Success Stories, Medicare Advantage Trends Drive I-SNP Growth in Nursing Home Sector

With the end of the public health emergency, industry stakeholders said the development of Institutional Special Needs Plans (I-SNPs) are of more interest to skilled nursing operators than ever before.

Mark Price, Chief Executive Officer of Curana Health, said the interest level in I-SNPs has significantly increased in the past few months.

“With the end of the public health emergency, providers are seeking ways to continue providing skilled care without requiring a qualified three-day hospital stay for residents. I-SNPs offer a solution that benefits both residents and facilities,” he said. “This change has driven interest as providers realize the potential benefits for their residents and facilities.”


I-SNPs are a specialized type of Medicare Advantage designed to meet the healthcare needs of SNF residents by offering coordinated care, a specialized network of providers experienced in SNF care, comprehensive coverage for medical services, and personalized care plans tailored to each resident’s specific health needs and goals.

Price said the second reason for the rising popularity of I-SNPs is that I-SNPs have proven their effectiveness by demonstrating better health outcomes for residents and higher financial benefits for facilities across the country, regardless of size.

“There are numerous success stories, which have increased enthusiasm for the I-SNP model,” he said.


Still, he said, operational and leadership capacity may hold some facilities back.

“While many operators recognize the value of I-SNPs, they may be hesitant due to the ongoing stress and change management they are experiencing,” he said, adding that operators should consider if now is the right time to adopt a new care model while managing other challenges.

“There are partners available who can assist providers in navigating the change management process and alleviate some of the burden,” he said. “These options are encouraging, but bandwidth remains a significant barrier for some groups.”

No need to ‘reinvent the wheel’

Steve LaForte, Cascadia’s director of corporate affairs and general counsel, told SNN that the I-SNP concept started to come across their radar in 2017.

“We could see from other managed areas and other hospital and post-acute care relationships with [Accountable Care Organizations] that value-based care and risk taking were areas that were coming to the fore,” he said.

He added that with higher acuity, lower reimbursement rates, and increased expectations from residents and families, taking a risk on creating a new model made sense.

“One of the realizations that they came across earlier was to not try to reinvent the wheel,” he said. “You don’t want to become an insurance company because you’re not an insurance company, you’re a post-acute care operator.”

For operators, there are different paths available to develop I-SNP plans.

“Some providers choose to start their own I-SNPs, while others opt to contract with existing I-SNPs in the market,” Price said. “The former requires a longer process, usually taking about two years, and significant investment.”

He added that contracting with existing I-SNPs provides benefits without the extensive workload, capital requirements, and risk associated with starting an I-SNP from scratch.

“Some providers seek a middle ground by purchasing a minority stake in an existing I-SNP,” he said. “Ultimately, the choice depends on the provider’s goals, risk appetite, and available resources.”

After looking into different options, Cascadia decided to partner with American Health Partners to develop their I-SNP.

“Before we could pull the trigger, COVID hit, which caused us to take a step back and pause,” LaForte said. The Eagle, Idaho-based provider launched its I-SNP in January 2022.

“By that point, we were probably up to between 18 and 20 buildings in Idaho,” he said. “Today we’re at 25, so we’ve expanded the regions that we can work in.”

Rollout at the facility level

Paul Arnell is the President of Cascadia’s Envision Healthcare Region, of which 13 of the 15 buildings are part of the I-SNP.

Arnell said some of the buildings took ‘the bull by the horns’ and grew the I-SNP membership quickly to establish a strong presence in the building.

“Others were a little bit more hesitant and again, it boils down to education, and maybe a little bit of what was going on in the facilities at the time,” he said. “Back in 2022, we still had some issues with Covid and outbreaks and so trying to get in-person interviews with the folks at home made it very challenging to do the education.”

Arnell said the intended purpose of the I-SNP program is to assist facilities in effectively managing their long-term care patient base, adding value for patients and staff.

This additional support brings tremendous value and satisfies the desire for a personalized touch that all of us as providers crave and need, he said.

Arnell said the program has exceptional Preferred Provider Organization (PPS) support, providing social workers who engage with residents assistance in organizing birthday parties and celebrations throughout the month. Those special touches, he said, help expand the membership base.

“The primary benefit lies in the support the medical directors receive from the [Healthcare Preparedness Program] and the company,” he said. “This support includes additional oversight, audits, and clarity on data, which greatly benefits our management of this specific population.”

Arnell said that in the long run, as facilities can avoid unnecessary hospital transfers and achieve better results and outcomes, the program will have an impact on their star-rating, and ultimately, reimbursement.

“Specifically in Idaho, we have a quality measure program that helps influence our revenue stream from the Medicaid side,” he said. “If we maintain our quality measures and continue to achieve positive outcomes with our patients, we can expect improved reimbursement. So, definitely, it will help us.”

The rise of managed care and Medicare Advantage plans

Hank Watson, Chief Development Officer of American Health Partners, which has been developing assets with nursing partners around the country since 2017, said that with the rise of managed care and Medicare Advantage plans, there is more energy in the I-SNP area than ever before.

“There was a time when it was a new concept,” he said. “People were trying to understand what it was and how it fit into the shifting managed care landscape. Then, of course, the Covid-19 pandemic emerged and organizations had to focus on survival during that time.”

Watson said that today, nearly 80% of seniors are enrolled in a Medicare Advantage plan. He said that to be proactive rather than reactive to this changing dynamic, the I-SNP offers a clear approach for nursing homes transitioning from Medicare fee-for-service to managed care plans, allowing them to be proactive.

“There is likely an I-SNP provider in every market, making it easier for organizations to plug into an existing system rather than being the first to implement it,” he said. “As these factors converge, we are witnessing as much energy as ever around engaging with the I-SNP. The conversation is shifting from ‘What is an I-SNP?’ or ‘Should I do an I-SNP?’ to ‘What is the best approach for me to engage with an I-SNP product?'”

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