Articles

This article was originally featured in Fierce Healthcare. As the transition to value-based care (VBC) continues to present both opportunities and challenges, post-acute care (PAC) remains a significant cost driver for health plans. Traditionally overseen through administrative channels, it’s increasingly clear that health plans operating in today’s VBC landscape need a more innovative approach to managing post-acute spend – one that leverages a critical, yet often overlooked, clinical partner: the Post-Acute Director of Nursing (DON). DONs represent a largely untapped resource for health plans aiming to improve outcomes and control costs among their most vulnerable member populations. One of the...read more

Originally published in NADONA's The Director Quarterly Journal, Spring 2025 Issue. Over the past few months, we have all become aware of CMS Memo – QSO-25-07-NH – Revised Long-Term Care (LTC) Surveyor Guidance, which includes significant revisions to enhance the quality and oversight of the LTC survey process. With the effective date now pushed to April 28 (QSO-25-14-NH), surveyors continue to learn the revised guidance and prepare for upcoming surveys. In addition to these revisions, many facilities face increasingly complex surveys that span several years of review. CMS has also announced the reinstatement of the Internet Quality Improvement and Evaluation...read more

This article was originally featured in Fierce Healthcare. When it comes to value-based care (VBC), the Centers for Medicare & Medicaid Services (CMS) have made their intentions clear. CMS aims to align all Medicare beneficiaries with accountable care relationships by 2030 – whether through broad VBC strategies or targeted regulatory initiatives, such as the Transforming Episode Accountability Model (TEAM). For health plans and other risk-bearing entities, this shift to VBC requires proactive, data-driven strategies to manage costs, quality and outcomes. This is especially true in post-acute care, where high costs and variability in quality and outcomes are common. Unfortunately, many of these organizations...read more

This article was originally featured in Modern Healthcare. Health systems, accountable care organizations and others are bringing extra staff and tracking technology into post-acute care to reduce hospital readmissions. Health systems, such as OSF Healthcare, and accountable care organizations, such as Provider Partners Connect Care are using remote patient monitoring equipment, electronic medical records software and additional staff to ensure patients don’t have a set-back that will send them back to the hospital. Readmissions add costs that ripple through the healthcare system and the Centers for Medicare and Medicaid Services penalizes hospitals and nursing homes for higher-than-predicted readmissions within 30...read more