Characteristics of Accountable Care Organizations' Preferred Skilled Nursing Facility Networks

OBJECTIVES: To describe the prevalence and characteristics of preferred skilled nursing facility (SNF) networks established by Medicare accountable care organizations (ACOs). STUDY DESIGN: Cross-sectional analysis of a 2019 Medicare ACO survey. METHODS: We analyzed surveys from 138 Medicare ACOs to assess preferred SNF network prevalence, characteristics, and challenges. Chi-square tests compared ACOs by proportion of ACO Medicare admissions going to preferred SNFs (highervs lower network use). RESULTS: Results focus on the 77 ACOs that reported having a preferred SNF network (n = 77), with 38% being relatively new (formed in 2018 or 2019). Most ACOs (91%) did not offer financial incentives for preferred SNFs. ACOs reported a range of expectations of preferred SNFs, the most common being cost/quality data sharing (62%), automatic notification of patient admission or discharge (53%), and meeting length-of-stay targets (52%). ACOs also reported some clinical collaboration with preferred SNFs, with the top activity being developing condition-specific care pathways (49%). Commonly reported challenges included poor hospital discharge practices, SNFs' willingness to accept complex patients, and the availability of high-quality SNFs. ACOs with lower use of their preferred SNF network reported more difficulty impacting hospital referral patterns and receiving timely SNF admission notifications. CONCLUSIONS: Establishing preferred SNF networks is a known strategy among Medicare ACOs to manage postacute care spending and quality. Future research should document these partnerships more in depth and evaluate operational and financial alignment strategies among ACOs, hospitals, and SNFs in managing postacute care.