We wanted this to be part of our business, but we didn't want this to be all of our business," Paulk said. "We're looking for full-time residents.
Continued from page 7 Falls, missed medicine, unhealthy eating and other
behaviors can quickly produce return admissions. Re- turn visits ultimately would translate into penalties in the form of reduced payments from Medicare. But if they were able to save money, Medicare would share the savings with the ACO members. Medical provid- ers and the accountable care organizations they form need assurance that their patients will get appropriate services and supports. Some in the senior living industry see opportunity to participate as part of an ACO, work- ing with others in the healthcare field to highlight that their communities area safe places that help residents remain healthy. Shirley Paulk, The Arbor Company’s vice president
of sales and marketing, said their communities had been working to secure relationships to hospitals before ACOs began: “It sort of fell on deaf ears, but we came back and said, ‘We can have an impact on your fiscal performance. We can be part of the solution.’” The Arbor Company’s assisted living communities
have been proactive, showing hospitals their data with results including medication error rates, weight loss, skin condition and rehabilitation outcomes. The positive re- sults opened the door for hospitals to begin referring their locations to patients who were being discharged from a hospital but needed the resources of assisted living. Patients who would be alone or live in homes that aren't post-surgery friendly can stay in an Arbor community while healing and receiving help with care.
The Long-Term Viability of ACOs Some industry experts say communities should form relationships with ACOs now, securing their positions with what could become a lucrative referral market. As of January, the Centers for Medicare and Medicaid Services reported there are almost 500 ACOs, serving nearly 9 million beneficiaries. Having a relationship with an ACO is “going to be-
come very important because networks are going to be formed and when you’re out of the network, it’s going to matter,” said David Muhlestein, senior director of research and development at Leavitt Partners. “The reality is that, in many markets, they’ve still got a fair amount of time before it’s going to come down.” Those operating in markets with numerous or well- developed ACOs may have a year to form those partner-
8 SENIOR LIVING EXECUTIVE / JULY/AUGUST 2016
ships, Muhlestein said. Those in markets where ACOs are not as advanced may have as long as five years. The Centers for Medicare and Medicaid Services
has introduced numerous alternative-pay models since 2010, giving senior living communities opportunities to identify and partner with specific types of providers. The payment models reflect the Department of Health and Human Services' goal of shifting 30 percent of traditional Medicare payments to alternative payment models by the end of this year. (See sidebar on page 10.)
Senior Living as a Convener of Post-Acute Care Services Dr. Kevin O’Neil, chief medical officer at Brookdale Senior Living, said opportunities exist for many commu- nities to become conveners of post-acute care services. Patients could recuperate in senior living communities and those providing therapy or home health services would meet with them in those communities. Residents could be transported to medical appointments and, if needed, get help with medication management. Doc- tors and hospitals would have increased assurance that their patients were positioned to follow orders while in senior living. In most cases, forming these relationships will require
communities to educate about their services to hospitals, skilled nursing centers and others. The senior living industry houses ACOs’ target popu-
lation and ACOs have more than 10 times as many pa- tients as senior living has residents. Senior living serves about 835,000 residents, according to 2014 data from the Centers for Disease Control and Prevention.
Working in the ACO Marketplace Senior living companies need to define and outline for ACOs the benefits of senior living services to incentiv- ize them to partner. Informal relationships can direct post-acute referrals, giving senior living communities another opportunity to help patients while establishing new referral sources. Transitional Living Care, as The Arbor Company’s
service is known, is offered in 20 of Arbor’s 27 commu- nities. They didn’t launch TLC in all locations because markets differ and some states’ laws and regulations don’t allow them to offer the services that would make Continued on page 10
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