More Nursing Homes Seek Benefits by Connecting to Medicare Advantage

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As Medicare Advantage (MA) plans continue to grow in benefits and beneficiary numbers, nursing home operators are weighing their options on how to adapt.

“If you start thinking about positioning yourself with your relationships, with these types of organizations, whether it’s a network of providers, a member that has an Institutional Special Needs Plan (I-SNP) or a coordinating entity like Lifespark, it gets really interesting in terms of where you’re plugged in,” said Mike Cheek, senior vice president of reimbursement and market strategy for the American Health Care Association and the National Center for Assisted Living ( AHCA/NCAL).

Cheek, along with Matt Kinne, vice president of growth and partnerships at Minnesota-based Lifespark, spoke at the association’s conference in Nashville about MA’s plans and how changing benefits are informing the participation of SNF.

Lifespark offers value-based care options, while operating its own senior residences and skilled nursing facilities acquired through his purchase of Tealwood Senior Living.

Extensive services, but payments are a problem

MA plans can now offer services “outside the usual range” of benefits, said Cheek, a company CMS started several years ago.

Transportation for non-medical needs, indoor air quality equipment and services are some of these additional benefits currently available to HI recipients, but insurers are not receiving additional funds to provide such services. .

“To clarify a point, they have to cut [those offerings] what they already get in bonus payments from the federal government,” Cheek said.

Many of the additional benefits are very similar to Medicaid-funded HCBS, Cheek said; CMS does not pay extra for these services either. Either way, payers are faced with the task of including – or removing – these offers from recipients.

However, insurers have payment flexibility in terms of including additional benefits in bundled or episodic models.

This is where it is useful for SNF providers to launch their own plans or develop relationships with MA organizations to offer additional benefits specifically tailored to what their population is looking for.

“They give you more flexibility and control…it can really get you to a good place in terms of thinking about shared risk and shared savings opportunities rather than a traditional contract with Medicare Advantage plans,” said declared Cheek.

Skilled Nursing Lifespark

While Lifespark got its start in HCBS, the company’s model of providing more person-centered and seamless care extends to the skilled nursing sector as well. The company seeks to integrate full continuum services with insurance products, supported by a technology backbone, at every part of the post-acute end of the care continuum.

Its skilled nursing population health management model combines geriatric care management and clinical expertise, while investing in technology that brings Lifespark closer to person-centered care.

Lifespark’s “life managers”—who coordinate resources, life plan direction, and advocacy—are linked to the extended benefits of AM. Life managers tailor plans to residents’ needs and are further informed by data analysis.

“All of this is supported by our investment in technology, the creation of an electronic life record, which is really the layer that sits on top of all of these [electronic medical record systems] we have who don’t talk to each other,” Kinne said.

Lifespark offers MA plans, the REACH model of responsible care organization (ACO), as well as institutional, dual-eligibility, and institutional equivalent plans for special needs.

“We give our partners the option to participate in a downside or upside only risk agreement. Being the risk payer gives us a lot of latitude to bring a new revenue stream to vendors that they currently don’t have access to today,” Kinne said.

Its value-based model for NFCs has resulted in increased revenue, decreased expenses, and new value-based revenue resulting in 5-15% higher net operating income for operator partners, Kinne said.

“We’re definitely a magnet for new clients, we’re using that as a major selling point as families think about where to put their mom or dad. The natural place we’re going to direct people to is either to our own buildings or to those of our partners,” noted Kinne.

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