Avera Health’s alternative payment model for nursing homes recommended to HHS

The Physician-focused Payment Model Technical Advisory Committee (PTAC) recommended to the Department of Health and Human Services (HSS) full-scale implementation of Avera Health’s Intensive Care Management in Skilled Nursing Facility Alternative Payment Model (ICM SNF APM). The new payment model aims to reduce avoidable emergency department visits, provide timely access to physician care and lower costs for nursing home patients. The proposed model involves a geriatrician-led care team, which might include a nurse, social worker and pharmacist, working with the attending primary care provider (PCP) in partnership with a nursing home or skilled nursing facility. The care team provides 24/7 support via telehealth, mentorship, and “management of care transitions.”

The model presented by Avera Health is based on the Avera eLong Term Care (Avera eLTC) program. The model suggested two possible payment pathways: a performance-based payment and a shared-savings model.  In sharing the positives about the program, Joseph Rees, MD, a hospitalist at Avera McKennan Hospital explained the model could be implemented in smaller, rural geriatrician practices “if they have a really good interdisciplinary team.”