This article is sponsored by Longevity Health. In this Voices interview, Skilled Nursing News sits down with René Lerer, M.D., CEO, Longevity Health, to talk about the factors that have led to the company’s growth and its decision to create exclusive partnerships with national payers. He explains how his team is operationalizing value-based care in an impactful way to compete with larger players in the space. And he also provides an outlook on what the future holds for Longevity and its partners.
Skilled Nursing News: What life and career experiences do you most draw from in your role today?
René Lerer: I’m a board-certified internist and ran a practice in Connecticut for years. I’m a clinician above all else — that never goes away. For 40 years, I have been dedicated to ensuring that people get the right treatments at the right time and in the right setting. In the skilled nursing population, that’s critically important.
For many of us, the health care business is very personal. Our own experiences, with family members or ourselves or other loved ones, have informed our professional journeys. There’s almost always a story behind why someone is passionate about their area of health care. For me, it was my mother. She passed away at the age of 92 in a memory care unit dealing with severe Alzheimer’s. Watching how she lived in those final years, how she was treated, and what had the greatest impact on her quality of life helped shape my path. I still think about it to this day.
One of the things her experience taught me is that everyone needs an advocate. Everyone needs someone who cares, someone in their corner. Great providers advocate like they would advocate for their own family member and they advocate for that person’s total well-being. That’s not just a patient’s medical needs; it also includes their social needs and, importantly, what’s important to the patients themselves. When I think about my own experiences and history, it pushes me to think about what’s important to each patient and resident.
What are the key drivers behind Longevity’s impressive growth in recent years?
I’ll start with a little background. We set out initially to create a unique approach to caring for vulnerable seniors in institutional settings using I-SNP as the vehicle. We were essentially a clinical company with insurance licenses operating as MA plans. At the time, there weren’t many provider-owned I-SNPs where the SNF management team was partnering with the plan to create models that offered the greatest positive impact for their residents clinically/medically and for the SNFs themselves operationally and financially. Unlike today, none of the big insurance carriers (with the exception of one in particular), were focused on this population. So that left the market open for us to establish our own MA plans and clinical programs in partnership with the SNFs.
Over time, interest in the short- and long-term post-acute population grew dramatically. The long-term SNF population and I-SNP just hadn’t been an area of focus, so it’s historically been a highly underpenetrated market for Medicare Advantage. But post-Covid, and with current and expected growth in this vulnerable population, we are able to materially expand our national footprint and the number of residents we serve.
The theme throughout our evolution has been consistent – a foundational commitment to, understanding of, and expertise in caring for vulnerable people living in institutional settings.
As for what’s driving our growth, I would highlight a few key factors – our clinical models; transparency in our partnerships; and advocacy and education.
Our clinical models – operationally and philosophically – are a clear differentiator.
We built a company around fully understanding the needs of and improving the lives of our members. Clinical comes first in this population, focusing on quality, and then adding incentives to support our partner buildings in achieving shared goals around medical outcomes and cost.
Our Longevity advanced practitioners and clinical teams are on site in the SNFs, caring for members as a key part of the SNF team. By augmenting the facility’s own resources, we can help provide better care and deliver better outcomes for members. An important way that we deliver great care is by listening to members about what they want for themselves.
In health care people talk all the time about patient choice, but they usually aren’t referring to people living in nursing homes. Historically, there was little focus on discerning what these patients themselves wanted. We’re different. And this goes back to my mother’s experience. Our goal is to make what realistically are the last years of a patient’s life the absolute best they can be given their clinical circumstances. The only way to do that is to understand and respect a patient’s wishes.
Transparency in our partnerships is key and we have heard time and again how much SNFs appreciate it. Our model relies on sharing information with our nursing home partners on all aspects of the business – revenue, medical costs, administrative costs. We also share meaningful, actionable insights about clinical matters, including member outcomes and performance against quality standards. This is how we create true alignment of incentives. SNFs have the clinical and financial incentives to work with us to provide the support they need for their members and buildings.
We are also advocates for the population we serve and, by extension, our partners in that effort, including SNFs, payers and providers. We go out of our way to educate legislative and regulatory contacts at the federal and state level on the unique aspects of the nursing home population and Congress and CMS are an important target of that advocacy. Medicare is designed for the approximately 98% of beneficiaries who live in the community, but people living in facilities have very different needs. From a policy perspective, those needs have largely been given short shrift. We believe we have a responsibility to do what we can to make sure there are plans and programs that truly address their unique needs.
As we move from being a pure I-SNP to also partnering with national health plans as an IPA, we are already serving a much broader population. The oldest Baby Boomers will turn 80 in the next couple of years, so demand for quality care in nursing homes, assisted living facilities and other congregate settings will only grow. We thrive when our stakeholders thrive and we are well positioned to support our nursing home and payer partners as well as the members whose care we manage over the course of their lives.
