In an era of increasingly coordinated care, skilled nursing providers are vying to find their place in the care continuum and demonstrate their value in the post-acute care landscape. Yet for providers utilizing one particular care model under a Medicare Advantage Institutional Special Needs Plan (I-SNP), that proof recently became clear through the results of a study by Harvard Medical School researchers that demonstrated the model not only delivers improved outcomes for patients, but does so at a much lower cost.
The study, published in the American Journal of Managed Care,1 included members of UnitedHealthcare’s I-SNP, with care delivered by their partner, Optum®. Through an on-site clinical model of care, skilled nursing providers showed vastly lower rates of emergency department (ED) use, inpatient care and hospital readmissions versus their Medicare fee-for-service counterparts. I-SNP members had 38% fewer hospitalizations, 51% lower ED use and 45% fewer readmissions, while the rate of SNF use was 112% higher.
“With this type of model and the extra layer of care present, you can make a huge impact on the rate of avoidable hospitalizations and readmissions,” says Dr. Ronald Shumacher who currently serves as chief medical officer for Minneapolis-based Optum Care Services.
“These reductions are reflective of high-quality care, which comes with respecting every individual’s health-related goals and wishes.”
The study also estimates a massive potential saving for Medicare, to the tune of around $1.6 billion per year.
The Optum care model
The UnitedHealthcare and Optum I-SNP care model combines three key elements: clinical staffing, elimination of the Medicare three-day stay rule and the capitated financing of managed care.
“We look for options other than putting the patient in a high-cost acute care setting when they have a change in condition,” Shumacher says. “One of the ways to do that is to reimburse skilled nursing facilities to provide the appropriate care without transferring the patient.”
Under the program, clinical staff comprised of nurse practitioners or physician assistants work directly on site and coordinate with other care providers such as primary care physicians, hospital doctors and specialists. This care is provided at no additional cost to the patient. The plan also covers biannual comprehensive assessments, monthly visits for routine assessments and daily visits in the event of an acute illness.
The advanced practice clinicians have a dedicated focus on the long-term nursing care residents, and they are trained by Optum to serve the SNF population.
“Related to those advanced practice clinicians, we have a strong training and education component for them,” Shumacher says. “They need to be well-versed in evidence-based medicine and be very proficient with conversations about serious illness. These are things that often get overlooked. We train advanced practice clinicians to take care of people in this setting.”
Giving SNFs a seat at the table
While I-SNPs are not available in all counties, and still account for just a small fraction of Medicare beneficiaries, enrollment in I-SNPs continues to increase. Skilled nursing facilities can explore whether there are plans serving their area — many of which are supported by Optum.
“The bottom line is a focus first on clinical quality,” Shumacher says. “If you can consistently provide high-quality care, you can achieve optimal outcomes and the plan is eligible to receive additional payment via Medicare’s Health Plan Star Ratings. These dollars are subsequently reinvested in plan benefits for the enrollees. This is the kind of care that every nursing home resident deserves, but not all have access to it [yet].”
Optum is a leading health services innovation company that aspires to improve experiences and outcomes for everyone it serves, while reducing the total cost of care. Learn more about the Optum I-SNP care model for SNFs by visiting Optum.com/SNF.
1. McGarry BE, Grabowski DC. 2019. Managed Care for Long-Stay Nursing Home Residents: An Evaluation of Institutional Special Needs Plans. American Journal of Managed Care. 25(9): 400–405.