This article is sponsored by American Health Partners. Eight years ago, American Health Plans launched a provider-owned Medicare Advantage Institutional Special Needs Plan (ISNP) that has since become the fastest-growing provider-owned ISNP in the country. While others in the ISNP space have faced headwinds, American Health Plans continues to expand into new markets and deepen its partnerships.
In this edition of Voices, CEO Mike Bailey shares why he remains a steadfast believer in value-based care—and why he sees significant untapped potential for the ISNP model to improve outcomes for seniors nationwide.
Skilled Nursing News: What life or career experiences have most shaped your approach to the work you’re doing today?
Mike Bailey: I’d have to say that the most defining experiences in my career so far have been the years I’ve spent working in both Managed Medicaid and Medicare Advantage. Those roles gave me a deep understanding of how complex government programs can be, but also how vital they are for the people who depend on them.
I believe that if you’re running these programs, it’s your responsibility to make sure they truly work for the people they serve. That means building an insurance plan that’s operationally effective, efficient, and financially sound so individuals with coverage don’t have to worry. It also means partnering with care delivery teams that can provide coordinated, comprehensive care—meeting members where they are and addressing their needs.
My personal leadership style is very hands-on. I like to stay close to all aspects of the business to make sure nothing gets lost in translation. Fortunately, I have an outstanding management team here across our American Health Plans and TruHealth care coordination teams. We work closely together, diving into data and refining operations. We want to understand what it takes to help our provider partners succeed, and most importantly, what helps our members receive the quality care they’ve purchased and deserve.
When you launched American Health Plans eight years ago, did you imagine it would grow to serve over 8,000 members across 14 states, and has this growth exceeded your expectations? What do you attribute that to?
We always believed in the potential of the Institutional Special Needs Plans (ISNP) model, but I also have to admit that the scale and reach we’ve achieved so far is something we’re truly proud of. It’s a hat tip to everyone who’s been involved.
Growing to over 8,000 members across 14 states reflects, in my opinion, a clear market demand for provider-owned enterprises with a clinical model that puts providers in the driver’s seat. It aligns care delivery with financial accountability, and that’s a powerful combination.
The fact that nursing homes continue to embrace the unique clinical and financial opportunities presented by provider-owned ISNPs is a testament to this model. At the same time, I never take this growth for granted. It takes a tremendous amount of effort to achieve and maintain it. This is a complex business—it’s challenging, but also incredibly rewarding.
How is American Health Plans positioned to lead and adapt over the next five years?
Value-based care is really in our DNA. We didn’t just pivot to it, we built this business for it. Over the last eight years, we’ve worked hand in hand with providers to design and launch provider-owned ISNPs that are both clinically effective and financially sustainable, which isn’t easy to achieve.
What excites me, and us as a business, is that these plans are now maturing and thriving. We’ve established strong track records, built solid balance sheets, and expanded our market influence. I believe we’re well-positioned to lead the next phase of growth in this space.
Looking ahead, that means deepening our clinical impact, expanding our geographic footprint even further, and continuing to pioneer innovations in care coordination that align with CMS priorities and the needs of our provider partners. We’re very bullish on our ability to keep advancing in the value-based care arena.
What do you see as the biggest challenge facing Medicare Advantage today, particularly with ISNPs, and how is American Health Plans addressing that head on?
The biggest challenge I see is really change itself. Moving from fee-for-service models to risk-based or value-driven care can be uncomfortable for providers who are used to more traditional frameworks. But that’s where the provider-owned ISNP model truly shines. It offers a roadmap for navigating change by aligning incentives, empowering providers and partners, and delivering financial resources that other models simply don’t provide. Those resources are critical because they enable reinvestment back into care delivery and quality.
Our success comes from transparency, deep operational engagement at the facility level, and a relentless focus on outcomes. We work side by side with our partners to drive real, sustainable transformation.
Why do you believe that the provider-owned ISNP model is best suited for long-term success? What makes it unique, and what clinical advantages does it offer compared to other structures?
First and foremost, ISNPs are established in permanent law. They’re not temporary demonstration projects like some other models, and that provides long-term stability in a healthcare landscape often marked by regulatory uncertainty. As fully licensed HMOs with CMS contracts, these plans deliver monthly capitation payments that allow providers to invest in proactive, team-based care, which helps reduce avoidable hospitalizations for frail and elderly populations.
What really sets the provider-owned model apart is the level of engagement from owners, operators, and partners. At the heart of that engagement is execution at the bedside. There are a lot of models out there, but you have to be directly connected to the patient to truly understand their needs and engage everyone up and down the care team.
Our model is built around delivering coordinated, proactive care that improves clinical outcomes and enhances quality of life for each member. Central to this approach is our TruHealth team, which includes advanced practice providers, nurse practitioners, physician assistants, RN case managers, and more, working in close partnership with nursing home staff to provide person-centered care.
An area we prioritize, and that’s often overlooked, is mental healthcare. We believe it’s a critical component of overall well-being, and we integrate that focus into our care model. Especially in an era of acute nursing shortages, this additional layer of clinical support is a game changer for both nursing homes and residents.
Another key advantage is the flexibility to design benefits that best meet the local needs of each population. While Medicare Advantage now covers about 50% of beneficiaries nationwide, less than 20% are enrolled in any type of special needs plan, and only about 10% of eligible beneficiaries are currently enrolled in an ISNP. That shows there’s significant opportunity for this model to grow its market share.
Partnerships seem to be at the heart of American Health Plans model. What’s the key to building lasting successful partnerships with providers, and how do you maintain alignment as that plan grows?
Partnership is really at the foundation of everything we do at American Health Plans. It starts with finding the right people and organizations who share our belief that better care and better financial outcomes can go hand in hand.
Today’s environment is noisy and fast-changing, and it’s not always easy to navigate. But we have a track record that speaks for itself. For the past eight years, we’ve consistently delivered for our partners. We’re transparent, we listen, and we adapt. That’s how we build trust with each group we work with, and that trust allows us to grow together and stay aligned, even as the business scales.
We don’t believe in a one-size-fits-all model. Instead, we tailor our approach to each partner’s goals and culture. We take a long-term view, and when you combine that with aligned incentives and shared accountability, it creates durable relationships. That’s what has enabled us to foster a growing network of provider-owned plans across the country.
I believe this model will continue to thrive. I don’t see anything on the horizon that would stand in the way of that progress.
In the skilled nursing industry, 2025 is being defined by…
2025 will really be defined by what’s coming out of Washington and how the skilled nursing industry adapts to and overcomes those challenges. Alongside that, there’s a growing demand for integrated, outcomes-driven care models. The government—CMS, Medicaid, and legislators alike—is pushing the healthcare sector to deliver better care at lower costs with improved outcomes for frail elderly patients. That’s exactly what we’re working toward.
We believe 2025 will hinge on two things: the actions taken by the government and how the sector responds. In our business, through our ISNPs and TruHealth advanced practice providers, we’re focused on delivering that care directly at the bedside.
At the end of the day, everyone is seeking the same thing: aligned incentives, a value-based model that’s sustainable for the future, and strong outcomes for patients and their families. That’s our focus, and I think when we look back on 2025, that’s what we’ll see taking shape.
Editor’s note: This interview has been edited for length and clarity.
As the nation’s fastest-growing provider-owned Institutional Special Needs Plan (ISNP), American Health Plans partners with more than 50 leading providers and serves residents in over 600 skilled nursing facilities across 14 states.
Our model is built on collaboration, delivering proven results that improve clinical outcomes and quality of life for the people we serve.
Discover how American Health Plans can help your SNF thrive at: AmHealthPlans.com/contact
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].
