Amid plans to launch the largest provider-owned institutional special needs plan (I-SNP) in the U.S., Brickyard Healthcare is also making sure it surpasses certain other challenges facing the sector.

Along with this endeavor, eliminating agency use, preparing for managed Medicaid in Indiana, and being ready to face the staffing mandate, have all been top of mind for Brickyard Healthcare’s CEO Wesley Rogers.

Rogers sat down with Skilled Nursing News to discuss these developments and share plans for his organization to create the largest provider-owned I-SNP network with five other operators, scheduled to go live in January 2025.

Rogers also shared Brickyard’s staffing initiatives, and how the organization is focusing on its workforce from different angles by bringing in 100 nurses from the Philippines while also paying for certified nurse aide licenses and adding up to $10 an hour for caregivers who have perfect attendance or pick up extra shifts. All in all, it’s been about bolstering the workforce with short- and long-term solutions. 

Brickyard operates 23 locations in Indiana.

This interview has been edited for length and clarity.

What does Brickyard have planned for the future?

We’ve joined a partnership with five other providers in the state of Indiana to form our own I-SNP. We’re doing the network development for that this year and we’ll go live in January 2025. It’s the largest provider-owned network in the country. At this point we’ve got close to a couple 100 buildings participating in this program.

The six of us are working together and it’s been unique and exciting to collaborate and work together to deliver a high quality care model.

So Brickyard has really been focusing on reducing its agency use in the last year or so?

We’ve been focused on our core assets that we have for the last couple years, going through the pandemic. We recovered our census about a year prior to the industry recovering.

Last year was particularly challenging, getting out of temporary agency. Staffing has been an essential area of focus for us. We’ve stabilized and we’re almost entirely out of agency at this point in time. That’s really helped us a lot with being able to deliver the care that we want with the folks that are working for us, having the education and training that they need to provide the best care.

We have one building that is just on the verge of being entirely agency free, but we’ve eliminated it and it’s been out in most of our buildings for about five months.

Talk about the different tactics to get to this point in agency staff reduction.

We have our own internal recruiting team. We have five full time employees that focus on staffing, interviewing qualified candidates for us to bring into our care centers. That was really essential for us to have that level of focus on full time recruiting efforts.

We have CNA mentorship programs, RN mentorship programs, administrator in training programs, director of nursing services programs as well. We don’t have our own CNA classes but we pay for people to get their CNA license.

Any subsidies or incentives you’ve added for caregivers?

We have a lot of special pay options for caregivers, especially the frontline staff CNAs. They can make up to $10 an hour more through special incentive pay programs like perfect attendance, picking up additional shifts; there are a lot of opportunities for them to have incentive to make up to $10 more an hour.

Any other moves you’re making in anticipation of the federal staffing mandate?

We’ve been preparing in advance for situations like this, and just on our own independently wanting to have a higher level of clinical oversight, care and consistency. We hired 100 nurses from the Philippines; we’ve been working on that project for a year and a half. We’ve got about 20 that are here now and over the next nine months and we’ll have the remaining nurses join our organization. It’s been a really exciting project to work on. We have a three-year commitment for those nurses to work for us with an employment agreement.

We do believe that we need more RNs working at the top of their licenses in our business, and that’s one of the reasons why we went to the international nursing recruitment option.

Looking ahead, are there any other trends you have your eye on?

One of the biggest changes we’re seeing is the increase in Medicare Advantage penetration throughout the country. There’s challenges with Medicare Advantage and insurance companies that manage those plans and how we get paid, denials.

There are a lot more resources that we have to provide to participate in Medicare Advantage programs. Weekly updates with the insurance companies can be very time consuming, we don’t necessarily need to do that with Medicare. We do have a significant loss of revenue with Medicare Advantage versus traditional Medicare.

Indiana is a pretty unique state. We have a high Medicaid population. About 80% of our residents are Medicaid in the state of Indiana. We’re going through a process that’s going to go into effect July 1, where we have managed Medicaid introduced instead of a state-run Medicaid program, and so we’ve been working through all the challenges with that. It’s similar to what Illinois has, and Ohio and Arizona. So the state of Indiana has outsourced that to three different managed Medicaid providers that are commercial providers. It’s Anthem, United Healthcare, and Humana. Most states still run their own plans.

We’re seeing challenges with managed Medicare, or Medicare Advantage. How will managed Medicaid be different from what the state has now?

We’ve got a strong coalition of providers that are active and are in advocacy for what our needs are and what our expectations are. One of the concerns about moving to that model was, we had a really good payment and reimbursement system. The state has helped support us in putting safeguards in place with insurance companies.