This article is sponsored by Focal Point Care. As skilled nursing operators navigate shifting reimbursement models and mounting administrative burdens, many are turning to new partnerships to streamline operations, boost revenue, and stay focused on patient care. In this Voices interview, Skilled Nursing News sits down with Freda Mowad, M.S., CCC-SLP, Chief Strategy Officer at Focal Point Care, to explore how their integrated model is helping providers tackle managed care complexities, drive performance across departments, and prepare for a more sustainable future.
Skilled Nursing News: What aspects of your life and career have most shaped your approach to your work today?
Freda Mowad: I’ve been in health care for over 25 years now. I started as a speech pathologist, then became a Director of Rehab, and eventually a VP of Operations. I’ve been in the rehab space for a very long time but starting out in the field and seeing firsthand what it takes to care for patients has been the most impactful.
In 2018, I realized we needed to do things very differently in rehab because the reimbursement system was changing. So, I started QRM, Quality Rehab Management, an in-house rehab management company. I felt strongly that therapy departments needed to be in-house, not outsourced by a third party. They needed to be part of the team.
But that’s a very heavy lift for a nursing home or any post-acute entity because there are so many moving parts when it comes to rehab. Therapy is difficult. It’s tough to recruit for therapists, to train them, to make sure everything is compliant, to ensure documentation is where it needs to be, and supervision is what it needs to be. You have to be on top of patient outcomes, department cost, and revenue. QRM was created to bring the therapists in-house and oversee all of the rehab operations. It’s the best of both worlds: the operator doesn’t carry the burden of running a rehab department, we do that; but the therapists are theirs. They’re all in-house. They’re all part of the facility team.
QRM has been very successful in the last 7 years. We grew from two buildings to over a thousand, and it’s been amazing to see operators and therapists embrace it. That’s where I draw my love of the industry and my inspiration every single day. We work for the operator. We are very intertwined with the operator. We are very big on relationships. If they have any kind of challenge or issue, we’ll find a way to solve it. We have a lot of resources, and our mission is to help them keep their doors open, serve their patients, and support their therapists.
What is Focal Point Care, and how is it different from other companies in the long-term care space?
Focal Point Care is an entity we developed just about a year ago. It serves to enable the three powerhouse companies by consolidating the shared services within these companies, including Finance, Marketing, HR marketing and IT, allowing the business unit leaders to focus on delivering the highest level services and offerings to our clients. In addition, the team at Focal Point come with varying background and experience from within health care and outside of health care and provides guidance on tech and process innovation.
The first is Guided Care, which focuses on managed care contracting and case management. The second is QRM, the rehab management company I founded with my partners. And the third is Future Care Consultants (FCC), which is a billing, back-office, and financial services company. Each one operates under Focal Point Care, and I now serve as the Chief Strategy Officer for the organization.
There’s really no other company I know of that offers this combination of services in one place. Focal Point Care brings together different arms that support operators across the board, whether it’s associated with the delivery of care, supporting revenue drivers, or improving operational efficiency. Our work covers managed care, rehab and reimbursement, along with the financial back-office.
When you look across all three companies, you’ll see a spectrum of support that gives operators access to a wide range of services and efficiencies that aren’t easily found elsewhere.
Do all of the Focal Point Care entities operate independently? Or do they overlap in services, clients, etc.?
Yes, they’re all independent companies. Each one has its own president and operations team. But we do share some internal resources at the enterprise level. Each company is independent in its core service offering and each houses its own subject matter experts. All three companies are in the same health care space and, naturally, some of our clients do overlap. The three companies meet weekly, often multiple times a week, to talk through what we’re seeing in the field and to offer a wide variety of resources to our clients. For example, if a QRM client in one state acquires new buildings and needs help obtaining managed care contracts, we provide an intro to Guided Care. What makes this partnership special is the ease with which we can tap into each business unit to support the clients across our network.
Health care may seem big, but it’s actually a small world. So, we’re always sharing what changes may be happening in our division, whether it’s a change in reimbursement, a new market trend, or a new operator coming into a different state. That constant collaboration helps us improve our services and better support our clients.
We’ve been very mindful about how we present it. I came from QRM, which was solely focused on rehab. But as the industry evolves, we’ve had to evolve too. Within QRM, we built out a reimbursement team to help facility nurses with coding and MDS completion. We have also expanded into senior living so we could provide in-house rehab management to not just SNFs, but ALs and ILs as well.
At the same time, we know we can’t do everything, and our clients appreciate that. We’re not trying to dilute our services. Instead, we’ve partnered with companies that have been practicing in their respective field for decades.
As Focal Point Care continues to expand its suite of services, is the end game to become a one-stop shop for providers?
Well, it’s definitely developing into that. And we don’t take that responsibility lightly. Our clients trust us, and they trust what we do and how we do it. We’re never going to offer a service they don’t need. Our reputation comes first, and that’s true for every business unit under the Focal Point Care umbrella.
