Editor’s Take: Intriguing Operators Prove That Innovation Doesn’t Have to Be Flashy

If there’s been one common theme in my nearly two years covering skilled nursing and long-term health care, it’s the idea that the industry is a silver bullet or two away from success.

Maybe it’ll take the form of the silver tsunami, whenever the wave of baby boomers eventually begins requiring intensive institutional care. Maybe it’ll look like the next new great payment model from the Centers for Medicare & Medicaid Services (CMS). Or maybe it’ll be something even more — to use a term I heard more than a few times this past fall conference season — disruptive, like robot caregivers that don’t require wages or new telemedicine platforms that reduce physician costs while improving resident care.

But too often, at least from my perspective as an outside observer of the industry, it seems as though everyone is content to speculate on that change, whatever it may look like, without recognizing the real opportunities within the current landscape. Value-based payments, accountable care organizations, and Medicare Advantage are all still in their relative infancies as players in the skilled nursing and long-term care space, and while providers would be foolish not to prepare for their impact, we still exist in a fee-for-service world with its own set of problems and solutions.


For instance, having just wrapped up conference season, I’ve heard plenty of presentations on the importance of entering narrowing provider networks and the growing need for solid data under new payment models. But it took until this week — and some excellent work by my colleague Maggie Flynn — to get an in-depth look at the 60 West nursing facility in Connecticut, which boasts an eye-popping 95% occupancy rate.

That building’s operator, iCare, identified an underserved market niche — in this case, difficult-to-place inmates released from prison on compassionate grounds — and decided to become an invaluable partner to the hospitals that had few options. That model was enough to make one hospital case manager in Illinois jealous, telling SNN that a skilled provider like iCare would be “one of my best friends.”

Flynn also recently highlighted the success of a Colorado facility that uses special Medicaid reimbursements to care for residents with behavioral issues, a growing market segment that will only increase as the baby boomers age and the stigmas surrounding mental health treatment gradually melt away. But the demand doesn’t match the supply: Just 27 of the Centennial State’s 230 nursing facilities can take residents who require behavioral health care.


“There is a significant population that needs the care, and we’re searching for options,” Colorado Health Care Association president Doug Farmer said recently. “They’re very difficult to place, and to date, there are still very few centers in Colorado that are willing and able to care for this population.”

These facilities didn’t need to invest in high-tech solutions or enter every new payment scheme they could find to carve a way forward; instead, they just saw a gap and filled it. That doesn’t mean these strategies are easy to implement — 60 West faced legal challenges from both existing residents and the government for serving convicted criminals, for instance — and success isn’t guaranteed. In addition, each individual state has its own reimbursement and regulatory guidelines surrounding specialty residents, with not every market open to every novel fix.

But as the holidays begin and we start to look toward 2019, these recent stories prove that innovative providers don’t have to wait for the flashy savior to find success. Sometimes the best outcome for both operators and the most vulnerable residents is lurking just beyond the industry’s traditional margins.

Programming note

Skilled Nursing News will not publish on Thursday and Friday in observance of the Thanksgiving holiday. All of us here hope you spend the weekend with family and friends, and be sure to extend an extra thanks to the frontline caregivers, physicians, administrators, and other employees who will work over the holiday to ensure their residents’ continued safety and comfort.

We’ll be back with new content Monday morning.

Written by Alex Spanko

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