The focus of the AHLA Long Term Care Conference was on convergence of acute (hospital) and post-acute (SNF, home health, hospice) service delivery mechanisms.

A number of forces promote this convergence including:

• Accountable care organizations forming integrated delivery systems including doctors, hospitals, and post-acute services;
• Growth of exchange based insurance alliances that limit post-acute choices for the pre-Medicare population;
• Growing Medicare Advantage plans with forthcoming integration of the hospice benefit for the Medicare population.

There appears to be little energy for defense of the Medicare model of access to each and every provider at the same price, especially in the post-acute space.

The integrated models bring far more limited choice in favor of the private contracting benefits of costs control.

Winners may be larger organizations with the capital and organizational strength to develop integrated delivery systems.

Potential losers, especially in more urban markets, include independent providers at any level.

Rural service will be harder to integrate given the limited economic incentives to serve this market; as a result, independents that find ways to serve these markets should face less pressure.

The big players, hospital systems and larger post-acute providers, both indicate distaste for growth by acquisition (expensive) in favor of organic growth of necessary delivery models, especially given that through their broader systems they control patient flow.  Whether these systems have the talent to grow organically may be a real question.

If the incumbent providers have any advantage it lies in their market and labor force expertise.