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The federal government released a breakdown of strategies that accountable care organizations (ACOs) have used to successfully partner with skilled nursing facilities — a move that could indicate policymakers’ continued support of the care models.

The Centers for Medicare & Medicaid Services (CMS) recently released a care coordination toolkit for ACOs that drew from focus groups and interviews with representatives from 21 ACOs. The organizations participated in the Shared Savings Program, the Next Generation ACO Model, and the Comprehensive End-Stage Renal Disease Care Model.

The relationship between ACOs and SNFs has been a somewhat thorny one, with many ACOs saving money by cutting skilled nursing spending and cracking down on patient length of stay. But in conversations with CMS detailed in the toolkit, ACOs stressed the importance of coordinating with SNFs to provide appropriate and effective post-acute care for their beneficiaries.

They recommended the following strategies to support care coordination: establishing SNF networks, encouraging continuous quality improvement, and dedicating staff to coordinate care with SNFs.

Avalere Health, a health care consulting firm based in Washington, D.C., has seen all those strategies in its interactions with SNFs and ACOs, John Feore, a director at the firm, told Skilled Nursing News. Though sending staff to a SNF isn’t something he’s seen as frequently, ACOs are following all those overarching strategies, he said.

“In some respects, it’s clearly difficult for SNFs, because ACOs are clearly looking at skilled nursing as a big area to produce savings,” he told SNN. “And with that in mind, the ACOs are definitely trying to be aggressive at times — or at the very least thoughtful — about where they send their patients.”

To do that, ACOs have identified preferred SNFs for the networks based on publicly available data, such as CMS’s Five-Star Quality Rating System on Nursing Home Compare, and information submitted by the SNFs themselves, according to the toolkit. They then used this information to develop performance metric benchmarks based on clinical quality and operational efficacy.

In another key step, ACOs highlighted the high-performing facilities to support beneficiaries during the SNF selection process, the toolkit noted. Some created brochures for caregivers and beneficiaries describing the partner SNFs, while others set up analytics tools to communicate with clinicians about SNF utilization rates.

Many ACOs worked directly with SNFs to keep quality trending upward, the toolkit added.

“To facilitate these efforts, ACOs have developed data analysis tools, identified care management staff to meet with SNFs in person and via telephone, and enabled peer-to-peer knowledge sharing by establishing SNF collaboratives,” the report said.

Many scheduled regular meetings with SNF staff, and some would go so far as to dedicate staff to coordinate care for the SNF. These might include care managers, registered nurses, and physicians, the toolkit noted — with some staff embedded in the clinical setting and others available via phone.

It’s less common, however, to see such dedicated ACO staff embedded in a SNF, Feore said. But all three strategies show the need for SNFs to proactively work with ACOs and start conversations about becoming partners, he said. To do that, they should ask about the grading tools that the ACOs in their area use, and how well they perform under them.

For him, one of the most interesting things about the toolkit is the fact that it exists at all; this is not a document that was necessarily expected or required.

“I think it helps show that CMS is — despite big changes to the program — they’re still trying to grow the ACOs,” Feore told SNN. “As they move forward to the other models like bundled payments, I think these strategies [for SNFs] are going to be the same or similar strategies, whether it’s an ACO or bundled payment participating or something else. They’re going to look at similar strategies as it relates to skilled nursing.”

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