As Medicare Advantage (MA) continues to capture market share, skilled nursing facilities can seize the moment by focusing on quality to draw the attention of MA providers.
The MA plans themselves are starting to pay more attention to quality, compared with prior years when geography and SNF-hospital partnerships took precedence, Mary Hsieh, managing principal at Health Management Associates, told Skilled Nursing News.
This seems to fly in the face of a recent report that found MA plans funneling residents into low-quality SNFs, at least as rated by Five-Star Quality Rating System data from Nursing Home Compare.
Still, those results didn’t surprise Susie Mix of health care consulting firm Mix Solutions, based in Fountain Valley, Calif.
“Any time you have something that’s managed and that doesn’t allow you the opportunity to pick what you want, that’s going to happen,” she said.
But the findings of the study may change as MA grows in influence and scope. The number of MA plans available to individuals across the U.S. is set to grow from about 2,700 to more than 3,100 in 2018, according to the Centers for Medicare & Medicaid Services (CMS).
There’s also increasing pressure on the MA plans from their peers. This year, approximately 73% percent of MA enrollees with prescription drug coverage will be in plans that are rated four or five stars, compared with about 69% of such enrollees in 2017, CMS said.
“Many more plans are becoming higher-rated plans, and as the competition intensifies, they’ve got to look for ways to differentiate themselves from their competition,” Hsieh explained.
This makes the star ratings of SNFs a potentially crucial factor. MA plans have struggled with handling transitions and gaps in care, and as a result, the forward-thinking ones been paying increased attention to the quality of SNFs where enrollees end up, according to Hsieh.
For this reason, SNFs should pay attention to their star ratings, as these MA plans are starting to focus on finding facilities that provide the best care.
“They can say ‘We may not have as many [SNFs], but we work with them because they’re higher quality,’” Hsieh said.
This was consistent with what Mix has seen in her work with providers. Though most health plans are not yet making SNF stars a priority, some are, and the number of plans doing so is going to rise, she told SNN.
“Insurance companies — some of them are looking at star ratings and saying they will not contract with facilities that are below three stars,” Mix explained. “It is trending toward the health plans looking at providers and not just contracting with anybody.”
“Written by Maggie Flynn