If you ever need a speaker for a mid-afternoon “wake me up” slot at a conference, look up Joel Theisen, CEO and founder, Lifespark. The man can bring it, and he did on Tuesday when discussing the opportunity for seniors’ housing providers and new and existing value-based care (VBC) models.

Theisen made his enthusiastic presence known during a main stage session at the NIC Spring Conference in Nashville moderated by consultant Anne Tumlinson, founder and CEO, ATI Advisory, and fellow panelist Jacob Swint, vice president, strategic growth and operations support, National Church Residences.

The session bookended a day that started with officials from the Center for Medicare and Medicaid Innovation (CMMI) under the Centers for Medicare and Medicaid Services (CMS) declaring the agency’s intention to attract more long-term care providers into VBC models like REACH, LEAD, and ACCESS.

Gary Bacher, strategic leader and innovator, CMMI, said as much in the morning session, Tumlinson said. “His message to you is that your residents are a really important, foundational part of the CMMI strategy for CMS,” she said.

The more aggressive VBC models are part of a Trump Administration strategy to inject energy into the prevention of disease and management of chronic illness in line with its MAHA - Make America Healthy Again - agenda, Tumlinson said.

Why Do VBC?

For senior living and services provider Theisen, the reason to organize his company around value-based care is simply to be ahead of the healthcare curve, to work to prevent and manage the health of residents and patients and take advantage of the monetary rewards for doing so.

“You can unlock a whole pot of money,” he said. “Acute care should be working for us, not the other way around. Don’t let them drive the bus. The opportunity now makes this the best time ever to get into this.”

He then referred to the CMMI efforts on new VBC models, noting the floodgates have opened, so get off the bench and don’t complain later if you miss out.

“People are spending to be in your buildings, right? They're spending on medical? And so, if you have you been doing all the work, we’re the ones residents trust. We're doing all this stuff. And yet, you're getting half of the bucket of the money, and half of the bucket of the money is going to somebody else that sees them for four days or four hours or four times, and that's crazy to me?”

Theisen added that “our members, our residents, they trust us and love us and we love them, and we’re able to deliver this integrated model of care and that's really important.”

For Swint, being involved in accountable care organizations (ACOs) or arrangements with physician groups, preferred providers, or whatever system you prefer is vital to being proactive, noting his company used to be reactive in the way they managed healthcare. A long time back, we said “we wanted to do more and stop reacting to health events,” he said.

The Definitions

CMS defines accountable care as a person-centered care team taking responsibility for improving quality of care, care coordination, and health outcomes for a defined group of individuals, to reduce care fragmentation and avoid unnecessary costs for individuals and the health system.

For ACOs, CMS said this may include a group of doctors, hospitals, and other healthcare professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. ACOs may be in a specific geographic area and/or focused on patients who have a specific condition, like chronic kidney disease.

What Is on the Table

All eyes are on what details emerge from the new ACO model that CMMI announced late last year called the Long-term Enhanced ACO Design (LEAD) Model, which will launch following the conclusion of the ACO REACH Model at the end of 2026.

CMMI has said that LEAD builds on its earlier accountable care work and utilizes improved benchmarking to appeal to a broader mix of healthcare providers, including those with specialized patient populations and those new to ACOs, such as smaller, independent, or rural-based practices. Details and the RFA are expected soon on what this all means.

LEAD will focus on better serving coordinated care for high-needs patients, such as those dually eligible for Medicare and Medicaid, and those who are homebound or home limited.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.