Inside Good Samaritan’s Strategy to ‘Reimagine’ Care Through Its Restructuring

Exiting 15 states will enable the Evangelical Lutheran Good Samaritan Society to invest more resources into creating an integrated model with parent company Sanford Health, with a goal to deliver “cutting-edge care” to older adults regardless of where they reside.

That’s according to Good Samaritan CEO Nate Schema, who believes that for Good Sam and other senior care providers, “the status quo isn’t going to work anymore,” considering how the market has shifted throughout the Covid-19 pandemic.

The Good Samaritan Society is taking dramatic steps to shake up the status quo; last week, the nonprofit announced the plan to trim about 30% of capacity from its large portfolio of skilled nursing facilities and other senior care communities. The organization operated more 150 nursing homes at this time last year.

Sioux Falls, South Dakota-based Good Sam joined forces with Sanford Health in 2019. Also based in Sioux Falls, Sanford describes itself as the largest rural health system in the United States, with 47 medical centers and 224 clinics.

“We see it as one of those really unique times where we can reimagine ourselves, and look ourselves in the mirror and say, ‘What do we want to be moving forward … as a new integrated health system, four years into this relationship with Sanford Health?’” Schema told Skilled Nursing News.

‘Where the integrated care model really comes to life’

The process of narrowing the portfolio to seven states will take one to two years, Schema estimated. Cascadia is on tap to acquire 10 communities in the Northwest, and further transitions will be announced over time.

With regard to job reductions at the corporate level, Schema said that the company will “continue to make adjustments in time and over time,” but he does not anticipate a “huge reduction.” 

Once the restructuring is accomplished, Good Samaritan will have more resources to invest in its core markets, which have the greatest overlap with other Sanford Health locations and services.

“We see opportunities to reinvest, whether that’s new communities or new service lines, additional home and community based services; there will be additional expansion of virtual care,” Schema told SNN. “It could be opportunities to reinvest in some of our current communities that might be a little tired.”

A major goal moving forward will be to create a more seamless continuum of care, building on work that has been ongoing since Good Sam and Sanford combined.

Already, the combined entity has been able to better organize the workforce to avoid multiple levels of hierarchy within a given market, Schema said. He also highlighted pilots in several large markets to more effectively share information across the continuum, to streamline transitions from acute to post-acute care.

“We don’t have it 100% figured out, but I can tell you, we’re well along the path, and we continue to make improvements,” he said. “It comes together when we’re able to surround our communities with all these different resources and investments, and I think that’s what this strategy allows us to do.”

Enhanced virtual care is one major tool to be deployed to achieve these goals. In the fall of 2021, Sanford received a $350 million donation to support a virtual care initiative.

“We see virtual care as the infrastructure and the construct that might take us into a whole new generation of providing care across that continuum,” Schema said.

The idea is to bring virtual care into all Good Sam communities as part of one integrated and interoperable system, with seamless transfer of information across the greater Sanford platform.

Virtual care is especially critical to Sanford and Good Sam, due to the large number of rural communities they serve.

“Imagine a time where you can bring that cutting-edge specialty care, oncology care … into a rural skilled nursing facility, and bring it to the bedside and connect to a specialist in Sioux Falls or Fargo or another part of our system,” Schema said.

The Good Samaritan Society is not alone in its strategy to integrate skilled nursing and senior living communities within the larger health care system. Many providers are focused on value-based care strategies, given the rise of payment models that place a premium on being able to support population health and prevent costly interventions such as hospitalizations.

This trend is the “most exciting thing” in his three decades of work within the industry, American Health Care Association CEO Mark Parkinson said last month.

Being embedded within Sanford puts Good Sam in a position to be an industry leader in demonstrating how value-based care can redefine the skilled nursing model. Sanford has an associated health plan with about 220,000 members, and Good Sam offers a Medicare Advantage institutional special needs plan (ISNP).

But simply being part of a health system is no guarantee of success. The ProMedica health system was also aiming to create an integrated model through its 2018 acquisition of the former HCR ManorCare portfolio; this plan did not play out, and ProMedica now is transitioning 147 nursing homes to 15 regional operators.

Schema believes that the Good Sam restructuring will enable the organization to do the heavy lifting needed to bring a more fully realized integrated care model to life.

“I never want to oversimplify, but it often comes down to execution,” he said.

‘Game-changer’ for public policy

Good Samaritan’s new strategy is also borne out of the challenges facing the skilled nursing sector at the moment, such as a severe labor shortage and looming regulatory changes, including a potential federal staffing minimum.

In this environment, having an influence over public policy is crucial, and Schema thinks that concentrating Good Sam’s presence in key states will help in this regard.

“We’ve learned our advocacy efforts are at a totally different level where we have a significant presence in a state,” he said.

Recently, he sat down with Democratic Minnesota Sen. Amy Klobuchar to discuss workforce challenges, he noted. In states like Minnesota where Good Sam and Sanford have a “significant presence,” he and other leaders can get meetings with key state and federal officials “at a moment’s notice.”

“So, it’s a game-changer,” he said, of the decision to operate only in these key markets and continue to build density and influence in these locations.

And Schema believes future success will depend on both a successful strategic pivot and wins at the policy level — not only for Good Sam but for many other providers as well.

“It has to be a part of a very important concentrated effort to align your mission with the overall organizational strategy,” he said. “I think if you do that, and you can have those honest and open, collaborative conversations with policymakers — CMS, HHS — like we’ve been doing over the last year, I think the future can be very bright. But all those things have to come together.”