Skilled nursing experts are urging more small and possibly reluctant providers to begin embracing value-based care arrangements. The pressure to improve clinical outcomes and a coming wholesale shift of seniors to more accountable payment models may be the factors that push more to take the leap.
Accountable care organizations, Medicare Shared Savings Plans and Institutional Special Needs Plans are among the growing ways government regulators, payers and health systems are trying to manage costs and drive quality. But identifying the right opportunities — or proving they belong in a specific program — has been a standing challenge for independent nursing homes and smaller chains.
That is beginning to change, as those same providers recognize the opportunities they may miss by being shut out of certain population health partnerships.
“A lot of those models offer not only some additional financial awards and aligning incentives between the physician and the facilities, but it gets them additional clinical resources to be able to rely upon and meet the needs of their population,” said Jill Sumner, vice president of population health management at the American Health Care Association/National Center for Assisted Living. “You can have upside-only, and that probably makes a lot more sense for small providers.”
Sumner was one of many value-based care experts who spoke at AHCA/NCAL’s third annual population health management summit in Washington, DC, last week. She hosted a session on opportunities for independent owners, whom she said have been gaining a foothold in the value-based arena.
Facilities are often losing money on the managed care patients they treat, given many plans’ low-ball contracts. But more are offering incentives around reduced rehospitalizations or other quality metrics, and that’s an opportunity that small facilities need to seize on.
Being able to get into a value-based agreement could “at least get them back to break even,” Sumner told McKnight’s Long-Term Care News Tuesday. And upstream partners often provide clinical services such as rounding advanced practice clinicians and telehealth services to help ensure a skilled nursing partner’s clinical success, which helps boost quality and patient satisfaction.
Provider networks take hold
One of the key challenges for small providers is being seen by potential partners.
One way independent operators are pursuing more value-driven contracts and the incentives that come along with them is by banding together through provider-owned networks. Once the providence of physicians, these networks are now being used by skilled nursing facilities to share data, best practices and set benchmarks.
Together, they have bargaining power and a mass of beds that insurers and health systems need access to.
“There are several of them out there and more being developed, and it’s a great opportunity for independent operators and smaller organizations to participate,” Sumner said. AHCA has supported state affiliates as they encourage the growth of such networks, with new organizations in Iowa, Ohio and Indiana, to name a few.
Sumner noted that other private groups (and providers in other sectors) have used the approach in the past. She said most have found success if they can organize about 100 providers into one network. They can be from across aging services and represent assisted living and home care providers. The key is that they be united around goals and strategies.
Participants also need to consider the market they’ll be serving. Having a compact geographic footprint might make sense to some potential partners; others might want providers to span a broader area.
Either way, independent providers need to know what population health metrics potential partners build programs around and make sure that they can share group data that reflects they’ll be a good partner on that service line or outcome. Sumner said that by working together to negotiate contracts, some networks have been able to use average data across facilities to meet required goals.
Other value-based options growing
Echoing a theme of the Population Health Management Summit, Sumner Wednesday also noted that I-SNPs are more likely to serve small providers than they were initially; they also provide high-level clinical services to help improve targeted metrics.
And while ACOs have often overlooked skilled nursing as contract holders, Sumner said more are open to working with SNFs to align care through a shared primary care physician. She has seen an increase in the number of contract holders looking to work with high-needs populations living in skilled facilities. It’s a trend she expects to see grow as the ACO Reach model kicks off in earnest in 2023.
Finally, she said providers should also look to care management companies, which hold contracts with managed care organizations through which they assume risk and offer interventions to partner facilities.
With Medicare Advantage penetration expected to hit 50% this year and CMS pushing all beneficiaries toward accountable care models by 2030, it’s just a matter of time until providers are forced into more value-based partnerships.
To that end, AHCA is also encouraging state and federal regulators to modify programs and rules to make options more friendly to nursing homes. States, for instance, could require value-based incentives for skilled nursing providers in their Medicaid contracts. CMS could reevaluate an ACO 3-day stay waiver that allows community-dwelling seniors direct access to skilled nursing without a hospital stay, but denies long-term SNF residents the same.
In any case, Sumner wants more independent operators to take up the value-based challenge now so that they have a better chance of finding a good fit.
“It’s OK if you’re not ready to jump in with both feet, but at the very least undertaking what those scenarios could look like in your building and starting to have the conversation early,” Sumner said. “It’s a time to really analyze and do some scenario planning and look at all of your options. You may not have thought of partnering with a provider down the street, but it may be to both of your advantages to do so.”
