This article is sponsored by Theoria Medical. In this Voices interview, Skilled Nursing News sits down with Kevin Pezeshkian, Chief Strategy Officer, Theoria Medical, to talk about why SNFs should partner with physician groups to enter into value-based care arrangements. He explains how SNFs can equip themselves to be more successful in value-based care models, as well as the benefits of partnering with physician groups instead of convenors. He also provides an outlook on the future of skilled nursing and what it holds for Theoria and its clients.
Skilled Nursing News: What life and career experiences do you most draw from, in your role today?
Kevin Pezeshkian: We’ve been in this space for about five years now. We’ve shaped our business by continuously taking feedback and lessons learned from the different clients we work with and incorporating them into our operations. I certainly reflect on some of the earlier challenges we faced when breaking into the sector, and I use those experiences to shape our new programs, features, and the overall direction we’re taking our organization. It’s all really based on partner and provider feedback through the experiences that we’ve had, and I am constantly drawing on those encounters in my role today
Where do SNFs fit into the value-based care equation as that movement takes shape?
SNFs are in a very good position to work with value-based models. Historically, they’ve been neglected. In terms of what we’ve seen with bundled payments, ACOs, and similar models, SNFs are often viewed in a negative light, with efforts to reduce SNF spending and utilization as much as possible. We see this differently. We really believe that SNFs are well-suited to be successful in the value-based care world, particularly because of the higher cost and acuity of the patient population. There are many opportunities for developing more innovative models and leveraging those models to drive success, shared savings and outcomes in the value-based care world.
SNFs haven’t adopted these models as much as other sectors of the health care system. However, that’s starting to change significantly as folks realize that SNFs are very well-positioned to be successful in value-based care – particularly the High Needs ACO REACH program.
How can SNFs equip themselves to be successful in value-based care models?
SNFs in particular need strong partners to be successful in these models. Many entities are participating in value-based care, and SNFs need to find the right partner that aligns with their values, goals, expectations, and vision for where they want to go with value-based care.
Establishing and evaluating the right partnerships to enter into this is very important. Some SNFs have tried to enter into this arena themselves by standing up their own Medicare Advantage plan. Those models are great too, but they require a lot more sophistication, and I don’t know if that’s right for everyone. Finding the right partner is one of the biggest keys to success for SNFs in the value-based care continuum.
Why should SNFs partner with physician groups and not conveners?
Our philosophy is that you must have a robust clinical model and infrastructure coupled with technology to drive the outcomes and metrics relevant for success in value-based care. We strongly believe that medical groups are in a great position to achieve this. Conveners often don’t focus as much on the clinical aspect as medical groups do, and we’ve observed that those who have failed in the value-based care world typically try to implement these models just with a convener, without considering the necessary clinical infrastructure and technology to support successful outcomes.
It’s one thing to implement a value-based model, and it’s quite another to execute it successfully. We firmly believe that execution starts with strong clinical care delivery and having the necessary technology to support it. This is a principal reason why we believe SNFs should partner with medical groups, as they are well-positioned to drive the critical outcomes and metrics for success. Then, you can design the model to ensure that these groups are aligned in terms of their outcomes and goals with those models as well.
How does High-Needs ACO REACH program interact with iSNPs? Do they compete with one another, or is that dynamic different?
The common misperception is that ACOs compete with iSNPs, but we don’t believe that’s the case.
The way you structure the partnership will depend on each organization’s goals and their relationship with the iSNP plan. It’s true that iSNPs and ACOs are mutually exclusive, meaning patients can be in one or the other, not both. However, if organizations have an iSNP or want to implement one, they can do so effectively because you won’t achieve 100% penetration with your iSNP.
There will always be a subset of the population that opts not to join, and that’s where the ACO provides a perfect fit — it allows targeting those individuals through a Medicare program without them having to change their health insurance. This offers a much lower barrier to entry compared to an iSNP. By coupling both models, you’re able to capture a larger segment of the patient population with value-based care models than if you operated with just one.
What’s on the horizon for Theoria and its clients?
We’ve been diligently building our infrastructure and fine-tuning our technology to support our operations, leveraging strong analytics capabilities necessary for success in value-based care. Moving forward, we plan to continue evolving our model, implementing feedback from our partners, and applying lessons learned from our ACO to develop better solutions for managing our patient population. Our growth as an organization and expansion of our client base have been significantly catalyzed by the ACO, drawing considerable interest from potential partners across the country. We plan to build on this momentum and the valuable insights we’ve gained.
Finish this sentence: “In the skilled nursing industry, 2024 will be defined by…”
… strong clinical partnerships.
Editor’s Note: This interview has been edited for length and clarity.
Please contact Theoria to learn more about how you can participate in value-based care today: https://theoriamedical.com/partner-with-us
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].