How Offering Insurance Can Pay Off for Skilled Nursing Providers

Large skilled nursing providers across the country are increasingly selling private insurance plans to their residents, and it appears to be paying off for at least one of them.

Among them are Erickson Living and Signature Healthcare, two of the country’s biggest providers of skilled nursing services. Both Erickson and Signature offer private Medicare Advantage insurance plans to thousands of their residents with Erickson Advantage and Signature Advantage.

The purpose of Medicare Advantage is to offer a private alternative to the sprawling government program. As part of these plans, Medicare pays private insurers a monthly rate. Then, the insurer is responsible for covering treatment and case management. Many such plans offer extra benefits such as vision, dental, podiatry and transportation services.

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Some of them are classified as Institutional Special Needs Plans (I-SNPs), meaning they are designed for people in skilled nursing facilities or other long-term care settings.

Norcross, Ga.-based PruittHealth, the largest post-acute provider in the Southeast U.S., offers a private Medicare plan in partnership with AllyAlign Health called PruittHealth Premier. The plan debuted at 10 of PruittHealth’s 90 facilities last January.

One of the biggest advantages that PruittHealth affords residents is the level of face-to-face care they receive, Angie Tolbert, vice president of quality assurance and performance improvement, tells Skilled Nursing News.

Before launching Premier, Tolbert says PruittHealth was getting frustrated with Medicare Advantage representatives dictating how it cared for residents without knowing very much about their specific care needs. Now, dedicated nurse practitioners make regular visits to the facilities to work out treatment plans for beneficiaries of the private insurance plan.

“They just have an added level of clinical oversight that’s in-person, live, not by phone case management,” Tolbert says. “It’s just nice, especially for the aging population. It gets really frustrating dealing with your company when they’re on the phone or 10 states away.”

Another big perk is the added benefits and allotments for hearing aids, vision, mental health services, and non-emergency transportation, Tolbert adds.

Risk and reward

Though the plan has worked out in PruittHealth’s favor so far, it’s not without risks. After all, SNF providers who offer their own insurance plans are essentially agreeing to do Medicare’s job for themselves.

“It’s obviously a risk. You get the money to manage these individuals but you’re responsible for everything for them, meaning their hospital bills, everything,” Tolbert says. “It’s up to us to manage that well so that we don’t lose our shirt.”

So far, however, things have gone more or less peachy for the Georgia provider.

For example, PruittHealth hasn’t seen any residents drop the coverage in favor of another plan, the company reported. Additionally, the provider has seen downward trends in utilization of skilled days and hospitalizations.

“There are good months and there are months we could do better,” Tolbert says. “But for the most part I think we’ve done a good job.”

As a testament to its success, the company will start offering PruittHealth Premier at 42 additional facilities, with open enrollment starting this October. When the expansion officially starts in January, the company projects it will have between 2,000 to 2,500 enrollees.

And other providers have started to take notice.

“We’ve been approached by quite a few other companies that have found out we’re doing it. They’ve asked us basically just for some guidance on how to do it and do it well,” Tolbert says. “I think the trend is going to pick up.”

Written by Tim Regan

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