Q: What do you see as the major long-term care payment and policy topics these days?
A: There is a major push right now to move insurance risk onto providers — whether it be full capitation or some kind of risk sharing arrangement. This is a major focus of the Centers for Medicare & Medicaid Services. In my conversations with the post-acute providers, I see them trying to understand what risk sharing means for them.
Q: How is Medicare Advantage affecting long-term care?
A: MA enrollment continues to grow and shows no sign of slowing down. An increasing number of long-term care residents are now in MA plans rather than traditional Medicare. With MA comes managed care and the resulting push to lower the number and duration of post-acute care stays, which has revenue implications for the provider.
Q: One of your specialties is the institutional special needs plan (I-SNP) bidding process. What should providers keep in mind?
A: The biggest challenge is the change in mind-set. Financial incentives for the long-term care facility owner are not the same as those of an I-SNP owner. Being able to reconcile those two incentives when you are both the I-SNP and the provider can be difficult, but it is very necessary in order to be successful.
Catherine Murphy-Barron is a principal and actuary for Milliman.