In this Payment Perspectives interview, Skilled Nursing News is joined by Jonalyn Brown, VP of population health and rehab operations for Consonus Healthcare — a provider of rehab, pharmacy and consulting services for more than 700 facilities nationwide. Through the lens of Consonus’s parent company, Marquis Companies, which operates 25 post-acute and senior living facilities and an I-SNP, Brown shares her insight on the steps providers can take to prove their value to payers in today’s evolving payment landscape. She explains what operators can do to foster a more proactive approach to value-based care, and she also shares a perspective on how technology is helping operators navigate this shift.
Skilled Nursing News: What do health care providers need to do differently when it comes to payment evolution?
Jonalyn Brown: For context, the health care industry is undergoing significant changes. We are witnessing the implementation of new laws, revised payment plans, and the introduction of novel terms and processes. This dynamic environment is creating a sense of urgency for providers across the country to adapt and embrace new approaches to patient care.
As a provider, my recommendation is to shift your focus and prioritize the assessment of value-based care strategies that align with your unique market trends, demands, financial capacities, and risk tolerance. It is crucial to understand the quality measures that are under review and implement workflows and processes that enable you to effectively measure outcomes. This alignment with value-based payment outcomes is essential for successfully meeting expectations.
Additionally, strategic positioning with primary payers in your market is vital. This positioning helps minimize the risk of being removed from their network or facing unfavorable economic changes. By demonstrating your value to payers, you establish a solid foundation for your practice.
How can skilled nursing operators in particular prove their value to payers?
From my experience, it is not uncommon to encounter situations where payers themselves may not fully grasp their own priorities. It becomes crucial to assist them in understanding what truly matters to their organization. It is also essential to demonstrate your success in achieving value-based payment outcomes, such as reducing length of stay, minimizing hospital readmissions and managing emergency department visits effectively.
To facilitate this, it is important to provide payers with the means to review and monitor your success in real-time, utilizing appropriate technology and infrastructure. This approach can ultimately enable payers to shift their risk to providers, fostering a more balanced partnership. Additionally, effectively communicating how your services positively impact the overall medical spending for the members you serve is critical. Consider developing a platform to market your services to payers, ensuring they recognize the value you provide.
What’s something that most SNF providers will need to change to keep up with the payment evolution?
First, providers need to change their mindset and gain a better understanding of how payers make decisions regarding network inclusion or exclusion. This understanding should encompass the associated risks in managing the population, both within and outside the network.
Providers should also recognize the risk involved when payers bring in a third party to manage the population, as this can diminish control for the provider, creating challenges.
It is important for providers to develop strategies and solutions that involve either building the necessary infrastructure and technology to support value-based payment, or collaborating with a partner who already possesses these capabilities. This proactive approach allows providers to stay ahead of payers’ expectations.
Each unique market, payer and provider should be treated differently. It is essential to assess their individual tolerance for financial investment and risk, considering the specific circumstances and dynamics at play.
For instance, if a payer is examining a subset population of individuals aged 65 and older with exceptionally high medical expenses and the payer lacks the means to effectively manage costs and care, they may find value in contracting with a third-party convener to oversee the management.
From a provider’s perspective, this situation raises concerns as it removes total control over negotiation and interaction with the payer. Additionally, providers may face misaligned expectations since the third party does not share the same risks as the provider and may have motivations or incentives that do not align with the provider’s goals. Working directly with the payer ensures better alignment.
How do you see health care technology supporting the shift to new payment models?
Implementing a technology platform empowers us as providers to impact our models of care and service delivery. This platform provides us and the payer with direct insight into the location of their members, enabling real-time monitoring. By leveraging this platform, we can achieve results that enhance the individual experience of care, improve health outcomes, and reduce the cost per capita of care for each member.
Fill in the blank: “If I could change one thing about the health care payment landscape, it would be…”
…making more proactive payment models versus reactive such as fee for service.
Is there an aspect of skilled nursing payments that you think is commonly misunderstood?
One of the common misconceptions is that all facilities receive reimbursement under identical payment models, which is not the case. Medicaid and Medicare Advantage can vary significantly from state to state and even among different providers. Another misconception is the notion that there is a set percentage of the total payment dollar attached to Value-Based Payment (VBP) methods currently, but in reality, we are still far from reaching that point. When comparing our current practices to the potential future landscape, there is a notable difference.