The chorus of voices praising value-based care is growing louder. But at LTPAC, it still seems like the system is asking providers to do more (with less) and faster than ever.
For the past 25 years, financial strategy in long-term and post-acute care has been tied to two things: occupancy and payer mix. About 70% of residents are covered by Medicaid. The rest, divided between Medicare fee-for-service, Medicare Advantage and private pay, generate higher rates, especially Medicare. While fee-for-service can reimburse between $650 and $700 per day, Medicaid pays about $250, often less than the cost of providing care. For years, higher Medicare rates have helped fill that gap.
That margin is shrinking rapidly.
More than half of Medicare beneficiaries now enroll in Medicare Advantage. These plans typically pay less, require more prior authorizations, and add layers of oversight that take time and control away from care teams. That’s a real financial strain. But it is also a change of control. Providers are caring for higher acuity patients on stricter terms, and many feel that expectations continue to rise while support does not.
The incentives don’t match up…yet.
Navigating the change in expectations
Everyone agrees on the goal: better results, fewer hospitalizations. But when providers invest money and time in hiring staff, adding tools, or changing the way they work, they don’t always see those efforts rewarded. Referrals do not increase. Rates are not improving. And there is no guarantee that taking on more responsibilities will lead to better results for the organization.
Add to the complexity of managed care, LTPAC teams have more administrative weight and lose flexibility in clinical decision making. They are asked to act in conditions that were not created with their reality in mind.
It has become clear that accelerating adoption is not the solution.
The message of “opting in” to value-based care is not wrong, but it does not address critical considerations. Many providers want to move on. They just need a path that represents their starting point. Most conversations happen at the top: with large, multi-facility operators who already have equipment and tools. But smaller, independent providers are not in the same situation.
That’s where leadership matters most. The important thing is support that aligns with your reality. That starts with actionable data. Not dashboards or reports, but real information that helps people make decisions in the moment. It also means tools that take pressure off the front line, not add more. And perhaps, above all, it means recognizing the effort that suppliers are already putting in.
The 2030 goal and what it means for suppliers
The goal for 2030 is clear, but the path forward is not well defined.
CMS wants all Medicare and Medicaid fee-for-service payments to be tied to value-based care by 2030. But when incentives and systems don’t align, it feels like pressure, not progress. At LTPAC, where staffing is low and care is complex, providers struggle to focus on long-term change amid daily demands.
What LTPAC providers really need is time and flexibility to build these models so that they truly fit. If change happens too quickly (or without proper support), everything is at risk. Staff burnout increases. Resources are depleted too much. And short-term solutions replace long-term strategy. Real change is not about moving fast. It’s about building something that can last.
Finding the right pace for change
When your goals and your tools don’t match, even the most well-intentioned model will fall apart. Providers are not saying no to value-based care: they are saying that the conditions must make sense to achieve success. Providers are not rejecting the concept of value-based care. They are responding to real-world conditions that do not match what the model assumes.
The solution is not more urgent. It’s a smarter alignment. That starts with listening (really listening) to what providers face and building around that. Simplify where you can. Support where needed. And avoid adding layers that slow things down.
The potential is immense. But the deployment must change.
Value-based care, in essence, is the right direction. But we need financial models, workflows and policy expectations to align with how care actually works, or we risk continued lag in adoption.
The key is to remember that implementing value-based care is not just a political goal; it’s about finding a sustainable path that best supports patients and providers. The cadence to achieve that goal must be constant.
