In a wide-ranging conversation about value-based care, skilled nursing industry leaders said operators and owners need to be more willing to take on risk to benefit from such models.
Integrated Care Solutions CEO Brian Fuller and Eric Tanner, chief executive of SNF operator OnPointe, said during a fireside chat at the Synergy Summit that providers don’t feel comfortable taking on high-risk patients, despite the need to boost low occupancy numbers.
“If you’re going to actually deliver value, you have to have some type of component of financial risk, and we just had the former CMS director say that they’re desperate for providers to take that risk,” added Tanner, referring to Seema Verma’s presentation at the same conference.
OnPointe operates seven nursing facilities in Texas and New Mexico; the company also offers home health and population health management services.
SNFs may not take on such risk in part due to a pressure to deliver desired results within a certain timeframe, Fuller said – and may not have access to that risk due to hospitals’ misunderstanding of post-acute care.
“There’s a lot of eyes and ears on what you’re doing on specific patient issues — we have to escalate some of those issues. We do that every day actually. And so, that feedback loop goes back to whoever the referral partners are, whether it’s a payer, hospital or physician group,” said Fuller. “That’s the flip side … our accountability is back to our partners and being part of that feedback loop.”
ICS provides care management services, including coordination of care between acute and post-acute settings, as well as consulting for hospitals, physician groups and organizations focused on value-based care.
Accountability can be strengthened and post-acute care better understood in the wider health care industry if nursing homes can simply tell their story to the decision makers in acute care, Tanner said. Making a reference to Hamilton’s “The Room Where it Happens,” he argued representatives of the SNF sector need to have a seat at the table when decisions are made.
“We’re probably the best at managing the chronically ill, and knowing the price points of managing the chronically ill more than any other industry in the United States; we’ve been doing it for 50 years,” Tanner said. “Being able to tell our story on how we manage the chronically ill … how we can manage high cost, [high-complexity] new patient populations or patients that have had an exacerbation that, in lieu of the hospital, come to our facilities, I think that’s really important.”
Industry perception, in other words, needs to change for the better, Tanner explained.
If discharge planning was more efficient, Fuller added, SNF operators might feel more comfortable taking on high-risk patients within the value-based care model. Operators sometimes keep patients for an unnecessary length of time rather than starting up a discharge plan on day one, driving up length of stay, he argued.
Currently, discharge planning happens when a SNF operator has a first patient family meeting, Fuller said.
Another risk-friendly change involves marketing SNFs’ highly specialized clinicians.
“That’s how you’re going to win. I think in the future, those are the capabilities we’re looking for, because it all goes in if you’re holding risk,” said Fuller. “It’s [congestive heart failure], pneumonia, [chronic obstructive pulmonary disease] and sepsis, that’s where you win or lose, and those are your highest volume conditions. Those are very complex, high clinical service line-capability populations, and you need to build programs around them to differentiate yourself.”
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