In this Payment Perspectives interview, Skilled Nursing News is joined by Mark Price, CEO, Curana Health, to talk about what skilled nursing providers can do to navigate the current payment landscape and get paid for the extra value they provide. He explains how providers can leverage proprietary data to show payers the value they are providing, and he also discusses the role of health care technology amidst the current industry transformation.
Skilled Nursing News: What do you think skilled nursing providers need to do differently given the current payment evolution?
I see three things that they need to do differently. No.1 is acknowledging the massive change that is coming to the entire health care ecosystem as it shifts to value-based care. In particular, all of their referral sources are going to be moving to value-based care programs over a period of time.
No. 2 is ensuring they’re creating the most value possible based on how it’s measured in value-based care programs. Then No. 3 is setting up mechanisms to get a fair share of the value they’re creating.
How can skilled nursing providers prove their value to payers?
Let me first say it’s not just payers. Eventually, it’s going to be every referral source, whether it’s a payer, a hospital or a medical group — they’re all moving in this direction. Medicare Advantage has been down that path for a long period of time, but increasingly there are ACO programs and everything else. I think it’s really going to be about how they prove their value to everyone.
Everyone is going to care about this, and everyone is going to get so much more sophisticated than they are today. Those are the conversations I have with payers on a very regular basis: how they look at data more efficiently. All referral sources are going to get so heavily involved in this space, and the data’s going to get so much richer and more sophisticated over time.
There are four key things that payers and other referral sources care about and will care about.
No. 1 is the total cost of care for members. The next is optimizing the revenue that they get from each member. No. 3 is quality scores. And No. 4 is member satisfaction.
However, simply doing those four things is not enough. You also have to be able to demonstrate that you’re doing them, [and there is a] massive asymmetry in information, because payers have all the data. SNFs have to capture their own data to justify what’s a fair share of the value they’re creating. You need to do all of those things and demonstrate that you’re doing them, because the payers, out of the goodness of their hearts, are not going to come and offer you the upside.
Are there separate quality-related metrics driving those four things?
There are separate metrics for each of those four areas that can be measured at a facility level and that payors look at. Providers that are successful in these areas can negotiate better agreements with payors, or better yet they can become an owner in an ISNP and keep all of the value they are creating.
How do you see health care technology supporting the shift to new payment models?
I think value-based care wouldn’t be possible without health care technology.
When you look at the rise and fall of HMOs in the ’90s compared to today’s rise of value-based care and managed care, I think the biggest difference is that it’s all underpinned by technology now, which allows us to make much better decisions. It allows us to measure results more effectively than we could before. I think technology has enabled value-based care to take off today, when managed care HMOs failed 30 years ago in the absence of all the technology.
In particular, one of the things that matters most is that you can collect data from a variety of different sources, bring that data together, then activate it in a powerful way. Activating the data generally means putting it in front of clinicians who can use it to make great decisions. Things like swiftly identifying a deteriorating health status in one of your residents so you can take the proper course of action. Data has enabled value-based care to work in a much more powerful way than it used to.
Finish this sentence: “If I could change one thing about the healthcare payment landscape, it would be…”
…ensuring high performing health care providers get much better compensation for the work they do.
Finish this sentence: “The future of health care payment is…”
…value-based.
What is one of the misunderstood aspects of skilled nursing payments or value-based care that you would like to debunk?
I think the biggest myth about skilled nursing payments is that skilled nursing care is too expensive. The reason I think that’s a myth is because skilled nursing care is far less expensive than acute care, and skilled nursing could be used for many situations today.
I think there’s a massive opportunity to save CMS billions of dollars per year by doing more in the skilled setting and less in the acute setting. With the public health emergency going away in May, the three-day stay waiver will go away with that — but our ACOs and Medicare Advantage programs will forever have the three-day stay waiver. In those programs, we can always see people without a qualifying three-day admission. The data is very clear that when you use that data in an appropriate way, it’s better for the patient, for CMS, and it’s certainly better for the SNFs as well. It’s not too expensive, and there’s a major opportunity here.