This article is sponsored by American Health Partners. In this Voices interview, Skilled Nursing News sits down with Bridget Grover, VP, TruHealth, to learn about why provider-owned Institutional Special Needs Plans (I-SNPs) are growing so fast, and the advantages for the nursing home operator to own their own Medicare advantage plan. She explains how TruHealth is partnering with providers to help them navigate this changing landscape, and she also breaks down some of the key determinants of success for SNFs participating in a value-based model.
Skilled Nursing News: What career experiences do you most draw from, in your role today?
Bridget Grover: I started my career as a physician assistant and served the inner city population of Wichita, Kansas, which is where I grew my passion for not only improving patients’ lives, but also for how we deliver health care, in general. The clinic received a grant, which enabled us to get a medical RV and travel to areas of the city that needed health care the most.
Many of the individuals we served didn’t have the ability to get to a clinic or pay for care, and this opportunity created a deep-seated desire to meet patients where they are and provide them with the care they deserve. TruHealth does the same work every day by providing great care to some of the most vulnerable populations where they live, which includes skilled nursing facilities, assisted living communities and the community at large.
What do you find most rewarding about the work you do every day, and how have you been able to leverage that to make the greatest impact at TruHealth?
The most rewarding part of my work is being a true partner to the nursing homes that we serve. Since our clinicians have small caseloads, they become ingrained in our partner facilities, which allows TruHealth to fill in gaps with extra hands.
A recent study I read showed that nursing home facilities can improve quality of care and reduce hospitalizations with increased staffing — this is where TruHealth can make a significant difference. We help nursing facilities meet residents’ complex health care needs by providing TruHealth clinicians that serve alongside nursing home staff to educate, empower and enable the appropriate care.
Who does TruHealth serve, and what differentiates it from other fee-for-service providers?
TruHealth serves as the clinical team for American Health Plans, which is a sister company that operates the Institutional Special Needs Plans (I-SNPs) and Medicare Advantage Plans. We’re currently in 11 states, and American Health Plans serves more than 6,000 members in nearly 400 nursing homes. TruHealth nurse practitioners and physician assistants serve I-SNP members by providing holistic, proactive patient-centered care.
We believe TruHealth is innovative because we’re fundamentally changing the way we care for vulnerable populations. These patients are often very frail, with a high degree of complexity. Our model of care is built on the foundation of providing holistic, coordinated care to improve the quality of life of these patients. We also serve the members’ families as we strive to be a center of information and communication for their loved ones.
Often, families are scared and confused during this time. We do a lot of education on disease trajectory to ensure the family understands the next steps and course of action. We also serve physicians and other clinicians in the facilities because we’re not fee-for-service. We have the time to provide extended education on topics like advanced care planning, which can often take a long time to conduct. Then, finally, we serve the staff in the nursing homes by working alongside them to help provide great care for the residents.
What does a value-based network need to be successful, especially in skilled nursing facilities, which care for high-cost, high-acuity patient populations?
Skilled nursing providers need three key elements to successfully transition to a value-based model: a strong insurer that believes in its partners, a designated medical provider, and a value-based, care-conscious nursing home operator.
First off, an insurer like American Health Plans, which believes in its partners and has the acumen, financial strength and willingness to invest, offers providers latitude to implement a system of value-based care. Second, TruHealth as the medical provider gives SNFs access to advanced practice clinicians with the knowledge and appropriate structure to provide proactive patient-centered care. This allows for patients to stay healthier longer and reduces unnecessary hospitalizations.
Finally, we need a nursing home operator that embraces the value-based model of care. This operator must be willing to let the medical provider come in and disrupt the status quo of fee-for-service care to install a value-based model that will improve the health and quality of the residents. Our TruHealth team of advanced practice providers has expanded the capabilities of the existing clinical staff in the nursing home.
Of the 100,000 I-SNP members nationwide, roughly half are RN provider-sponsored plans. Why do you think the provider-owned I-SNP is growing so fast, and what are the advantages for the nursing home operator to own their own Medicare advantage plan?
A provider-owned plan allows the operator to directly benefit from their efforts instead of boosting the bottom line of a large insurer. In fact, American Health Plan’s partners received nearly $10 million in shared savings, in 2022.
The goal of value-based care is to align partners’ or providers’ incentives with outcomes, and ownership accomplishes that. With the help of TruHealth, our provider partners have seen a decrease in hospitalizations, with both ER and inpatient admissions, by approximately 40%.
What does the future hold for TruHealth?
I believe the future is bright for TruHealth. We are constantly seeking opportunities to innovate and provide the most up-to-date care. Throughout COVID, we stressed the importance of being gap fillers who truly partnered with our facilities to provide excellent care. That may look like assessing patients’ current medications for their long-term comorbidities, helping to check resident blood sugars, or even helping to pass out water.
TruHealth clinicians are really intentional about walking alongside our partners to provide the care and services needed each day. We serve our patients the way we would want our loved ones served, which provides a different perspective on caring and partnership. This is what we do every day, and it sets TruHealth apart from the rest.
Finish this sentence: “The skilled nursing industry in 2023 will be the year of…”
…recovery.
Editor’s note: This interview has been edited for length and clarity.
As a division of American Health Partners, TruHealth contributes to the company’s continuum of care and benefits from its expertise acquired over three decades. TruHealth’s providers expand patients’ access to care and may act as care managers for specialized for American health Plans’ Medicare Advantage health plans serving residents in long-term care communities. To learn more, visit https://ourtruhealth.com/#home.
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].