Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-day Rule Waiver:
  • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR §425.612.
• Waiver for Payment for Telehealth Services:
  • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR §425.612(f) and 42 CFR §425.613.

Other Services

Outpatient Case Management

Ochsner Accountable Care Network will provide outpatient case management for a limited period of time to beneficiaries who are considered high risk for healthcare complications as determined by an appropriate algorithm. This effort will achieve triple aim results through enhanced care coordination with the goal of reducing the incidence of healthcare complications.

Care Coordination

In order to achieve better health for individuals, better health for populations, and lowered growth in expenditures, Ochsner Accountable Care Network provides various interventions, including home visits, visits in the community, and phone conversations as an in-kind service.

Partial Backstopping of Shared Losses

Ochsner Accountable Care Network will financially assess all participant community practitioners a portion of shared losses incurred at the ACO level. This will be calculated based upon beneficiary attribution and not to exceed a set amount per practitioner. All participants will therefore be responsible for some level of downside financial risk in order to create accountability for their attributed population of beneficiaries. It is necessary to limit the exposure to downside financial risk for community participants so that potential penalty does not preclude them from participation. This also allows Ochsner Accountable Care Network to reach wider geographic and socioeconomic spread of beneficiaries. This effort will achieve triple aim results by creating a shared incentive to improve care coordination.

Electronic Health Record System

Ochsner Accountable Care Network will provide a subsidy and/or discount to participant community practitioners to join into a single, unified Epic EHR platform. Participant community practitioners that can adequately interface with Epic will have the option to retain their own EHR system, and all other participants will be required to use the Epic EHR. Ochsner Accountable Care Network will also give participants the option to lease the necessary hardware needed to operate the Epic EHR at a discounted rate to eliminate the barrier for adoption. This effort will achieve triple aim results through improved EHR communication and care coordination.

Digital Medicine Program(s)

Ochsner Accountable Care Network has a primary goal of advancing the Triple Aim for the Medicare beneficiaries attributed through the Shared Savings Program. In order to achieve better health for individuals, better health for populations, and lowered growth in expenditures, Ochsner Accountable Care Network will enter beneficiaries suffering from certain chronic conditions and diseases into our digital monitoring program(s). To help them manage these conditions and diseases, we will provide items to promote beneficiaries’ adherence to their care plans and proactively identify changes in their health. This effort will achieve triple aim results through enhanced care coordination with the goal of reducing the incidence of chronic disease.