Tell us about your new IPA payer partnerships model. In what ways did it influence your decision to create partnerships with national payers?
As you know, Longevity started as a pure I-SNP and only recently began partnering with national payers as an IPA. This really has been a natural evolution of our company because it builds on our core capability, which is understanding the needs of and managing care for vulnerable seniors living in institutional settings. The financing of that care – whether we are the insurer as an I-SNP or we are working with a national payer offering an I-SNP, D-SNP, or C-SNP – doesn’t matter. Longevity has evolved into a clinical management company for seniors that is agnostic regarding the type of product residents are enrolled in.
Our payer partnership model draws on the complementary strengths both parties offer. National payers have the insurance license, ample risk-based capital, comprehensive and state-wide provider networks, best-in-class rates, national size and scale, and claims and compliance infrastructure.
What we bring to the table is expert clinical management. We help our payer partners identify the benefits that are most appropriate for an institutionalized member versus a member living in the community. We help payers rise to the unique challenges of caring for people living in nursing facilities.
It’s a win-win for us, the payer, and, importantly, the SNF and the member. Payers have the opportunity to attract members to whom they typically wouldn’t have access. They get incredibly robust clinical models that are specifically tailored to and supportive of this population. And we bring expertise in clinical support and patient management.
The reality is, in most health insurance companies, it’s about managing medical costs, i.e., classic managed care. For this population, it’s not. I coined the term “managed life,” which means taking responsibility for these patients’ health care, social care, and their interactions with family and their doctors. It’s not primarily about whether they should go to the hospital, but rather what does the patient want and is what we do for them in their best interest. By allowing the payers to focus on their areas of strength, we can focus on supporting the life care of these patients, going beyond simply providing the clinical interventions when something happens.
How is longevity operationalizing value-based care in an impactful way for its partners?
SNFs and nursing homes occupy a unique role because they not only provide the care in the facility, they also have the greatest insight into the total picture of their residents’ well-being. We encourage facilities to work collaboratively with us and the payer to truly oversee, review and manage the total care of the patient, including what happens beyond their four walls. We apply evidence-based guidelines to achieve optimal medical outcomes given the clinical situation of each individual patient, delivering care that aligns with individual patient goals in the most efficient manner and in the right setting.
We encourage them to support the management of “life care” through a value-based arrangement that rewards them financially for delivering real value – clinically appropriate, effective care – not just for managing utilization or medical costs.
As a smaller, newer organization, how is Longevity competing with the key players in this space?
We may be comparatively small in managed care and Medicare generally, but we’re a material player in the I-SNP space. We’re the second largest in the long-term care I-SNP industry overall, the largest independent I-SNP, and the fastest growing.
The fact is that the special population that we focus on – vulnerable seniors living in institutions – has historically been overlooked by the big MA players.
Penetration in the I-SNP market is slightly higher than 10%, where traditional MA is more than 50%. A lot of otherwise eligible people are not in I-SNPs. That could be because they live in a facility that doesn’t offer one or they haven’t heard about them or they don’t understand them.
There is clearly an opportunity to grow through education and awareness. We educate nursing home operators, members and caregivers, compliance staff and regulators about I-SNP, so they know what it is, how it works and what value we bring. As they learn more, they understand our motivation is centered around supporting the clinical needs of the patient. That focus is what allows us to grow. That’s not typical with other payers.
What lies on the horizon for Longevity and its clients?
We will continue to be vigorous advocates for the people we serve and the partners who join us in that effort. We have built an incredible team of people who are driven by a passion for taking care of seniors, so it’s a priority for us to create the kind of culture that attracts and supports the kind of people who embrace that responsibility.
What comes next? Better support of our nursing homes, better clinical integration, more powerful data, and a more comprehensive view of our members so we get a more holistic sense of what’s happening in their care to further enable our success. We’ll be using artificial intelligence and predictive capabilities to try to anticipate needs before they happen.
We’re always evaluating new opportunities to bring our unique capabilities to the market – new vehicles, new tools, D-SNPs and C-SNPs, ACOs. There are vulnerable people who need someone in their corner in all those programs. And finally, we will look at markets to become more innovative and build creative strategies when it comes to serving our members.
Finish this sentence: “In the skilled nursing industry, 2024 will be defined by…”
…government regulations, and an increased need to manage sicker, more diverse populations.
Editor’s note: This interview has been edited for length and clarity.
Longevity Health is a clinical services company and national Institutional Special Needs (ISNP) plan dedicated to serving individuals in senior living settings. Via its own plans and as an Independent Provider Association (IPA) in partnership with leading national health insurers, Longevity aims to optimize the quality of life of people in long-term care by focusing on their individualized health needs through collaborative value-based solutions. It currently operates in 11 states. To inquire about partnering with Longevity or to learn more please email [email protected].
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].