Impact of Accountable Care Organizations on Facility-Based Post-Acute Care
Jul 25, 2025Accountable Care Organizations (ACOs) have become key drivers of how skilled nursing facilities (SNFs) and other institutional post-acute settings organize, deliver, and measure care. While home-based models and nursing home specialization remain important, the most pronounced shifts in facility-based care are now orchestrated by ACOs through targeted utilization management, embedded care coordination, and value-based referral strategies.
ACO Strategies Reshaping Skilled Nursing Facilities
• Decreasing Length of Stay
ACOs analyze readmission and cost data to identify opportunities for safely shortening SNF stays, prompting facilities to accelerate rehabilitative milestones and discharge planning.
• Streamlining Discretionary Services
By reviewing therapy utilization, ACOs guide facilities to limit low-value treatments, reallocating resources toward interventions with the strongest impact on functional recovery.
• Preferred Provider Networks
Facilities that consistently meet ACO quality and cost benchmarks earn a place in preferred networks, ensuring high-performing SNFs receive a steady patient flow.
• Embedded Staff and Virtual Coordination
ACO-employed nurse navigators and care managers work on-site or via telehealth in SNFs, enabling real-time adjustment of care plans, medication reconciliation, and early identification of clinical deterioration.
• Interdisciplinary Rounds Across Settings
Joint case conferences involving hospitalists, ACO coordinators, and facility clinicians foster seamless transitions, align treatment goals, and reduce duplicated assessments.
Measurable Effects on Facility Performance
Facilities aligned with ACOs report:
• Lower 30-day readmission rates
• Improved patient satisfaction scores
• Shorter average lengths of stay without compromising functional outcomes
• Enhanced compliance with evidence-based care pathways
• Greater financial stability through predictable referral volumes
Policy and Future Directions
To ensure that ACO-driven innovations in facility-based PAC benefit all populations, policymakers may consider:
• Tying network participation to equity performance measures
• Expanding incentives for SNFs that serve higher proportions of dual-eligible or minority patients
• Integrating home-based and facility-based models under unified ACO quality frameworks
• Supporting telehealth infrastructure within under-resourced facilities
By centering facility-based care coordination, ACOs are not only reducing costs but also transforming how post-acute services are delivered, measured, and experienced in skilled nursing and long-term care settings.
