This article is based on a discussion with Patrick Hoertt, Vice President of Business Development at Theoria Medical. This discussion took place on September 11, 2024 during the SNN RETHINK Conference.

Skilled Nursing News: Let’s dive in with an overview of Theoria Medical and its role in value-based care within skilled nursing.

Patrick Hoertt: Theoria Medical is a tech-based, value-based care national physicians group specializing in senior care. We operate in skilled nursing, assisted living, and independent living. Theoria started about 5.5 years ago when our CEO and founder, Dr. Justin Di Rezze, was a hospitalist who became a medical director at a skilled nursing facility. He noticed the lack of technological tools available compared to hospitals, so he developed communication and tech systems to improve support and outcomes. This initiative helped us thrive as value-based care became more prominent.

Can you talk about Theoria’s involvement in high-needs ACOs and how you’ve adapted to support SNF operations?

Theoria has embraced value-based care models, and last year Medicare launched the High-Needs Reach ACO, targeting long-term patients in skilled nursing with higher acuity. When we provide care under these programs and maintain costs under the set threshold, the savings are shared with the SNF operator. This is a new revenue stream for our partner facilities. Our initial results for 2024 are very encouraging—we’re projecting nearly double the shared savings we originally forecasted, all without SNFs taking any financial risk.

With the new High-Needs Reach ACO, there was initial excitement, but also skepticism about shared savings. Can you speak to that?

I understand the skepticism. Some operators have had mixed experiences with other models like Institutional Special Needs Plans (I-SNPs). However, we take on all the risk with the High-Needs Reach ACO. Based on our 2024 results, we’re seeing substantial shared savings due to our clinical outcomes and the high-acuity level of patients. For example, operators with 3,000 qualifying patients are forecasted to see $18 million annually as their portion of the shared savings for 2024.

Predictive analytics is a hot topic in value-based care. How does Theoria use technology to improve decision-making and prevent costly events like readmissions?

Technology is key. We’ve developed a tech platform that integrates with EMRs, monitors quality measures in real time, and identifies risks for readmissions. Our AI system scrubs patient data and flags those likely to be readmitted within 4-7 days, suggesting treatment plans to prevent hospitalization. Additionally, our telemedicine program offers after-hours and weekend support with tools like Bluetooth-enabled EKGs, stethoscopes, and wound assessments to improve outcomes and reduce return-to-hospital rates.

What are the common challenges SNFs face when transitioning to value-based care?

The two biggest barriers are resistance to change and competing priorities. Many operators are hesitant to adapt, especially if they’ve worked with the same medical directors for decades. But without change, their clinical platforms don’t evolve. Secondly, SNF operators are often juggling many things—budget seasons, surveys—and adding value-based care can feel like too much. However, the financial rewards, especially with programs like the High-Needs Reach ACO, are worth the effort.

As we wrap up, can you tell us what’s on the horizon for Theoria?

We have several exciting initiatives. In January 2025, we’ll be launching Theoria Mind, a behavioral health platform focused on chronic behavioral issues in seniors. We’re also expanding our High-Needs Reach ACO, with plans to engage hospitals and improve communication between them and SNFs. Additionally, we’re entering the Guide Program, focused on memory care in assisted living, which offers shared savings opportunities for meeting Medicare’s performance thresholds.

Theoria Medical is a leader in tech-enabled, value-based primary care, revolutionizing healthcare for senior living communities nationwide. To learn more, visit: https://www.theoriamedical.com/.