ProMedica Senior Care President: ‘We All Have to Get Comfortable With Where We Add Value’

As Medicare Advantage enrollment continues to climb and operators look for a seat at the table, ProMedica Senior Care President Angela Brandt believes now is the time to recognize the role long-term care facilities can play in value-based payment.

“We all have to get comfortable with where we add value for the health care continuum for all stakeholders,” Brandt told Skilled Nursing News.

Medicare Advantage enrollment now represents 46% of all 57.7 million eligible Medicare beneficiaries, according to a July report released by the Medicare Payment Advisory Commission (MedPAC).

“You have to think about how you add value as a skilled nursing facility to help a hospital have the appropriate length of stay for the acuity of their patients. How do you help the physician work through a bundle of care where skilled is a portion of that bundle where we historically have not always been. So skilled nursing can really help in those kind of value based programs, specifically Medicare Advantage,” she explained.

ProMedica currently serves communities in 28 states by offering acute and ambulatory care, an insurance company with a dental plan, as well as its post-acute line.

Paramount, ProMedica’s insurance arm, includes Medicare Advantage plans.

When providers along the health care continuum are aligned on the same goal — providing the appropriate setting of care to a patient at the lowest cost to them — everyone wins, according to Brandt.

The reason why SNFs may not have had a seat at the table previously “was both a clinical and a financial conversation where the shared savings was not distributed to skilled nursing facilities.”

“So we were helping facilitate the goals of others, and I know that sounds very provocative, but we’re OK with that if that’s our role. We just need to make sure that we are all aligned in our incentives and making sure that we’re all aligned in our objective, even if we don’t receive a portion of the shared savings,” Brandt explained.

ProMedica remains active through partnerships

The company last month launched its Healthcare Redefined Initiative in an effort to prioritize social determinants of health and think about the industry beyond its traditional settings.

The program aims to use data and other tools to improve overall health and well-being by focusing on the environments where people live, work and play. Specifically on the senior care side, the initiative focuses on healthy aging and independent living.

The initiative will expand to Baltimore, Chicago, Cleveland, Detroit, Pittsburgh, and Philadelphia after being piloted in the company’s headquarters of Toledo, Ohio.

Looking at housing in particular through its partnership with the Green & Healthy Homes Initiative, Brandt said through these types of partnerships and data the organization is able to ensure those patients who are being discharged home can safely do so and continue to get stronger.

“Using those partnerships we can make sure our patients and our families are getting to where they need to be and I think skilled plays a really important role in that value chain and into those steps and processes to get people safely home,” she added.

Brandt took the helm as ProMedica’s leader on the senior care side in July — less than a year after the health system announced it would rebrand its HCR ManorCare chain of nursing homes and other senior living facilities under the “ProMedica Senior Care” banner.

The change applied to facilities that operated under the Heartland, ManorCare and Arden Courts brands.

ProMedica acquired HCR ManorCare’s operations in 2018 in an 80-20 joint venture split with real estate investment trust (REIT) Welltower Inc, (NYSE: WELL).

In August, ProMedica and Emory Healthcare announced they would team up to design and build two skilled nursing and rehabilitation centers in the metro Atlanta area.

The new facilities will have private rooms and baths as well as “innovative therapy areas” aimed to get patients safely back into the community. They are expected to take two years to build once regulatory processes are complete.

“Emory has a great strong health system, has a high degree of credibility and leveraging our expertise in skilled nursing, we can create something better together,” she said.

Workforce challenges

Not unlike others in the industry Brandt recognized the ongoing workforce challenge “is really our biggest barrier at the moment.”

According to a recent survey of 1,183 nursing homes and assisted living providers from the American Health Care Association and National Center of Assisted Living (AHCA/NCAL), nearly every nursing home is currently asking staff to work overtime or extra shifts and more than half are limiting new admissions due to staffing shortages.

And Brandt echoed the reality that there remains a “significant” number of referrals coming into facilities that can’t be accommodated because of workforce challenges.

“I would challenge that while home care is still an important part of people healing, our abilities to be able to accommodate patients in skilled facilities has only been limited by our workforce challenges,” she said.

ProMedica is working to find ways to allow for career progression and more scheduling flexibility for staff, but even more importantly Brandt believes one thing all care providers should be focusing on now is removing the stigma surrounding a career in skilled nursing.

“Our objective is going to have to really be thinking about workforce, and how do we appeal to a clinical nurse who can really find their own purpose and passion being connected in the skilled nursing environment,” Brandt said.

Despite these concerns, Brandt remains optimistic about the future of skilled nursing.

“If we can work through the workforce pandemic, we’ll really emerge as a strong partner for hospitals, physicians and families,” she said.