HealthInsight Nevada is one of seven organizations across the nation selected by the Centers for Medicare & Medicaid Services (CMS) to lead the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The statewide initiative, Admissions and Transitions Optimization Program (ATOP), tested models to improve quality of care and reduced avoidable hospitalizations in 24 of Nevada's Medicare-Medicaid-certified eligible nursing facilities by 2016. As an Enhanced Care and Coordination Provider (ECCP), HealthInsight Nevada has provided education and supplemental staff to the 14 nursing facilities participating in Phase 1 of the model.
Under this second phase, CMS has selected six ECCPs to partner with long-term care (LTC) facilities and practitioners to implement and test a new payment model. Phase 2 will be implemented in a manner consistent with meeting CMS’s objectives of the initiative’s first phase:
- Reduce the frequency of avoidable hospital admissions and readmissions
- Improve resident health outcomes
- Improve the process of transitioning between inpatient hospitals and LTC facilities
- Reduce overall health care spending without restricting access to care or choice of providers
Also under this second phase, CMS will be testing two models. The first is a continuation of the clinical intervention work of Phase I along with implementation of the new payment model. Nevada’s 24 participating facilities will be eligible to engage in this model (the Nevada facilities are also referred to as “Group B” during the second phase). The second model is to implement the new payment model alone, without any additional assistance provided to the facilities via the clinical intervention supported by the ECCP. HealthInsight Nevada will be working to identify 24 eligible facilities in Colorado to participate with this second model (the Colorado facilities will be referred to as “Group A”).