Provider Partners Health Plan, a Medicare Advantage HMO plan, has announced new affiliations with two senior care providers in Chicago and has plans to expand further into the Midwest.
PPHP has enrolled more than 1,000 members in 22 long-term care facilities, focusing first on Maryland and Pennsylvania. In Chicago, it will provide an Institutional Medicare Advantage Special Needs Plan (I-SNP) to 12 buildings in The Alden Network and nine buildings in the Aperion Care network.
By offering long-term care residents a personalized and coordinated approach, hospitalizations can be reduced, according to CEO Bruce R. “Rick” Grindrod.
“Our whole purpose for being a company is to facilitate letting long-term care providers use their clinical expertise, have clinical improvements, reduce unnecessary rehospitalizations and create savings to Medicare,” he said. “The way to execute on that model for RN and nurse practitioners is through an institutional special needs plan.”
Providers are turning to PPHP due to the company’s understanding of the challenges in skilled nursing.
“We are provider-sponsored and provider-financed,” Grindrod shared.
As pressure increases on skilled nursing, there is “an opportunity to create financial gain by improving clinical capabilities,” he added.
PPHP has applications with the Centers for Medicare & Medicaid Services to expand in Missouri and Texas.
Grindrod came from the provider side of the industry, including working through college as a nursing assistant.
“I know nursing homes from the ground up,” he said. “Providers choose us because we have extensive experience in both the long-term care providers side as well as the Medicare Advantage side.”
From the June 6, 2019 Issue of McKnight's Long-Term Care News
