Comparing nursing home care models

Comparing accountable care organizations to institutional special needs plans

Many nursing homes participate in value-based care through physician group accountable care organizations (ACOs), which aim to improve coordination and reduce unnecessary utilization. While these models can be effective, their ability to influence care delivery is often limited by fee-for-service structures and episodic physician engagement.

Institutional special needs plans (I-SNPs) take a more integrated approach by combining health plan accountability with embedded clinical support. Interdisciplinary teams — including nurse practitioners, registered nurses and care coordinators — work directly with residents and facility staff to proactively manage health conditions and support care planning.

The model also enables capabilities that are difficult to achieve in traditional arrangements, including:

• Treat-in-place interventions
• Benefit design flexibility
• More coordinated decision-making across the care continuum

Because accountability extends beyond individual encounters, the focus shifts toward managing overall resident health and preventing avoidable escalation of care.

For nursing home leaders considering value-based care strategies, understanding these differences can help determine which model is best positioned to support organizational goals, resident outcomes and long-term sustainability.