Operators See Opening to Shape Managed Care Policy in States

Managed care is on the rise in both Medicare and Medicaid, but skilled nursing and long-term care (LTC) providers don’t necessarily need to play catch-up.

In fact, they have room to influence the direction of managed care in their states, according to a panel at the National Investment Center for Seniors Housing & Care (NIC) Spring Investment Forum in Dallas last month.

“There’s opportunities to kind of help shape the direction the state is going,” Suzanne Gore, deputy of administration for the Virginia Department of Medical Assistance Services, said during the discussion. “I think we’re still very early in the MLTSS (managed long-term supports and services) and the integrated care development.”

From reactionary to relevant

The provider community in Alabama became involved decided to increase its advocacy efforts when the state’s Medicaid agency began moving in the direction of managed care some years ago, Ron Chaffin, CEO of SeniorSelect Partners said — though he noted the state still has fee-for-service Medicaid.

Owned by nursing home operators and other LTC providers in the state, SeniorsSelect Partners is a a group of investors representing 28 providers and 120 skilled nursing facilities.

The company has two wholly owned subsidiaries: Simpra Advantage, a Medicare Advantage plan with an institutional special needs plan (I-SNP) and Dual-Eligible SNP; and Alabama Select Network, LLC, which was formed to participate in the Alabama Medicaid Integrated Care Network (ICN) managed LTC program.

The state is expected to hold a competitive procurement process for the ICN program soon, Chaffin noted. Though Alabama abandoned plans to move to a managed Medicaid model last year, the fact that providers stepped up to have a say is significant, Chaffin said.

“To me, the most important part of it was the provider-owners themselves — who were investors and going [to be] at risk for this — decided this was really an opportunity to make themselves more relevant in the health care environment,” he explained. “It starts as a defense mechanism, but then it turns into: ‘We’re a responsible provider, we’re multigenerational owners, we see an opportunity here to invest and become more relevant in health care delivery.’”

When asked how providers can work more closely with a state Medicaid agency on a managed care program, Cleopatra Kitt, director of special projects and operations at rehab provider Medical Facilities of America (MFA), stressed the importance of providing details to the state.

LifeWorks Advantage, MFA’s provider-owned plan, took part in Virginia’s procurement process and and developed a proposal that incorporated a care coordination and medical management process — which included an in-house medical and behavioral health director to coordinate care.

“We’re able to meet the goals of our state Medicaid… process to be a provider on the continuum of care,” she said. “We also are able to give our residents the ability to be treated in place without constantly going out to the hospital.”

The provider advantage

Skilled nursing operators have found benefits in providing I-SNPs and are increasingly considering moving into the insurance space. And if the providers have a strong local foothold and the knowledge that comes with it, they can add significant value to the state. Nursing home operators, care coordination staff, and social workers are some of the few people who know how to handle transitions from the hospital, Gore explained — an area of expertise that has been lacking in Virginia so far.

“Depth of knowledge of coordinating services in a geographic area isn’t where we’d like to see it,” she said of the issues the state of Virginia has seen in working with health plans, notably the larger ones.

Providers looking into entering this business should examine their competitors, the product lines they offer, and their delivery systems, Chaffin said. If there’s a dearth of Medicare Advantage, I-SNP, or dual-eligible options, they could have an advantage.

“If the state’s going to go in the direction of managed care, there should be recognition that provider-sponsored plans will do the same things [as insurers’ plans], but they’ll probably be more in touch with the beneficiaries that they serve because they’re already serving those beneficiaries,” he said.

Written by Maggie Flynn