This article is sponsored by CareConnectMD. In this interview, Skilled Nursing News sits down with Kim Phan, CEO and Co-Founder, CareConnectMD, to talk about the growth of accountable care in skilled nursing, and what the future holds for providers as the industry evolves. She discusses the driving forces behind the formation of CareConnectMD and explains how the organization we’re partnering with provider groups and SNF operators to help drive the industry forward.
Skilled Nursing News: What life and career experiences do you most draw from in your role today?
Kim Phan: I live in a multi-generational Vietnamese family, and I’ve experienced firsthand how challenging it can be to access and navigate the health care system, especially when my dad was diagnosed with lung cancer. My personal journey in supporting my parents has deeply inspired me to create companies focused on caring for the sickest populations. In my current role, I have the privilege of helping the most fragile and medically complex patients, many of whom reside in nursing homes.
We collaborate with physicians in nursing homes to develop an interdisciplinary care team model. Our objective is to lower barriers to care and enhance the quality of life for the patients we serve. I am truly proud of our clinical culture. Our Chief Medical Officer, Dr. Idylle, is especially passionate about fostering a culture of caring to ensure the best possible outcomes for our patients, their families and our clinicians.
Why was CareConnectMD formed, and how is the organization impacting the skilled nursing industry as a whole?
Early in my career, I was the administrator of a 99-bed nursing home owned by a health plan. During my time there, I saw the need for improved coordination in primary care for nursing homes. In 1996, along with my partner, Dr. Christine-Mlot, we established the first skilled nursing facility (SNF) medical group in Southern California. It was then that we began to introduce nurse practitioners into nursing homes, a practice that was not common at the time, and our work primarily involved managed care organizations. That marked our entry into the field.
The medical group continues to provide services and has been the foundation for our high-needs Accountable Care Organization (ACO). In 2002, we launched a hospice company that collaborated closely with Medicare Advantage plans, eventually becoming the second largest in Southern California through joint ventures with these plans. Over the past five years, we have also provided palliative care services for Medicaid plans in California. Currently, our focus is on expanding our high-needs ACO. We believe that the insights and experiences gained over the last 30 years have been instrumental in our early achievements.
From a macro perspective, describe the growth of accountable care in the long-term care industry. How do nursing facilities fit into this picture?
Combining Medicare Advantage with ACOs, about 70% of Medicare beneficiaries are currently in an accountable care relationship, and this number is steadily increasing. It’s fair to say that, until now, nursing homes haven’t reaped the benefits of the shift from fee-for-service to managed care. However, I believe this is on the brink of change. ACOs — especially high-needs ACOs like ours — offer nursing homes a unique opportunity to leverage their position, control both quality and economics, and importantly, shape their strategic future.
For the first time, nursing homes can take the initiative in managing costs and quality for a vulnerable population and become key players in achieving the goals set by the Centers for Medicare & Medicaid Services (CMS).
What is High Needs ACO Reach, and how do nursing homes have an opportunity to participate in accountable care today that they didn’t previously have? What is CareConnectMD’s involvement in the program?
Historically, Institutional Special Needs Plans (I-SNPs) have been the primary alternative for nursing homes. However, CMS introduced the high-needs ACO model in 2021, which we believe is ideally suited for the demographic served by long-term care nursing homes. The high-needs ACO REACH program significantly differs from other ACO models. There are three types of ACO REACH programs, and ours is a high-needs ACO REACH. We are one of only 14 in the country, which tends to cause a common confusion about high-needs ACOs.
The distinctiveness of high-needs ACOs lies in the fact that although only 10% of Medicare beneficiaries qualify for high needs, yet this small group accounts for almost 50% of Medicare expenditures. A significant portion of this cohort resides in nursing homes. The early experiences with high-needs ACOs have shown that care for this population, given through the value-based care model, can not only be enhanced but can also generate savings. Our current mission is to effectively communicate the advantages of a high-needs ACO to nursing homes.
How are you working with nursing homes to help them make this shift to accountable care?
Unlike other ACOs, we improve facility staffing with our own clinical resources by bringing in nurse practitioners and care managers to assist with managing at-risk patients. These patients are often very frail, fragile, immobile and generally in the last two to three years of their lives, constantly facing the risk of hospitalization. It’s important to have resources that can respond immediately, and we prioritize rapid engagement. Responding swiftly to calls is critical.
For two decades, we’ve been committed to providing compassionate direct care to post-acute and high-needs patients. We have been pioneers in advancing care for this vulnerable population.
Where is accountable care going in the future of the LTC market?
Overall, we see that the shift towards value-based care is evolving and is here to stay. It’s important for nursing homes to have a seat at the table, especially considering the significant costs associated with this population, which makes up only about 10% of the Medicare demographic but requires a significant amount of attention. Nursing homes cater to the majority of long-term care patients, and CMS has tailored the high-needs program specifically to align with their structure and patient cohort. We are keen on partnering with nursing homes that share our perspective and goals.
Finish this sentence: “In the skilled nursing industry, 2024 will be the year of…”
…transformation, as more nursing homes will recognize the value of partnering with a high-needs ACO.
Editor’s note: This article has been edited for length and clarity.
CareConnectMD provides compassionate, patient-centered, and high-value care to its patients and their families when they need it the most. They are revolutionizing healthcare for fragile and vulnerable populations through compassionate, team-based, and innovative care, while building loyal partnerships with their patients, families, facilities, and communities. To learn more, visit https://www.careconnectmd.com/.
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
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].