance resident care, staff efficiency, and operational success, ECP’s technology is trusted by over 8,000 of communities nationwide. With a commitment to seamless integrations and data accessibility, ECP is making senior living software simpler and smarter.
