This article is sponsored by American Health Plans. In this Skilled Nursing News Voices interview, Marybeth O’Connor, National Director of Business Development for American Health Plans, explains why nursing home operators are increasingly looking to the provider-owned ISNP model to improve financial performance and achieve superior clinical outcomes. She also offers her outlook of the future of the ISNP market and how innovative new partnerships are writing an exciting new chapter in the Medicare Advantage space.
Skilled Nursing News: What career experiences do you most draw from in your role today?
Marybeth O’Connor: Earlier in my career, I worked with large self-funded employer groups introducing population health strategies to improve the health outcomes of their high-risk employees. This experience dovetailed perfectly into my work with the frail, long-term care nursing home demographic. There were some obvious differences, but both groups need benefits that would improve health outcomes. ISNP Medicare Advantage plans are designed to specifically fit the needs of the long-term care resident. Plans like ours bring primary care support to the bedside and really ease the administrative burden on facility staff as they have to manage fewer Medicare payors.
I’ve worked with ISNPs for over 12 years. I believe in it. I believe it’s the best Medicare plan option for long-term care residents and for the nursing home owners and operators that serve them.
When done well with a partner offering clinical support, like we do through our TruHealth care management team, and financial support, the ISNP is an asset for our partners. Seeing that partnership strategy work is so rewarding.
With your extensive experience working for large insurers and more than a decade in the ISNP space, why do you think the provider-owned model is growing so rapidly?
The ISNP model is by no means a new concept. It’s proven. It’s no longer a novelty. Currently, there are over 100,000 ISNP members and that number grows every month. The ISNP space is now a 3-billion dollar market and the provider-owned ISNPs make up almost 50% of the market share. So, the ISNP model is established.
More nursing home owners are choosing the provider-owned model and are opting out of signing just another contract with a large insurer. The provider-owned ISNP model offers a genuine partnership that you just don’t get in a standard insurance vendor contract. We always ask our existing and prospective partners, “Would you rather be a rate taker, or do you prefer to own the Medicare Advantage plan yourself and take better control of the clinical outcomes in your nursing home and reap the financial rewards for providing better care?”
What are the key differences between a provider-owned ISNP and more traditional types of plans offered by large Medicare Advantage insurers?
I’ve had the opportunity to work with various insurance providers, including the largest insurance company ISNP and the American Health Plans provider-owned ISNP. From my experience, there’s a clear difference between the two. As nursing home owners ourselves, we understand nursing home operations. We manage our ISNPs and advise our nursing home partners from a provider’s perspective. We’re not just collaborating — we’re building a genuine partnership. We are living this with our partners. We are both investing capital to create the ISNP, and our investment ensures that we support our partners and provide them with the strategic, financial, and clinical resources that they need to be successful.
Of course, this partnership only works if we deliver on our promises. Our TruHealth care management team works with and reinforces the facilities’ interdisciplinary care team. They create specific care plans for each member, work with nurses and doctors to coordinate care, and make sure that these proactive care services are leading to better clinical and financial outcomes.
What about those smaller operators who may think they don’t have the resources to invest in owning a Medicare Advantage plan? Do you have ways of partnering with them?
Some nursing home owners and operators believe that being provider-owned means they have to invest money upfront. But that’s not the only way. While many do choose to invest, these smaller facilities can also enjoy the benefits of a provider-owned ISNP partnership without a capital commitment. We can be flexible and work with small nursing home owners. In fact, a growing number of our members today are from nursing homes that we have a contractual partnership with.
When you partner with American Health Plans through a contract, you still get to benefit from our experience, our knowledge from managing our own nursing homes, and our expertise in a complicated ISNP model of care. We successfully manage provider-owned ISNPs across 11 states, working with over 30 partners and 400 nursing homes. You also have the support of our TruHealth clinical team at no additional cost.
Going solo or just being another client to a big insurance company doesn’t compare. Trying to set up an ISNP by yourself can be tough. But with American Health Plans, our successful track record can benefit both our equity partners and those we have contracts with. We want to help you be successful from day one.
What is the one piece of advice you would offer to a nursing home operator thinking about investing in a provider-owned ISNP?
Switching from traditional Medicare to an ISNP is like seeing things in a whole new light. If you’ve made the decision to embrace value-based care, you have to go all in. Everyone in your organization needs to buy in and be value and quality-focused. This shift means you’ll be talking to your local hospital differently; you’re talking to payors in a new way. It’s really a fundamental shift in the way your organization thinks about what you do.
Once you’re set on value-based care and investing in an ISNP, picking the right partner is the next critical choice. Who you collaborate with matters. When people ask us how to pick the best partner, we say: ask around. Are the ones you’re thinking about teaming up with recommended by others who’ve done well with their plan? Have their partners seen real benefits?
I can proudly share that at American Health Plans, from 2020 to early 2023, we paid over $15 million to our partner facilities through our shared savings program. With the help of our TruHealth care management team, our ISNP partners have seen 30 to 40% fewer unnecessary hospital and emergency room visits.
The right partner can truly make all the difference.
In your role, you have to pay very close attention to the changing dynamics in the Medicare Advantage market. What are some of the key trends you’re watching and how is American Health Plans positioning itself to seize new opportunities for growth?
An emerging trend in the Medicare Advantage market is the ISNP offering more ways to work together with your healthcare community that go beyond just the nursing home. Now, things like community-based Medicare Advantage plans and PACE programs see that people in nursing homes might benefit from stronger care right where they are.
When nursing home owners partner with a Plan like American Health Plans, they can use that to make more connections in their healthcare community. The ISNP can create opportunities to work with hospitals, physician groups, or payors to provide high-quality, affordable care to nursing home residents all under one roof. Care initiatives, like SNF At Home, are also possible in this model.
In a couple of words, finish this sentence: “In 2023, the skilled nursing industry has been defined by…”
…the importance of being proactive rather than reactive. Providers have never felt more pressure than they feel right now whether it’s increasing census, staffing, changing regulations or reimbursement. At American Health Plans, we focus on long-term thinking instead of just getting through the day. We want to create a value proposition that puts the nursing home owner in control of their own destiny with better clinical support and financial stability, even in an unstable operating environment. We want to be that steady partner they can rely on to navigate a rapidly changing landscape.
Editor’s Note: This article has been edited for length and clarity.
American Health Plans is a leader in the provider-owned Medicare Advantage industry. American Health Plans operates the fastest growing provider-owned Institutional Special Needs Plan (ISNP) in the U.S., with more than 30 provider partners and plans in more than 400 nursing homes across 11 states. To learn how American Health Plans can help your SNF improve its clinical and financial outcomes, visit: AmHealthPlans.com.
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].