What we’re doing is developing solutions based on what our clients are asking for. If they choose to take it, great. If they don’t need it, that’s fine too. A lot of times, our clients will say, “Let’s pilot this in one building. Let’s work together, figure out pricing, look at the numbers in two months, and if it doesn’t work for either of us, let’s change it.” That’s what I’ve always loved about our approach and our relationships. It’s never black and white. We’re truly building something together.
Health care takes a village. We’ve developed service lines in each business unit that probably touch every single department in a nursing home, but that doesn’t mean every provider needs everything. They might just need certain services in certain buildings or markets, especially post-COVID with staffing challenges across the board.
We’re always working together to figure out how to use our resources most effectively. And if we end up becoming a one-stop shop, fantastic. Because these are well-established, deeply experienced business units offering very specific and valuable services.
What is the need of the hour for SNF owners and operators heading into 2026?
For me personally, I really feel that managed care is number one. There are now more managed care patients than there are traditional Medicare patients across the country. And that’s the directive from CMS: everything is shifting toward managed care.
It used to be kind of an afterthought. Maybe you had one or two managed care patients and 20 Medicare patients, but that’s just not the case anymore. It’s completely flipped. So, we’ve put a lot of energy into supporting operators with managed care contracting and case management, because it’s become absolutely essential.
It also overlaps with the billing space. Through this journey, we’ve created a product called Managed Care Solutions, or MCS. It brings together the resources from all three business units in our network, because managed care touches every single part of a nursing home’s operation. By doing this, it gives us the ability to leverage our collective expertise and really support managed care from every angle.
From the start, even before the skilled patient enters the building, we’re verifying benefits, confirming contract terms, securing authorizations, and case managing those patients. On the rehab side, we’re communicating the terms to the therapists so they understand the contract parameters and what the insurance companies are requiring regarding documentation for both the skilled and HMO B patients.
Then, on the billing side, we handle managed care claims for both skilled and long-term care patients, and we handle the collections. There are many operators who don’t bill HMO B patients, or Managed Medicaid, which is also referred to as GDT, because the reimbursement was so low or you had to spend too much time chasing minimal dollars, but we’ve changed that narrative.
Can you give us examples of how managed care solutions can be used?
Oh, sure. When we first started, Guided Care handled managed care case management alone. Their responsibility is to ensure the clinical documentation is in place to support the reimbursement level and length of stay. They often need to guide the facility nursing staff and rehab staff regarding detail or frequency of documentation.
Now, with MCS, we can utilize QRM’s resources to ensure the therapy evals are completed promptly, documentation is supportive of the care, and safe discharge planning is underway. We can utilize the Future Care Consultants’ resources to bill timely, make sure authorizations and carveouts are in place, and collect.
The burden this removes from the building is tremendous. Managing HMO patients from admission through discharge, and getting paid correctly and promptly for that care is a heavy lift for facilities. But we take that on. And it frees up the Admissions team, the MDS Coordinator, the Director of Rehab, and the BOM’s so they can focus on their day-to-day operations without having to keep track of the many steps involved with the managed care companies.
It really is a very cumbersome, tedious task. You might have 10 or 20 managed care patients in a single building, and each one could be in a different plan. To expect the facility to know every detail of those plans, deliver the care accordingly, and still keep their doors open is daunting.
This is something we’re incredibly passionate about. We see it as our responsibility, because we have the structure, the expertise, and the support across all our business units to manage it effectively. And it’s been a real pleasure to develop this for our clients.
Fill in the blank: In 2026, the skilled nursing landscape will be defined by…
Collaboration. Delivering high-quality care is incredibly difficult right now. When you zoom in on the granular day-to-day of care delivery, it’s easy to point fingers and say, “This was bad,” or “They dropped the ball here.” But when you see how much is placed on operators to provide that care, you realize how overwhelming it truly is. It’s a massive task.
What I’d love to see is the excellent work that operators are doing shine through. Despite all the red tape, the documentation requirements, the audits, the takebacks, and the surveys, they’re still showing up every day for their patients. And if we can take even a little bit of that burden off their plate, then they’re able to do what they came into this industry to do: help people.
Editor’s note: This interview has been edited for length and clarity.
Focal Point Care brings together the expertise of Guided Care, QRM, and Future Care Consultants to provide healthcare organizations with a unified, trusted resource for operational, clinical, and financial performance. Through this collaboration, Managed Care Solutions was created, a holistic approach built to address the most pressing challenges operators face today surrounding the world of MCO’s. Each business contributes its distinct expertise, enabling Managed Care Solutions to offer end-to-end support that simplifies payor navigation, enhances processes, and protects financial outcomes.
To learn more about this service offering or explore the full network of support available through Focal Point Care, visit FocalPointCareco.com.
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].
