This article is sponsored by American Health Plans. In this Voices interview, Skilled Nursing News sits down with American Health Plans Vice President of Operations Jason Haney to learn why SNF operators are increasingly turning away from insurer-owned Medicare Advantage institutional special needs plans (I-SNP) and moving into owning these plans themselves. Haney offers his outlook for the growing I-SNP market over the next 12 to 18 months, and shares why SNF members of American Health Plans’ I-SNPs are seeing a 99% retention rate.
Skilled Nursing News: Jason, what career experiences do you most draw from in your role today?
Jason Haney: I started washing dishes in a nursing home at age 15, and eventually became a licensed nursing home administrator. As an administrator, I experienced the challenges of reimbursement, regulations and staffing firsthand. That background hardwired me to think like a provider. American Health Plans represents the convergence of providers and Medicare Advantage.
Importantly, we are not an example of a payer becoming a provider. We and our partners are providers first and are aligned in our goal of delivering high-quality outcomes and a high-touch experience.
There is a lot of momentum behind the growth of Medicare Advantage plans, especially with I-SNPs, which you manage. Why do you think this segment is growing so rapidly and what is your outlook for continued growth for the next 12 to 18 months?
Haney: Medicare Advantage delivers high-quality outcomes while also removing costs from the health care system. Over 40% of beneficiaries are now enrolled in a Medicare Advantage plan, and CMS has continued to support and invest in the program. It’s a strong environment for established Medicare Advantage players and new entrants. I-SNPs represent segmentation of a maturing Medicare Advantage market.
There’s opportunity to serve specific populations creating products and services to meet individual needs. This important evolution represents the understanding that we are not a one-size-fits-all industry. Strategic investment of resources can deliver high-quality outcomes. Our outlook is strong. Not only do we believe Medicare Advantage will grow, but we are confident that the I-SNPs segment is ready to mature. Only about 10% of eligible nursing home residents are enrolled in an I-SNP, so the runway is long, and that growth will be in the provider-owned space.
As recently noted in your publication, large insurer-led I-SNPs lost membership during the pandemic while provider-owned plans grew. I believe that growth, despite the challenging environment, is due to alignment of goals.
At American Health Plans, you often talk about the power of the provider-owned I-SNP versus one that’s owned and operated by an MA insurer. What is that power? And why do you believe that model is superior to other I-SNP models?
Haney: Large insurers love I-SNPs. It has been a billion-dollar market with no competitors for decades. That monopoly pumped hundreds of millions of dollars in profit back to the large insurers. We believe that providers should receive those dollars to take care of America’s frailest population. The power of the provider-owned model is equal parts alignment and transparency. Providers know how to deliver care and want to do a good job. All they need is a partner that will help them get there.
We are aligned with our provider partners helping mitigate risk and delivering 100% of shared savings back to providers so that they can reinvest in services that directly impact residents. Transparency is the second key difference. Large insurers are eager to discuss cost and pressure providers for improvement. I encourage providers in that situation to ask about revenues and profits.
Being benchmarked on cost is meaningless without knowing revenue. American Health Plans believes transparency is a critical aspect of partnership. Each of our plans have a governing board with partner participation and that structure ensures every dollar is visible to providers.
From an operational standpoint, why should a SNF owner or operator consider partnering with American Health Plans in a provider-owned I-SNP?
Haney: Our strongest differentiator is the joint-venture model we create with partners. This concept has proven to be resilient and sticky, ensuring all parties are aligned in strategy, operations and results. We are also the only full-service provider-owned Medicare Advantage solution. Our core competencies cover providers from applications to network build, implementation, enrollment, model of care delivery, compliance and analytics.
This full-shop approach combined with our culture of partnership and transparency is one of a kind. Our provider partners deliver great care on their own, and our plans add concierge-style clinical service through our TruHealth division, which is made up of a team of nurse practitioners, physician assistants and registered nurses. Through the TruHealth partner collaboration, we can point to 40% to 50% reductions in unnecessary hospitalizations and emergency room visits, improved quality measures and reductions in polypharmacy.
We also know that not every need a nursing home resident has is clinical. With that in mind, American Health Plans adds member advocates as part of our service. These individuals focus on ways to combat loneliness and isolation. We have hundreds of life-changing stories that illustrate the care these individuals deliver. Imagine your mom is in a nursing home and a TruHealth nurse practitioner establishes a weekly conference call for you and your siblings so that everyone is updated on mom’s condition. Or imagine you live out of state and a member advocate visits your visually impaired father once a month to assist with phone calls and help write birthday cards for the grandkids.
These are real examples of the support we provide members and their families, and this high-touch approach rewards our plans with a retention rate above 99%.
I’m sure a lot of smaller nursing home owners may want to own an MA plan, but they feel they don’t have the financial resources to invest. How big does a nursing home have to be to invest in a partnership with American Health Plans to create a provider-owned I-SNP?
Haney: Large insurers have tried to scare providers out of ownership using industry jargon and worst-case scenarios to introduce doubt. The key is to have the right partner. American Health Plans brings subject matter experts into the partnership, allowing providers to focus on delivering care. Providers choosing I-SNPs have decided to focus on quality versus quantity. Those operators should be rewarded when better outcomes are achieved through clinical operations.
American Health Plans is unique in that we put our money where our mouth is. We are not a management company collecting a fee while providers bear the risk. Instead, we invest alongside our provider partners. This helps lower the barrier of entry and guarantees our commitment to the I-SNP’s success. Our proprietary structure creates a path to ownership for providers of all sizes. We have partners that operate a single campus yet own a piece of a Medicare Advantage organization.
Operators large and small can benefit from a coalition of providers who add scale, diversify risk and work together. Above all, we seek like-minded operators committed to delivering the highest level of care, and if that’s your organization, we have a place for you.
We hear a lot about how SNF operators can realize shared savings if they partner with American Health Plans to create a provider-owned I-SNP, but how much can that really mean for their bottom line?
Haney: As an example of the outcomes our partners can achieve no matter their size, despite the devastating impact of COVID, our nursing home provider partners have earned more than $5 million of shared savings by improving quality. That wasn’t just a stroke of good luck, as our partners are on track for 2022 to be the best year yet. Those savings come only through delivering the highest quality of care to members. Some of our partners have had a 100% return on invested capital in under two years.
Finish this sentence: “The skilled nursing industry in 2022 will be the year of…”?
Haney: The year of action. 2020 and 2021 were lessons that the status quo is not sustainable. Unfortunately, the industry is being blamed for pandemic-related outcomes. Operators are in a position to take action on everything from advocating for the necessary resources to deliver care, pushing back on price gouging staffing agencies and Medicare Advantage ownership.
Editor’s note: This interview has been edited for length and clarity.
American Health Plans is dedicated to providing quality health insurance at the lowest price, serving all individuals, families and small businesses. To learn how American Health Plans can help your SNF, visit AmHealthPlans.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].
