New CMS Models and What They Mean to Long Term Care Providers

In this episode, host Debbie Stadtler speaks with Nisha Hammel, Vice President of Reimbursement Policy and Population Health for AHCA/NCAL, about the rapid shift from fee-for-service to value-based care and what it means for long-term care and assisted living providers. Nisha reflects on her journey from geriatric social work to national policy leadership and explains how CMS has introduced roughly 11 new payment models in the past year. These models place increasing emphasis on prevention, provider accountability, technology-enabled care, and patient engagement, with more than 70 percent of payments now tied to quality and patient experience. The conversation explores several models that could affect providers, including the mandatory TEAM model, the state-based AHEAD and GEO AHEAD initiatives, and the forthcoming 10-year LEAD ACO model. Nisha encourages providers to stay informed, talk with clinical partners about ACO participation, understand their baseline utilization data, strengthen on-site clinical workflows to reduce avoidable transfers, and take advantage of AHCA/NCAL resources such as toolkits and the Population Health Management Summit. Perspectives in Long Term Care is produced by Association Briefings. Transcript Debbie Stadtler: [00:00:00] The transition from fee-for-service to value-based care is here. Learn the latest on new CMS payment models in this episode of Perspectives in Long Term Care. Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Healthcare Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long Term Care, a monthly podcast produced by AHCA and NCAL. Each month we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long term and post-acute care profession. My guest today is Nisha Hammel, vice president of reimbursement policy and population health for AHCA and NCAL. She leads the association's policy and strategic initiatives on value-based care and innovative payment models. She brings 20 years of experience in post-acute care and senior living. Welcome, Nisha. Thanks for being with [00:01:00] us. Nisha Hammel: Thanks, Debbie. Thank you for having me. Debbie Stadtler: We'd like to start at the beginning, so tell us a little bit about you and your career journey. What led you to get started in long term care? Nisha Hammel: My career journey really began next door with my maternal grandparents who were like second parents to me. I grew up in a home and culture that really revered old adults, so my passion for aging was shaped early. You could say, I honestly never stood a chance of choosing anything else. Even when my peers would ask like, what are you majoring in? I stuck with geriatric social work as my master's program back when only a couple of schools in the entire country offered it as even as an optional major. From there, I started out as a social worker in a skilled nursing facility and moved [00:02:00] through a variety of operational and leadership roles in assisted living, home health, hospice, affordable housing. Really, I think each step taught me something new about caring for older adults with dignity. I really feel very blessed for that incredible journey. Eventually, I joined a state association where I helped lead providers in exploring new ways to work together that included some of our earliest conversations around value-based care and population health, and even how long term care could participate in Medicare Advantage in a meaningful way. It was an experience I still consider a privilege, and it has carried me into essentially the next chapter of my journey, which led me to AHCA, where I now have the opportunity to help advance models and policies that [00:03:00] transform care for older adults and support the truly exceptional providers who care for them every single day. Also, having the opportunity to advocate for some common sense policies to Medicare Advantage. I'd say each position has really felt like something I was called to do, and I am deeply humbled by this path and incredibly grateful that it all started with two grandparents right next door. Debbie Stadtler: I'm always amazed at how many people have that personal connection, whether it's a grandparent or a family friend or a mother/father that really started them out in this profession. And I think, like you said, so many people feel it's a calling. It's really such a personal connection to this work, and I think that makes it really special. I want us to talk about value-based payments. Set the stage for us. [00:04:00] Where are we now? What has happened recently? What's going on in this area? Nisha Hammel: Sure. I'd say value-based care has consistently received support from both Democratic and Republican administrations. While each may emphasize different elements, I think the overall ...