Longevity Health Plan and Humana Inc. (NYSE: HUM) announced a partnership to expand institutional special needs plan (ISNP) offerings that support the requirements of Medicare-eligible individuals living in skilled nursing facilities.
The partnership will begin in South Carolina and Georgia this year and will expand to additional states in 2024 and 2025. The two companies are “committed” to being in more than a dozen states, according to a press release issued Thursday.
“Those are markets that we mutually identified based on the overall opportunity based on interests of skilled nursing facility operators,” Marc Hudak, Chief Growth Officer with Longevity, told Skilled Nursing News. “And these were two sets of markets where Humana already had a strong presence.”
Hudak said that most value-based care models aren’t designed with skilled nursing operators in mind.
“They’re not designed for the skilled nursing facility operator, they’re designed for the PCP, the specialist, and the hospital system,” he said. “This one is uniquely focused on empowering the skilled nursing facility to take a leadership role.”
Longevity ISNPs offer exceptional transparency for skilled nursing operators, Hudak emphasized, adding that the open exchange of information drives improvements in clinical and cost outcomes. These results in turn lead to financial upside for operators.
The clinical plans are Medicare Advantage plans that combine Original Medicare (Parts A and B) with prescription drug coverage (Part D) and are designed for members with special needs or characteristics, like those living in long-term care facilities.
According to the company, the model provides an onsite, dedicated advanced practice clinician for comprehensive care management, coordinated and collaborative care with facility staff and physicians to provide care in the facility and prevent unnecessary hospitalizations, preventative and hearing aid coverage, an over-the-counter benefit to cover health and wellness products, $0 copays for primary care and behavioral health visits, transportation to medical appointments and other supplemental benefits.
Hudak said that the ISNP market is an exciting growth segment for national health plans.
“When you look at the ISNP, [the] target addressable market is around a million people,” he said. “And when you look at the data, a little more than 100,000 people are enrolled. So when you do the math, and you compare the penetration for ISNP versus MAPD [Medicare Advantage with Part D], it’s 10% versus 50%. So it’s a very large population.”
Hudak said the marketing focal point will be to engage with local skilled nursing operators who are committed to value-based care and treating residents in place, working with facilities to identify what the “value proposition” is for members.
“We go through a process that’s required through CMS where we have something called the ‘permission to contact’ and once we have permission to contact we engage with that member if they’re able to make decisions on their own,” Hudak said, although he noted that most members have a family member make decisions for them.
Hudak said that for smaller operators looking to build a strategic value-based collaborative ISNP model, working with national health plans can be more beneficial than trying to create their own ISNP.
“What makes our model unique is that in our partnership with these national health plans that have licenses, contracts with CMS, they have comprehensive networks that are already very well-established with value-based partnerships across the country,” he said. “They’ve got strong capabilities because they serve millions of Medicare Advantage members every single day.”
Longevity has also partnered with another national insurance company, Aetna, with a co-branded product serving about 500 beneficiaries in Pennsylvania.
