Healthcare Innovation

Program of All-Inclusive Care for the Elderly (PACE) is a capitated health plan that provides comprehensive Medicare and Medicaid covered services to frail, older adults in the community who are eligible for nursing home care. New research from ATI explores the latest enrollment trends and highlights latest opportunities for PACE growth.

LEAD gives MSSP ACOs and health systems with deep value-based care experience a way to serve High Needs beneficiaries on payment terms that align with their acuity and changing care needs. Its benchmarks, risk adjustment, and monthly capitation features respond to structural challenges that established organizations have encountered in other models, aiming to generate lower utilization and total cost of care for High Needs beneficiaries while improving outcomes.

The transition from hospital to post-acute care is one of the most under-engineered handoffs in American healthcare. Providers are navigating the convergence of clinical workforce shortages and rising patient acuity, which will only intensify as the population ages further. Momentum is building around technology-enabled solutions and payment reform that may help close the gap. In a piece for U.S. News & World Report, ATI Founder & CEO Anne Tumlinson identifies opportunities for hospitals to leverage new technologies and programs to improve the transition to post-acute care.

ATI’s latest resource draws on analysis of CMS enrollment data to map where C-SNP growth is happening and which populations and conditions represent the highest-value opportunities. The tool provides considerations for building a high-performing plan, walking through five critical decision points and a six-phase launch roadmap while identifying common pitfalls.

In December, CMS released a long-awaited RHTP funding announcement. States moved into a critical and rapid implementation period, negotiating final budgets under the cooperative agreement process. States are now working on revising and submitting their budgets to reflect their final award amounts by January 30 for approval by CMS. ATI unpacks the key activities that states are undertaking in the short term to ensure their success under this program.

CMS released the CY 2027 Medicare Advantage (MA) and Part D Advance Notice, outlining proposed technical and methodological updates that could materially shape plan performance beginning in 2027.