As Medicare Advantage (MA) plans continue to expand in benefits and number of beneficiaries, nursing home operators are weighing their options on how to adapt.
“If you start to think about positioning with your relationships, with these types of organizations, be it a provider network, a member that has an Institutional Special Needs Plan (I-SNP) or a coordination entity like Lifespark, it gets really interesting in terms of where you’re plugged in,” said Mike Cheek, senior vice president of reimbursement and market strategy for the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
Cheek, along with Matt Kinne, vice president of growth and partnerships at Minnesota-based Lifespark, spoke at the association’s conference in Nashville about MA plans and how shifting benefits are informing SNF participation.
Lifespark delivers value-based care options, while also operating its own senior living and skilled nursing facilities acquired through its purchase of Tealwood Senior Living.
Expanded services, but payments an issue
MA plans can now offer services “outside of the usual array” of benefits, Cheek said, an endeavor that CMS began several years ago.
Transportation for nonmedical needs, indoor air quality equipment and services are a few of these supplemental benefits available to MA beneficiaries now, but insurers aren’t receiving additional funds to offer such services. .
“To make one point clear, they have to carve [those offerings] out of what they’re getting in premium payments already from the federal government,” Cheek said.
A lot of the supplemental benefits look and sound a lot like Medicaid-financed HCBS, Cheek said; CMS doesn’t pay more for such services either.In any case, payers are faced with the task of either carving in – or out – these offerings to beneficiaries.
However, insurers do have payment flexibility in terms of including supplemental benefits within bundled or episodic models.
That’s where it’s helpful for SNF providers to launch their own plans or develop relationships with MA organizations to deliver supplemental benefits specifically tailored to what their population is looking for.
“They give you more flexibility and control … it can really take you to a good place in terms of thinking through risk sharing and shared savings opportunities rather than a traditional contract with Medicare Advantage plans,” Cheek said.
Lifespark in skilled nursing
While Lifespark got its start in HCBS, the company’s model to provide more person-centered, seamless care extends to the skilled nursing sector as well. The company seeks to integrate full-continuum services with insurance products, supported by a technology backbone, to every part of the post-acute end of the care continuum.
Its population health management model in skilled nursing combines geriatric care management and clinical expertise, all while investing in technology that gets Lifespark closer to person-centered care.
Lifespark’s “life managers” — who coordinate resources, life plan guidance and advocacy — tie in with expanded benefits under MA. Life managers tailor plans around resident needs, and are further informed by data analytics.
“All of that is supported by our technology investment, the creation of an electronic life record, which is really the layer that sits over the top of all these [electronic medical record systems] we have that don’t talk to each other,” said Kinne.
Lifespark offers MA plans, the accountable care organization (ACO) REACH model, along with institutional, dual-eligible and institutional equivalent special needs plans.
“We’re giving our partners an opportunity to participate in a downside or upside only risk arrangement. Being the risk payer gives us a lot of latitude to bring a new revenue stream to providers that they currently don’t have access to today,” said Kinne.
Its value-based model for SNFs has translated to higher revenue, decreased expenses and new value-based revenue, equalling 5%-15% higher net operating income for partnering operators, Kinne said.
“We’re certainly a magnet for new customers, we’re using this as a major selling point as families are considering where to place their mom or dad. The natural place that we’re going to direct people is either to our own buildings or that of our partners,” noted Kinne.
