Bandera Healthcare is expanding its nursing home service lines for residents through community partnerships and working with health plans and hospitals. And the company isn’t done.
The Arizona operator and Ensign Group (Nasdaq: ENSG) affiliate is looking at more services that also align with taking on more risk, and align with the needs of health plans in certain markets.
Bandera’s leaders designed the company’s Ensign Pennant Care Continuum (EPCC) program to identify gaps in the industry, especially for specialized care options, and provide wraparound services for patients.
“We own some of these services, but we’re also working through partnerships. We know that we can’t solve every problem, and we already have provider partners out there that are solving those problems,” said Lisa Leveque, who is vice president of strategic alignment and care transformation and director of contracting and payer relations at Bandera. Leveque spoke on a panel at the LTC 100 Conference in Scottsdale, Ariz. – Bandera’s backyard. “We’re working together to create a system in which we’re wrapping those services around the patient.”
Bandera operates 41 skilled nursing facilities, or 6,000 beds total. Services include bariatric care, behavioral health, in-house dialysis, therapy and rehabilitation, subacute services, and substance abuse recovery, along with skilled nursing, long-term care, assisted living and independent living settings.
Factors in creating a suite of service lines
Bandera’s experience creating new service lines stemmed from a few different needs. In multiple cases, a health insurance plan came to Bandera asking to work together on missing lines of business, including behavioral health and substance abuse recovery. Banera worked with partnering health plans among other stakeholders to vet potential service lines and to make sure the program is needed.The company also brought in administrators, Medicaid partners and managed care organizations.
Bandera has been lucky to have engaged government and community partners in Arizona, but that’s not the case across Ensign’s 17 different states.
“When I talk to my partners, they’re not as fortunate,” said Leveque. “We have decades of partnership here in the state of Arizona. We have invested health plans, invested state Department of Health Services and invested Medicaid programs that we meet with regularly, and we have these conversations that allow us to get creative.”
Controlling costs is another component of Bandera’s efforts to create a suite of services for its residents. Controlling costs means thinking beyond the SNF walls, Leveque said, and thinking about how the health plan gets paid.
“They’re getting paid per member, and for us, how do we get paid a portion of that, for the portion of the services that the patient needs?” asked Leveque.
Bandera must also find a way to control the costs involved in taking risks, control preventable readmissions and ensure the operator’s patients are at the right level of care so that they can step down to a less acute level of care when they’re ready, Leveque added.
Interdisciplinary teams help with service line direction
Bandera takes an interdisciplinary approach when assessing new programs or business lines in a nursing home to figure out the best way to create a program and provide a service. The company works with multiple roles including therapists, clinicians and those in human resources.Interdisciplinary teams determine service line direction
Osborn Health and Rehab’s bariatric services is the perfect example of the interdisciplinary approach to incorporate a service, Leveque said, working for years to develop a model that best helps their patient population in Scottsdale, Ariz.
Ensign remodeled the property to care for this particular patient population. The company worked with the local police department, fire department, the hospital across the street and many department health services in order to provide the best bariatric care possible.
“The health plan came to us and said, ‘how do we support this? These members are ours. How do we support you in providing care to this very, very different population?’ Their needs are different, the equipment is different, all the services we provide to these patients look very, very different,” said Leveque.
Health plan contacts of Leveque’s are reaching out to see what their members are needing based on the market, and especially when it comes to services that help behavioral health patients, those with high acuity or those that are bariatric patients.
Operators like Bandera and their health plan partners both want their patients to get the specialized services they need, but depending on location, they are limited by reimbursement. That’s where those deep relationships and advocacy play a huge role in creating a comprehensive suite of post-acute care services, she said.
“We need to make sure we’re the ones telling that story. Our data story is powerful, being able to share those stories and how we can solve problems with our health plans, with our state Department of Health Services Medicaid system,” said Leveque. “But we have to be able to prove that we can do these services within our walls, under our licensure in a safe way.”
Homing in on data and building service lines, Leveque added that nursing home operators are already measuring themselves with quality measures and five-star ratings that tell them how they’re performing publicly, but there’s also a lot of internal data that can tell operators where their opportunities are.
A technology partner can be a boon when telling that data story and when planning ahead to meet each community.
“There is a way to embed that type of technology to better tell the story than we have,” said Leveque.
And in contemplating what’s next in terms of service lines, Bandera has focused on creative contracting, creative modeling and taking on risk – the operators is in a good position with all of its partners and all of the service it’s been able to provide, to start considering what more risk looks like.
“It’s a scary thing for us, right? We work in this fee-for-service world … what does it look like to take on risk and take on responsibility? We’re going to have to think differently, we’re going to have to shift our mindset and how we run a business,” said Leveque. “That excites me, but I also know it’s going to take a shift in habit.”
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