Dina’s Regional Vice President of Sales Yassin Sallam (below) attended the recent National Association of ACOs (NAACOS) fall conference in Washington, D.C., where a common point of discussion included strategies to enhance the level of service in the home. He shares five key conference themes.

For at-risk providers, it is common for risk arrangements to be delegated to a specific set of networked, independent service providers – both medical and non-medical. For provider groups participating in multiple risk agreements, the identification, selection, and referral processes can get messy quickly, as networked service provider groups change depending on the patient or member being served.

Today, most at-risk stakeholders are motivated to enhance the level of service in the home center as a strategy to maximize value-based care. This adds another level of complexity. In many cases, it requires social determinant services that are not yet triggered in the same way as clinical services – presenting its own set of coordination challenges.

But evolution is imminent and it’s exciting to be part of the solution. The recent NAACOS conference was a fantastic environment to observe the rate of this evolution. 

Maximizing Home-Centered Services

Many ACOs find that transitioning care back into the home can keep people out of the hospital and help patients with complex care needs manage their conditions in a lower-acuity setting. Activating new care models and delivering measurable quality improvements can present logistical and organizational challenges. But technology advances and value-based payment changes continue to fuel the trend. Clinical operations, finance, and patient engagement are key areas to evaluate to build effective care-at-home programs. 

Reducing Leakage Remains Top Concern

Preventing leakage across all points of service continues to be a major issue. ACO leaders are interested in strategies to drive traffic to in-network providers across the continuum to ensure network integrity. This also helps facilitate care coordination, streamline care delivery, and better manage patient outcomes and quality. 

Don’t Silo SDOH

The requirements of high-need, high-cost (HNHC) individuals often are not addressed by health systems focused on specialized and facility-based care. Dr. Kevin Biese, vice-chair of the University of North Carolina Health Care Senior Alliance, said people with complex needs often can be kept out of the ER and in the home setting when social workers partner with clinical resources to plan and coordinate care. He made a fascinating correlation that cements the fact that addressing social determinants of health is everyone’s job across the service delivery value chain, and not solely relegated to social workers operating in a silo. 

ET3 Payment Model


Like many in the healthcare ecosystem, Emergency Medical Service (EMS) providers are expanding their business model to support delivery of care in the home setting. Innovative EMS providers are partnering with hospitals to support hospital-at-home service delivery, thus reducing transports to the ER. 

Accelerating the change is the new Emergency Triage, Treat, and Transport (ET3) program, a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address the needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call. ET3 aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

SNF 3-Day Waiver 

The SNF 3-Day Rule Waiver waives the requirement for a three-day inpatient hospital stay prior to a Medicare-covered extended-care service for eligible beneficiaries. The waiver is intended to provide ACOs that are participating in certain performance-based risk tracks with additional flexibility to increase quality and decrease costs. The key for ACOs will be to operationalize the waiver rules to keep people out of the ER when a lower-cost place of service is appropriate. 

At-risk stakeholders are motivated to enhance the level of service in the home center and it’s exciting to be part of the solution. Dina-powered ecosystems have a positive impact on total cost of care expenditure and quality measures. Reach out at ysallam@dinacare.com to learn more.

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