Pandemic May Have Been ‘Ultimate Stress Test’ for I-SNP Success in Nursing Homes

Nearly a decade after the Centers for Medicare & Medicaid Services (CMS) established accountable care organizations (ACOs) in conjunction with the Affordable Care Act, the health care landscape has shifted even further toward a focus on outcomes and value.

As recently as October CMS and the Centers for Medicare & Medicaid Services Innovation Center (CMMI) unveiled an updated 10-year strategic plan which highlighted its goal to shift all Medicare and the majority of Medicaid beneficiaries out of fee-for-service (FFS) and into value-based payment and alternative methods with a special emphasis on accountable care and health equity.

Some in the skilled nursing industry see the move away from traditional fee-for-service payment as daunting while others like American Health Care Association President and CEO Mark Parkinson believe it’s essential for the industry to embrace.

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Parkinson recently told Skilled Nursing News that providers taking on risk and value based purchasing models was “the most exciting development that’s taking place in the long-term care sector for many years.”

“The reality is, and I know we’ve all been hearing this for a long time, but the reality is that fee-for-service is dying. And along with it though, there are tremendous opportunities in the area of population health management. As providers and as a sector, we have a fundamental decision to make: do we die along with the death of fee-for-service or do we grasp on to the opportunities available in population health management and prosper,” Parkinson said during the association’s Population Health Management Summit held earlier this week in Washington, D.C.

At any given time there are roughly one million long-term care residents in skilled nursing facilities and I-SNPs have captured nearly 10% of that population, Parkinson said.

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I-SNPs restrict enrollment to people eligible for MA who, for 90 days or more, need or are expected to need the services of a SNF or another institution.

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).

Special needs plan enrollment, particularly Institutional Special Needs Plans (I-SNPs) and Institutional Equivalent SNPs (IE-SNPs) have grown from 53,073 enrollees in 2015 to 93,945 enrollees in 2021, according to analysis from health care consulting firm ATI Advisory.

ATI Advisory’s analysis further showed that 26% of I-SNPs are operated by long-term care provider organizations. In 2015 there were only five LTC provider-led I-SNPs, a number that grew in 2021 to 64.

Parkinson said he was initially “greatly concerned” at the outset of the COVID-19 pandemic that providers who created their own I-SNPs would be negatively impacted, but “fortunately” the plans largely survived.

“I would suggest that the pandemic was the ultimate stress test in the I-SNP world and the I-SNPs made it which to me just further increases the excitement that I have about not only the concept but what happens in the real world with the concept,” he said.

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