A non-profit health plan and a care coordination company in the Minneapolis area teamed up with almost 80 senior care locations to offer a Medicare Advantage plan specifically tailored for adults in long-term care, assisted living, and memory care settings.
The institutional special needs plan (I-SNP), Medica Advantage Solution PartnerCare, will be available for January 1, 2020 effective coverage, offered exclusively to eligible individuals living with 10 different senior care providers in the Twin Cities area.
The Minneapolis-based Genevive will be providing primary care and care management services. Owned by the non-profit health system Allina Health in Minneapolis and the Roseville, Minn.-based Presbyterian Homes & Services, the primary care and care coordination provider will act as the contracting agent for Medica with the participating senior care organizations.
Medica, a non-profit health plan in Minneapolis, designed and will be offering the health insurance plan; the company holds the contract directly with the Centers for Medicare & Medicaid Services (CMS), with a “standard participation agreement” with Genevive to provide services, according to Chris Reiten, who is overseeing the program for Medica.
The senior care providers — Benedictine Health System; Cassia, an Augustana/ELIM affiliation; Catholic Eldercare; Episcopal Homes of Minnesota; Goodman Group; North Cities Health Care Inc.; Presbyterian Homes & Services; Saint Therese; Volunteers of America; and Walker Methodist — represent 78 sites where patients will be able to sign up, making the Medica Advantage Solution offering one of the largest rollouts of an I-SNP in the U.S., Genevive CEO Amanda Tufano said.
Long-term care facilities account for about 48 of the total care sites covered under the plan, with 30 assisted living properties. The insurance product is specifically focused on patients who would be buying Medicare Advantage or supplemental Medicare insurance, rather than patients dually eligible for Medicare and Medicaid, she noted, which makes the potential pool of enrollees a bit more specialized.
“You have to qualify by living in long-term care, assisted living, and having certain clinical needs, and need more care to be in the product,” she explained. “It’s not the 65-year-old golfer, traditional Medicare Advantage product.”
The goal is to have 325 enrollees by December 2020, Reiten told SNN. Training with partnering facilities has just begun, she added, and its leaders plan to eventually expand past that number — even though it’s not clear yet what that might look like.
Specifically, the partners are working on a governing board related to the I-SNP that would plot what growth would look like, and whether expansion might mean a wider service area, more facilities, or entrance into other states, Reiten said.
I-SNPs have been a hot topic in the long-term care world, with data from the Medicare Payment Advisory Commission (MedPAC) showing that the number of such plans grew by 29% from April 2018 to April 2019. SNF providers in particular have been driving growth in the number of special needs plans that are enrolling institutionalized Medicare beneficiaries, according to one analysis.
The conversation about moving into I-SNPs in the long-term and geriatric space “is occurring nationally,” Tufano noted, but the Medica-Genevive project itself has been “boots on the ground” for about a year. The two entities have been working together for several years, Reiten noted, and they happened to be looking into I-SNPs at the same time — making partnering on the plan an obvious move.
Genevive’s care model includes a team with physicians, nurse practitioners, care coordinators, specialists, a pharmacy consultant and others, allowing it the chance to be the “quarterback of care,” according to Tufano.
“As care practice, care managers, how do we make sure we create something that is valuable to the patient that is worth paying for?” she asked rhetorically in an interview with SNN. “I think that is really alignment between facilities, the payer, and the medical practice — which we’re all heading in the same direction.”