Are long-term and post-acute care (LTPAC) providers ready to participate in emerging Integrated Health Care Delivery Models (ICDMs) like Accountable Care Organizations (ACO), payment bundling and value-based purchasing? 

Yes and no, according to the results of a self-evaluation that Dixon Hughes Goodman conducted with 50 LeadingAge members in 2011.

A report on the evaluation can be found on Dixon Hughes Goodman (registration is required). 

Most of the LeadingAge members participating in the Strategic Comprehensive Organizational Readiness Evaluation (SCORE©) were not at significant risk of being left behind as ICDMs continue to emerge, according to Ansley Dee of Dixon Hughes Goodman Healthcare Consulting. But SCORE results also suggest that LeadingAge members may need to take a more aggressive approach to building their health information technology (HIT) systems and aligning their care goals with potential acute-care providers.

Strong structure and partnerships

LeadingAge members received an average overall SCORE rating of 4.1 out of 6 for organizational readiness to participate in future ICDMs. Members participating in the evaluation scored 3.3 for environmental readiness. Specific SCORE findings include:

  • Organizational infrastructure: 42% of respondents said their organizations have a leadership team that spearheads health care reform positioning efforts. This team is empowered to bring about organizational changes to achieve sustainable success. 
  • Good relationships: 48% of respondents said their organizations have established meaningful relationships with potential partners in future ICDMs, including hospitals and physicians. 

Lagging HIT onfrastructure

Only 14% of respondents said their organizations have an electronic health record (EHR) system in place that would facilitate clinical integration and interoperability with potential care delivery partners. 

HIT will be required for participation in future ICDMs and will take several years to develop, according to Dee.

“Waiting for the market to demonstrate signs of ICDM acceptance may not be a prudent strategy in this area,” she suggested in a report on the assessment findings.

Need to educate strategic partners

LeadingAge members who participated in the self-assessment appeared to have a higher rate of readiness for ICDMs than other stakeholders in their external operating environments, including their strategic partners, according CAST Executive Director Majd Alwan.

“This is probably because the members who participated in the assessment are the more forward-thinking and proactive among the LeadingAge membership” said Alwan. “It also implies that providers can improve the environmental readiness for ICDMs by actively reaching out and educating potential acute-care partners about what LTPAC providers can do for them.”

Need for better alignment with partners

Only 10% of respondents said their organizations have defined common care objectives, performance metrics, incentives and tracking mechanisms that aligned with area hospitals and physicians. 

This gap could have an impact on the ability of LTPAC providers to provide potential acute-care partners with strong historical performance metrics, according Dee and Alwan, who was quoted in the report.

“LeadingAge members need to have the right HIT infrastructure that allows them to coordinate care with acute-care providers,” said Alwan. “Long-term and post-acute care providers also need to have common care goals and quality measures with their strategic acute-care partners and need to demonstrate delivering on such goals.”


Dixon Hughes Goodman developed SCORE in collaboration with LeadingAge and CAST. The tool is designed to help LTPAC providers assess, evaluate and understand how well they are strategically positioned to participate in future ICDMs. 

SCORE was available online to LeadingAge members for a limited time in spring 2011.

For additional information on the SCORE© self-assessment tool and ways LTPAC organizations can expect to participate in ICDMs in the future, contact Keith Seeloff at Dixon Hughes Goodman or read Post-Acute/Long-Term Care Planning for Accountable Care Organizations, a Dixon Hughes Goodman whitepaper.