The chorus of voices singing the praises of value-based care is growing ever louder. But in LTPAC, it still feels like the system’s 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. Around 70% of residents are covered by Medicaid. The rest—split between Medicare fee-for-service, Medicare Advantage, and private pay—bring in higher rates, especially Medicare. While fee-for-service might reimburse $650 to $700 per day, Medicaid pays closer to $250—often less than the cost to provide care. For years, higher Medicare rates have helped cover that gap.
That margin is shrinking fast.
More than half of Medicare beneficiaries now enroll in Medicare Advantage. These plans generally pay less, require more prior authorizations, and add layers of oversight that take time and control away from care teams. That’s real financial pressure. But it’s also a shift in control. Providers are caring for higher-acuity patients under tighter terms, and many feel expectations keep rising while support does not.
The incentives don’t line up—yet.
Navigating the Shift in Expectations
Everyone agrees on the goal: Better outcomes, fewer hospitalizations. But when providers put money and time into hiring staff, adding tools, or changing how they work, they don’t always see those efforts rewarded. Referrals don’t go up. Rates don’t improve. And there’s no guarantee that taking on more responsibility leads to better results for the organization.
Layer on the complexity of managed care, and LTPAC teams are carrying more administrative weight while losing flexibility in clinical decision-making. They’re being asked to perform under conditions that weren’t built with their reality in mind.
It’s become clear that speed to adoption isn’t the solution.
The message to “get on board” with value-based care isn’t wrong—but it doesn’t address critical considerations. Many providers want to move forward. They just need a path that accounts for their starting point. Most of the conversations happen at the top—with large, multi-facility operators who already have teams and tools in place. But smaller, independent providers aren’t in the same position.
That’s where leadership matters most. What’s important is support that lines up with their 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 frontline—not add more. And maybe most of all, it means recognizing the effort providers are already putting in.
The 2030 Goal and What It Means for Providers
The 2030 goal is clear, but the path forward isn’t well defined.
CMS wants all Medicare and Medicaid fee-for-service payments linked to value-based care by 2030. But when incentives and systems don’t align, it feels like pressure—not progress. In LTPAC, where staffing is stretched and care is complex, providers struggle to focus on long-term change amid daily demands.
What LTPAC providers really need is the time and flexibility to build these models in ways that actually fit. If the shift comes too fast—or without the right backing—it puts everything at risk. Staff burnout goes up. Resources get stretched too thin. And short-term fixes take the place of long-term strategy. Real change isn’t 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 up, even the best-intentioned model will fall apart. Providers aren’t saying no to value-based care—they’re saying the conditions must make sense to realize success. Providers aren’t pushing back on the concept of value-based care. They’re responding to real-world conditions that don’t match what the model assumes.
The solution isn’t more urgency. It’s smarter alignment. That starts with listening—really listening—to what providers are facing and building around that. Simplify where you can. Support where it’s needed. And avoid adding layers that slow things down.
The potential is immense. But the rollout must shift.
Value-based care, at its core, is the right direction. But we need financial models, workflows, and policy expectations to align with how care actually works or risk a continued lag in adoption.
The key is to remember that implementing value-based care isn’t just a policy goal; it’s about finding a sustainable path that better supports patients and providers. The cadence to reach that end should be a steady one.
