Skilled nursing providers are adapting to a new, post-pandemic landscape for working with acute-care partners and participating in value-based care models like accountable care organizations (ACOs).

However, it remains essential for SNF providers to get a seat at the table early in the process and play a role in building partnership models.

These are some of the takeaways leaders from Journey Skilled Nursing and Ocean Healthcare shared during a panel discussion at Skilled Nursing News’ RETHINK Conference in Chicago.

Indiana-based Journey has 22 facilities in six states, while Ocean operates 12 facilities in New Jersey.

‘Build the hoop’

Regarding partnerships with acute-care organizations and being included in high-performing networks, Ocean Healthcare is “everywhere we want to be,” said Joe Kiernan, chief strategy officer and senior vice president of network development.

“It takes a lot of work to get there, takes a lot of work to stay there,” he said.

Kiernan said the company adapted to meet network demands and that agility and early adoption are key to getting a seat at the table with hospitals and other partners in arrangements such as accountable care organizations (ACOs).

“Oftentimes people take a negative approach and say, ‘They just want me to keep jumping through these hoops and jumping through these hoops,’” he said. “Well, maybe get to the table a bit earlier and design the hoop, figure it out, own part of the hoop, and then you don’t have to jump through it, you can actually hold onto it with them.”

Journey Skilled Nursing’s ties to post-acute partners and ACOs were strong in 2019; they had stakeholders attending meetings and tying Journey’s results into their ACO metrics, COO Matthew Trammell said. But the pandemic slowed that momentum by creating a “battening down the hatches” mentality.

“I think the landscape has changed,” he said, adding that Journey is “really getting back to what’s changed in this current acute care hospital system, who are the key players, and let’s get ourselves tied into that.”

The company recently had a facility receive a perfect survey score, so they’re exploring how they can use that to market to ACOs and be a better partner, Trammell said. However, some of the buildings that Journey has acquired already do have strong partnerships in place.

“Certainly we have some, I would say, pre-made situations that are historically tied in,” he said.

Whatever SNFs do to partner with acute care organizations, it’s important to keep patients and their needs top of mind, Kiernan emphasized.

“Ultimately, there’s a human being on the other end of that process and that strategy,” he said. “Let’s not lose sight of that.”

Adapting to competition from in-home care

More seniors want to age at home, even with more complex and difficult to manage conditions. Some in-home care providers have adopted hospital-at-home models, which can put pressure on nursing homes to meet their census goals. Trammel and Kiernan both said they weren’t too worried about competition at this stage, however.

“I would say that I’m not sure that that higher level of acuity is, on a large scale, proven successful in home health yet,” Trammel said. “SNFs can be a hub for complex care. When you get into high levels of acuity, like a vent or dialysis unit, if it fits into a market, let’s get in there.”

Trammel added that a time will come in the near future, as the baby boomers age, that there won’t be enough beds in either home health or SNFs to provide the needed care. He said SNFs should focus on growing their ability to take on higher acuity patients to meet this demand.

That could mean significant renovations to run oxygen hoses, add generators, or convert rooms to private, but having acute care partners on board can make the changes worth it.

“You need to make sure that your local acute care partners are saying, ‘Absolutely, this is going to be a win for both of us,’” Trammell said. “That’s something we tend to look really closely, at trying not to misstep.”

Along with the rise in hospital-at-home, skilled nursing-at-home models also have started to gain some traction. But Kiernan does not see this as a mature model with sufficient reimbursement to scale.

He cited a recent case out of Tampa, Florida. There, a company was offering what it called SNF-at-home, but it was geared for respite care delivered by a licensed home care provider, to prevent caregiver burnout. The program “when you break it all down,” came to about $2,500 for a year of care, according to Kiernan, who said this “ little bit of extra reimbursement” is “great and wonderful” but doesn’t cut it for high acuity patients.

“The reimbursement is not there yet to enable providers like us to step up and say, ‘We’re going to be able to fill this need for you,” Kiernan said, referring to the ability to provide SNF at home services.

Skilled nursing at home still requires a three-day qualifying hospital stay, which can lead people to fall through the cracks in the care continuum.

“You still have to have a skilled need, and you have to have a benefit period,” Kiernan said. “We’re not even seeing that. We’re seeing the observation stays. I can’t admit people who need to come to our buildings because they don’t have a three-day qualifying stay, and they’re not homebound, so they’re not going home with skilled home care either. So where is this person falling? They’re going to fall through a care gap, and they’re going to end up back in that ED.”