Managed care holds opportunities for SNF, experts say

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Dan Mendelson, CEO of Avalere Health
Dan Mendelson, CEO of Avalere Health
Skilled nursing facilities are at a precipice, where they must improve their quality of care and relationships with acute providers to survive, a group of experts said Thursday.

Most operators are still focused on census levels and a fee-for-service model, said Avalere Health CEO Dan Mendelson, the moderator for “Managed Care and SNFs: What Will the Growing Role of Managed Care in Medicaid and Medicare Mean for SNFs?”  The morning session was a highlight at the annual National Investment Center for the Seniors Housing and Care Industry conference in Chicago.

Nineteen states will expand enrollment in managed care plans between 2012 and 2014, he noted, as states tend to like that capitated contracts improve budget predictability. Twenty states will seek managed care plans for dual eligibles.

“Quality measurements are transforming the way healthcare plans think,” Mendelson said. “You will need to measure your quality and prove your quality.” Quality metrics can range from preventative care to diabetes management or testing for COPD.

Skilled nursing facilities have an excellent opportunity to show they are the best at post-acute care, emphasized panel member James Gomez, the CEO and president the California Association of Health Facilities. SNF operators must have the data to back up their relationships with referring providers, he said.

“If you don't know your rehospitalization rate and that of all the other facilities in your ZIP code, get the hell out of the business,” he says. “Quality will be the No. 1 factor of success.”

Despite consolidation in the industry, small or independently-owned facilities still have chances for success with managed care plans, he said -- especially if they are willing to change their business model. Members of state associations also should reach out and ask for help in navigating managed care contracts.

“Single operators can survive with good quality, and good rehospitalization rates,” Gomez said.

NIC concludes Friday morning at the Sheraton Chicago Hotel & Towers.

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