Former ProMedica Senior Care President David Parker took on a new role at Optum this summer, putting his 30-plus years in skilled nursing executive leadership to good use as vice president of strategy for its complex care management division.
Optum is the care delivery arm of UnitedHealth Group, and has offered value-based care plans for more than 20 years, Parker told Skilled Nursing News. Now Optum aims to grow its relationship with provider-led institutional special needs plans (I-SNPs), as well as chronic condition, dual eligible and institutional-equivalent SNPs run by the provider.
SNPs are types of Medicare Advantage (MA) plans that restrict enrollment based on eligibility. Most SNP recipients are expected to or need the services of a skilled nursing facility or other institution.
Originally planning to take time off after his departure from ProMedica, Parker was recruited by Optum for his deep ties to aging services advocacy groups like the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), and post-acute care operations perspective gained from 26 years of experience with Toledo, Ohio-based ProMedica.
Parker is known for fostering relationships that lead to expansion during his time at ProMedica, overseeing the acquisition of nursing home giant HCR ManorCare announced in 2018, and teaming up with real estate investment trust (REIT) Welltower Inc. (NYSE: WELL) to buy ManorCare’s real estate in a joint venture.
He started his career in the skilled nursing industry as an administrator for a Louisiana facility at 21 years old, eventually running nursing homes “from the Atlantic to the Pacific, and from Canada down to the Gulf,” Parker told SNN.
Skilled Nursing News’ conversation with Parker was edited for length and clarity.
How did you find yourself in this new role with Optum, after 30-plus years in the skilled nursing space and leadership at ProMedica?
When I left, I really was going to take some time off and try to work on my mental health and get a little bit of rest and relaxation. But, I’ve had a terrific and strong relationship with the Optum executive team for a very long time. They reached out to me and asked if I would be interested in potentially coming on board with Optum.
So what are you doing in your new role?
I’ve spent a lot of time in my last, you know, 25-30 years, working around advocacy, government relations, looking to help drive policy change, improve the outcomes and the payment models. Optum wants to take a stand in that. We want to stand with the industry and advocate for improvement in support and services, a change both from capital investment as well as reimbursement and regulatory relief around skilled nursing and assisted living.
The pandemic taught me and many others that were in skilled nursing and assisted living, that it was a time for change. We need to be able to support capital investment in skilled nursing.
It sounds like a lot of advocacy work on behalf of the skilled nursing industry.
I’m going to continue to work with Mark Parkinson and Cliff Porter, state executives like Pete Van Runkle in Ohio, to be a voice and a strategic partner in trying to change and evolve with what is going to be needed in the industry in the very near future.
Your role with Optum also has you working closely with skilled nursing operators, and their provider-led I-SNP plans?
I think with the pandemic, the decline in occupancy and the increase in hospitalizations has complicated those provider-led I-SNPs and IE-SNPS. They aren’t performing at the level that many predicted and I think that many of those plans have now seen that they need to partner with a proven leader in that space.
So that partner would be Optum?
We partnered with a provider-led plan — West Virginia Senior Advantage — owned and operated by Stonerise, about two years ago. That plan has grown over the last two years with our involvement. [We] have found that to be a very rewarding way to help providers that have stood up their own I-SNP plan.
Obviously we still want and have a priority around our Optum-owned and operated I-SNP plan for UnitedHealth Group, but those that have decided that they want to lead their own plan … if you are going to do that, I think it’s best for both the patient and the outcome, and for the provider, that they do it with a proven and committed organization that brings value, that brings innovation and integrity and compliance.
Where is your department at with provider-led I-SNP partnerships?
I have multiple conversations that are occurring with provider-led plans right now, with the opportunity for Optum to step in and be their leader both on the clinical side and the sales and membership side, as well as a third-party administrator. That side of our business will continue to build out.
How exactly will Optum assist with provider-led plans?
We’re not going to be what I would call a financial partner, you know, a joint venture type model in the plan, but we believe for those plans that are owned by providers that we can come in with our experience, and run their plans, deliver quality outcomes for their members, and create a return to lower cost of care to treat in place than anyone else based on our years of experience.
Any other interesting aspects of your role and Optum’s clinical care management division?
Really just working with our executive team within complex care management, helping educate them on the operational side and the care delivery side within the skilled nursing centers — understanding the pressures they’re under, continuing through this pandemic, and in this very challenging employment market and trying to make sure that I can help them understand what really happens inside of the post-acute world, and how we can best, not just as an organization, but as an executive management team, and as caregivers, how we can best support them.
So you’re their window into the post-acute space?
I have a role in working with each one of the executives on our team and making sure they get kind of an inside look at what operations inside a skilled nursing facility and an assisted living facility looks like — I think that’s an eye opening experience.
What other trends are you seeing in the skilled nursing space, in terms of operators at this point in the pandemic?
I think the pandemic has really highlighted the challenges and the difficulties in the operating space, and obviously I have experience in that for over 30 years. Challenges around appropriate funding for skilled nursing facilities has really been highlighted during the pandemic and trying to exit the pandemic with challenges around paying our caregivers.
Any other trends you feel those in the industry should pay attention to?
There’s been a lot of changes in ownership structures and corporate structures throughout the industry over the last 10 years. That has escalated significantly due to the challenges and operating environment during the pandemic. And so, you know, it’ll be interesting to see how things evolve over the next couple of years.
Post-pandemic, the industry is still recovering from the challenges and the decline in occupancy and again, the challenges around employment. We’re going to have to work collaboratively from a Medicare Advantage standpoint as well as in states to make sure that there’s appropriate funding for the outcomes that are expected and the care that is expected. Otherwise, it’s going to be a continuing difficult operating environment.
What about the evolving relationship between acute and post-acute care, given your time at ProMedica?
My company that I worked for for 25 years — HCR ManorCare was acquired by an acute care company, a not-for-profit organization that owns 13 hospitals. They own physician practices, and they own their own managed care plan. Obviously, I had the opportunity over the last three years to learn a great deal from the executive team at ProMedica and from all the clinical leaders and executives in the acute care space, as well as into their physician component with ProMedica.
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