Senior Care and Senior Living

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.

Nearly six years after Medicare Advantage opened up to people with end-stage renal disease, enrollment has climbed to nearly 280,000 beneficiaries, more than half of all Medicare beneficiaries with ESRD, and almost double what CMS originally projected. ATI Advisory's analysis of six years of Medicare data shows Medicare Advantage has become the primary way ESRD care gets paid for. Nephrologists, dialysis providers, and MA organizations are now negotiating payment rates, building provider networks, and navigating utilization management for a population that used to be financed almost entirely through fee-for-service.

Beginning January 2028, CMS will launch a nationwide, mandatory bundled payments model for the first time. The Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, an expansion of the recently concluded Comprehensive Care for Joint Replacement (CJR) Model, will hold more than 2,000 acute care hospitals nationwide accountable for the cost and quality of inpatient and outpatient lower extremity joint replacement (LEJR) episodes. Episodes will span the initial LEJR procedure and all Medicare spending in the 90 days following the procedure, including post-acute care.

Aging services and senior living organizations are designed to keep frail older adults with complex, chronic needs healthier, more independent, and out of the hospital and emergency room. This work generates economic value by lowering the total cost of caring for the populations served. A robust value-based payment strategy turns that value into revenue the organization keeps.

Beginning January 1, 2030, Dual Eligible Special Needs Plan (D-SNP) enrollment must be fully aligned with Medicaid plan enrollment, and beneficiaries will no longer be able to stay in their current D-SNP. Building on a previous ATI resource, this brief outlines a transitional strategy for states subject to the impending D-SNP enrollment alignment requirements to consider.

New research from ATI shows that in 2023, Institutional Special Needs Plan (I-SNP) enrollees had lower mortality risk and fewer emergency department visits, hospitalizations, and hospital readmissions than non-I-SNP MA beneficiaries. This brief investigates the association between I-SNP enrollment and mortality, healthcare utilization, spending, and quality outcomes for long-term care residents enrolled in Medicare who had one or more nursing facility stays of 90 days or longer during the year.