As the COVID-19 public health emergency draws to a close, nursing home operators face a critical moment of transition. The expiration of COVID-related waivers and the challenges that lie ahead necessitate a re-evaluation of strategies to embrace value-based care and secure partnerships that can help navigate these uncertain times.
Provider-owned Medicare Advantage Institutional Special Needs Plans (ISNPs) present an ideal solution for nursing home operators seeking to elevate resident care and achieve superior financial outcomes. With provider owned ISNPs operating or in development in 14 states, the opportunity is likely in your market today.
Provider owned ISNPs offer nursing home owners and operators three key advantages:
1. ISNPs for superior clinical results
As the COVID-19 pandemic reshaped the healthcare landscape, nursing home operators adapted quickly by implementing COVID waivers that facilitated flexibility in care delivery. However, with the expiration of these waivers, nursing homes must seek sustainable solutions to continue providing high-quality care.
Embracing ISNPs enables nursing homes to transition from crisis management to value-based care models. By prioritizing proactive care coordination, ISNPs empower nursing homes to optimize resident outcomes, reduce unnecessary hospitalizations, and enhance overall quality of care.
This isn’t just theoretical. We’ve partnered in provider-owned ISNPS with 30 nursing home owners across the country. Working with our clinical division, together we’ve achieved greatly improved wound healing rates and a 30% to 40% reduction in unnecessary hospitalizations and emergency room visits. The model of care works.
2. Unprecedented growth opportunities
The national Medicare Advantage market just exceeded 50% penetration, with over 28 million members and a value of $340 billion. This market segment continues to grow at an impressive annual rate of 10%. Consider this: there are currently 1-million dual eligible beneficiaries living in long-term care facilities. This population represents $30 billion in Medicare premium.
However, 9 out of 10 of these dual eligible beneficiaries are not currently enrolled in special needs plans. As the aging population increases and the demand for skilled nursing care grows, the landscape is primed for a significant shift. This presents a huge opportunity for nursing home operators to explore and leverage the potential of ISNPs to cater to the increasingly complex and evolving needs of this rapidly expanding market.
3. Improved financial sustainability
The financial implications of the pandemic have been profound for nursing home operators. As the industry seeks stability and sustainability, embracing provider owned ISNPs provides a pathway to improved financial outcomes. And that’s true for partners investing capital or operators who enter into a contracted relationship.
Either way, provider-owned ISNPs offer full financial transparency, enabling nursing homes to gain a comprehensive understanding of their financial levers for success. By aligning incentives between the nursing home and the ISNP, significant shared savings can be achieved, leading to a more robust financial position for the nursing home operator.
Again, our experience shows the proof is in the results. Even with the pressures COVID-19 placed on nursing home operators, our provider-owned partners have earned more than $15-million in shared savings since the start of the pandemic. This is money earned by providing superior care to residents with the help of our TruHealth clinical team. A well-executed provider owned ISNP will deliver superior clinical and financial results.
As the COVID-19 public health emergency concludes and nursing home operators face a new era of challenges, the importance of embracing value-based care and securing trusted partnerships cannot be overstated.
Provider-owned ISNPs offer nursing home operators the opportunity to elevate resident care, navigate the changing regulatory landscape, and achieve superior financial results. By leveraging the benefits of provider-owned ISNPs, nursing homes can confidently embrace value-based care models and thrive in the post-COVID era. Now is the time to explore these transformative partnerships and chart a course towards elevated resident care and financial resilience.
Michael Bailey is President and CEO of American Health Partners, a diversified post-acute health care provider with seven divisions delivering the full continuum of health care for adults and seniors. The company’s American Health Plans division is a leader in developing specialized Medicare Advantage plans and is the largest provider-owned ISNP platform in the United States.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.