With the Supreme Court’s ruling on King v. Burwell behind us, many of the doubts that have held back new healthcare developments have been absolved. An accelerated rate of change is expected across the board in healthcare, especially where Medicaid is concerned, and we must move fast to keep pace.

Long-term care facilities face a steep climb to not only keep the business sustainable, but to prove to potential investors and credit rating agencies that it can thrive in a value-based paradigm. In a $3 trillion Medicaid budget, long-term care is just a small piece of the puzzle – but it’s also perhaps the most antiquated part of the healthcare system. In the reform process, long-term care providers are likely to feel whiplash as they focus on not only catching up to other areas of healthcare, but standing out as valuable providers in a new health landscape overall.

Transforming for survival

A transformation plan is essential for ensuring the survival of the business – thanks to new incentives that revolve around patient satisfaction and outcomes. It’s also part of the “secret sauce” that makes a long-term care provider appear to be a valuable investment opportunity. Skilled nursing facility operators that understand the current local gaps in care and have the ability to fill them in with high-quality care at lower cost are the ones that will ultimately thrive.

But what does a successful plan for change actually look like?

The plan must focus on staff role changes and training, along with strategies for tracking and improving upon clinical outcomes, patient satisfaction and integration of services within the local medical ecosystem.

Clearly, staff retraining and retention will be an essential part of achieving real change in day-to-day operations, and to getting everyone in the organization (including outsourced staff) rowing in the same direction as strategies shift and evolve. Staff must also be guided by new KPIs and other goals to help them break old habits and mentalities – less focus on cost per patient and more focus on patient satisfaction (including quality of communication with the patient and family unit), hospital readmissions, use of opioids, etc.

Collaboration with clear responsibilities drives transformation

For successful transformation, long-term care organizations will need to break down silos to bring together the financial, clinical, regulatory and data-focused teams and create new and better ways of serving patients and attaining better outcomes. The emergence of integrated, multidisciplinary centers of excellence, focused on the continuum of care, can serve as a prime example.

While collaboration is essential, each employee in each department must also understand and attend training on their individual responsibilities in the transformation process. Here are several key roles to pay particular attention to:


At a more granular level, the CFO, in particular, will have to accept significantly expanded roles and responsibilities for transformation. She will now need to have a broader understanding of clinical outcomes and quality metrics and their impact on the financial results of the organization. And as the government demands increased transparency, the CFO also will need to ensure the data is accurate, complete, and both predictive and reactive.

Why the CFO? Because the dollars are the means to the end, and who better than the CFO to ensure the business is not only spending, but securing the funding to keep the business healthy? The CFO must demand a strategic change that focuses on the metrics needed to secure funding  and future growth capital needs, or she and other senior leaders are not doing their jobs. No spending cuts could possibly equate to the revenue that could be gained with a strategic focus on securing new revenue.

Nursing staff

The nursing staff transition plan, without a doubt, must focus on patient satisfaction, safety protocols and quality care. But the training, metrics tracking and follow-up required for those goals will require significant managerial skill and effort. It involves not only monitoring adherence to facility protocols and measuring staff rapport with patients, but also ensuring that nurses and other professionals are working at the “top of their license.”

Outsourced staff

While coordinators are often third party entities, they still require special retraining as they are key drivers of overall patient satisfaction and health. SNFs will need to embrace care coordinators in order to ensure smooth transitions of care for patients and their families and caregivers.

Similarly, rehab staff – whether in-house or outsourced – should be aligned with your new standards. Rehab care will become much more integrated with nursing and medical care, and staff must be retrained across these disciplines.

From an operational level, a workforce transformation plan will be essential for ensuring everyone inside the organization and hired out is on board with your new, Medicaid-reform friendly strategy. But bear in mind that it’s also absolutely essential to demonstrating value as a business and securing new revenues.

David Friend, M.D., is Managing Director with BDO Consulting and Chief Transformation Officer for BDO’s Healthcare Advisory practice, where he co-leads Clinical Strategy for The BDO Center for Healthcare Excellence & Innovation. He can be reached at dfriend@bdo.com.

Mike Musick is assurance partner and National Leader for the long-term care sector with BDO. He can be reached at mmusick@bdo.com.