Imagine a company of nearly 50 facilities that offer both short-term rehabilitation and managed long-term care, along with at-home care, EMT services, adult day care, assisted living, in-house physician practices and the latest in medical technology.
At Centers Health Care, I lead managed care teams in New York, New Jersey, Rhode Island, Kansas and Missouri. We are continuously meeting with leadership at most of the largest health insurance enterprises in this country. The challenges nearly fully lie along the lines of the ever-changing landscape of the healthcare insurance industry and of course, the federal government.
How does Centers Health Care differentiate itself from other nursing homes consortiums when it comes to managed care? We do not turn away difficult or specialty patients because we can handle almost any specialty pertaining to the senior patient.
When companies meet with the Centers Health Care at a conference or function, potential customers from the insurance industry love hearing about our model. These potentials want to know more about the company’s clinical capabilities. They want to hear about the ability to focus on the data and work on specific metrics that they want to concentrate on. For example, lowering rehospitalization rates, the yearly preparation for the flu vaccine, the offerings of such programs such as the GO Program and new technology. We are able to take the risk as the “one stop” of contact for contracting, credentialing, billing, and anything back office.
Even with Centers Health Care facilities existing in those five states, big insurance companies can tie a local representative to work with Centers Health Care. Working with the big companies such as United Health Group/Optum, Cigna or Aetna, and then more local companies such as Emblem and HealthFirst, the goal is to be their partner. Larger national companies may work with 10 different providers all servicing the many areas of managed care. Centers Health Care can give everything under one roof. For smaller companies, the goal is to offer everything from our skilled nursing facilities to everything outside of the facility. Beyond the facility, this includes the labs, our home agency, licensed agency, our durable medical equipment provider, ambulance company, adult day care centers, so Centers Health Care being sits as a major player in the post-acute care world. One entity, one contract.
In addition to our skilled nursing facilities, Centers Health Care owns two certified home health agencies, two licensed home care services agencies, urgent care centers, as well as the largest ambulance company in New York and New Jersey. People often take advantage of our soup-to-nuts menu rehabilitation therapy, which includes physical, occupational and speech therapy where they come back for daily therapy and go home that day. We learned early on that you treat the overall person. We want to see the people go home. That’s the goal for managed care.
A career in managed care
In the 30 years of my career, the overall challenges have interested me on a daily basis. The world of managed care is far from stagnant: It’s an ever-changing environment of state and federal regulations. Every day is different.
For example, there are ongoing negotiations with existing partners and health plans. Experts in each state have different health plans, plus we meet with C-suite executives locally and nationally as we negotiate contracts. Many times, you learn of the changes in the industry through potential customers by sitting down and contracting new types of payment models, such as value-based and fee-for service. This is how new partnerships are developed within our service area. It starts by networking in person and keeping in mind the goal which is to answer their needs.
It’s funny: With all the new technological advances within the Internet and social media channels such as LinkedIn, Facebook and Instagram, I still feel the best way to have relationships is by having those face-to-face meetings. The human aspect still going strong. These are how real business relationships begin and can last.
Franklin Segura is a Vice President and Director of Managed Care at Centers Health Care.