As the I-SNP model continues to expand across the skilled nursing industry, some see it as one way to effectively push telehealth services into smaller, rural facilities that don’t have the infrastructure to support the services by themselves.
“We’re seeing a lot of traction in the I-SNP model,” TapestryHealth Co-Founder and Chief Growth Officer Mordy Eisenberg told Skilled Nursing News. “Especially provider-owned I-SNPs. For example, let’s say a provider has 60 buildings and 40 of them are large enough or have a large enough profile for I-SNPs. We’d focus on those, but using telemedicine, we can bring the I-SNP to every one of their homes, even the smallest, most rural ones.”
“You don’t need the expensive on-site NP (nurse practitioner) because we can do it remotely,” he added. “Our model is aligned completely with the I-SNP model.”
The I-SNP is a type of Medicare Advantage (MA) plan that restricts 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.
I-SNP enrollment and Institutional Equivalent SNPs (IE-SNPs) enrollment has grown significantly over the years, from 53,073 enrollees in 2015 to reaching 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.
TapestryHealth recently took on a “big I-SNP contract” in New York, according to Eisenberg, as it’s seen demand for its telehealth services only increasing for nursing facilities.
“In this 60-buildling chain, I think they had about 14 buildings that they considered rural remote, which they weren’t even thinking about putting into their I-SNP and now they can,” he explained.
Since it’s all managed remotely, the care is the same across the board, Eisenberg added.
“It works both ways. More smaller facilities can get telehealth services through the I-SNPs and smaller rural facilities can be included in the I-SNPs,” he said. “Using telemedicine you can bring I-SNPs to very small places. Some very small homes.”
The use of telehealth exploded during the pandemic as the number of Medicare fee-for-service (FFS) beneficiary telehealth visits increased 63-fold in 2020, from approximately 840,000 in 2019 to nearly 52.7 million in 2020, according to research from the Office of Health Policy.
For I-SNP provider Longevity Health Plan, which recently expanded to Colorado with plans to expand into Florida, Illinois and New Jersey this year, telehealth can help bridge some of the smaller facilities in its network to the larger ones.
“We are really thinking about how to leverage telehealth in your rural settings as a new model,” Marc Hudak, chief growth officer for Longevity, told Skilled Nursing News. “Historically, the I-SNP model has really focused on larger buildings where you can enroll a lot of members because medical practitioners are very expensive resources. If an NP all-in costs $180,000 a year and you have 10 I-SNP members in that building, that’s incredibly expensive and not sustainable.”
The earliest movers in the I-SNP space focused on larger buildings, he added.
He said that Longevity is designing models to allow it to serve more and more of those rural buildings and a key part of that is telehealth can help create new clinical models to make it easier to serve those populations.
“Longevity is taking a very different approach because so many of our partners are in rural buildings,” Hudak said. “So many of our partners own smaller buildings and we don’t want to say to them that these buildings are not a good fit.”
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