Some States Skeptical of I-SNPs as Long-Term Solutions for Nursing Home Coverage

Special Medicare Advantage plans for long-term nursing home residents have emerged as a significant growth opportunity for operators in the space, but state governments around the country may not necessarily be on board. In fact, states may see Institutional Special Needs Plans (I-SNPs) as directly in opposition to their goal of shifting residents away from […]

Sharp Rise in Ancillary Medicare Advantage Benefits — from Adult Day to Home Care — Coming in 2020

Medicare Advantage plans are rapidly expanding the supplemental benefits recently approved by the federal government, with 116 plans offering more than one of these services for the 2020 contract year. Those supplemental benefits provide more options for care at home for beneficiaries — and could potentially represent paths away from the skilled nursing setting. In […]

I-SNP Case Studies Show Promise in Era Where Fee-for-Service Medicare Looks Unsustainable

Despite the challenges, skilled nursing facilities have succeeded at setting up their own specialty Medicare Advantage plans — and the strategy represents a key potential weapon amid the rise of alternative payment models. Institutional Special Needs Plans (I-SNPs) remain a small part of the overall Medicare Advantage landscape, according to a panel discussion at the […]

‘It’s Not That Easy’: What Skilled Nursing Operators Should Consider Before Launching — or Joining — an I-SNP

On paper, a skilled nursing facility starting its own specialty Medicare Advantage plan sounds like an easy decision: In an era of tight reimbursements, staffing pressures, and length-of-stay declines, why not control the payment source that so frequently vexes them? But according to René Lerer, the calculus for Institutional Special Needs Plans (I-SNPs) just isn’t […]

10 Long-Term Care, Senior Living Companies Develop 78-Facility I-SNP

A non-profit health plan and a care coordination company in the Minneapolis area teamed up with almost 80 senior care locations to offer a Medicare Advantage plan specifically tailored for adults in long-term care, assisted living, and memory care settings. The institutional special needs plan (I-SNP), Medica Advantage Solution PartnerCare, will be available for January […]

Trump Signs Order Seeking Parity Between Fee-For-Service, Medicare Advantage Rates

President Trump on Thursday signed an executive order asking top federal officials to explore a wide variety of Medicare Advantage expansion efforts, including a call to more closely align the rates paid by MA plans and traditional fee-for-service Medicare. Among the order’s provisions is a request for Department of Health and Human Services (HHS) secretary […]

Each Medicare Advantage Plan Can Treat PDPM Differently — and SNFs’ Mileage Will Vary

Skilled nursing providers looking for a simple answer to how managed care plans will react to the new Medicare payment model will likely have to face an inconvenient truth: It’s complicated. Private Medicare Advantage insurers didn’t have to follow the old Resource Utilization Group (RUG) model when deciding how to reimburse for skilled nursing services, […]

Medicare Advantage Plan Options to Increase by 600 in 2020 as Enrollment Reaches 40%

The Trump administration continued to cheer on the growth of Medicare Advantage plans Tuesday, with the nation’s top Medicare official touting the wider array of options available to beneficiaries next year. American seniors will have 600 additional Medicare Advantage plan choices next year, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma announced in […]

Lawmakers Call for Medicare Advantage Reform, Citing $100B in Overpayments

Skilled nursing operators frequently decry Medicare Advantage plans’ focus on lower reimbursements and shorter lengths of stay, but a group of lawmakers claims that insurers in the space are spending far too much money — and potentially putting their beneficiaries at risk. A group of six U.S. senators, all Democrats, wrote a forceful letter to […]

Skilled Nursing, Post-Acute Providers Must Embrace ‘Death of Dogma’ to Survive Shift to Episodic Care

As payers and hospital networks increasingly treat skilled nursing facilities as just one stop along an overall episode of care, operators in the space have received a variety of messages about how to survive: Bring data, get to know referral partners’ problems, demonstrate your worth. But a leader at a major Philadelphia-area hospital network took […]

UnitedHealth’s I-SNPs Reduced Readmissions, Emergency Visits While Boosting Skilled Nursing Use

In-house Medicare Advantage plans have emerged as a hot trend in the skilled nursing space, as operators look for ways to take control over their reimbursement destiny — and a new study shows that the model could have real benefits for both patients and Medicare at large. Members enrolled in insurance giant UnitedHealthcare’s Institutional Special […]

Why Skilled Nursing Operators Can’t Bank on ‘Silver Tsunami’ — or One Good Month Under PDPM — for Relief

As the post-acute and long-term health care industry struggles through shortened lengths of stay and compressed reimbursements, an oasis has lingered just beyond the horizon: the so-called silver tsunami. If operators can wait out the current downturn, the thinking goes, the glut of baby boomers turning 80 and older over the coming years will be […]

I-SNP Exec: Skilled Nursing Operators Must Approach Insurers to Succeed — But Few Do

Skilled nursing operators frequently bemoan the shorter lengths of stay and lower daily payment rates for Medicare Advantage residents, but the leader of one plan says it’s also up to providers to present novel ideas to insurance executives. Before taking the CEO role at the nursing-home focused Longevity Health Plan earlier this year, René Lerer […]

Inside an Anthem Subsidiary’s Attempt to Reward Skilled Nursing Facilities with Medicare Advantage Bonuses

Managed care and Medicare Advantage companies can be a sore spot in the skilled nursing world, but as the sector evolves, a subsidiary of a major insurer is looking at how to reward facilities for providing quality care — while keeping in mind the financial pressures that providers face. CareMore Health, a subsidiary of Medicare […]

‘Under Siege’ for Years, SNFs Face Uphill Battle for Respect Under New Payment Models

Though skilled nursing facilities have experienced significant pain under the structures of alternative payment models such as accountable care organizations (ACOs), they still have the opportunity to show value. But it’s something of an uphill road, according to Harvard Medical School professor and Medicare Payment Advisory Commission (MedPAC) member David Grabowski. “I absolutely think that […]

Under PDPM, Benefits of In-House Medicare Advantage Plans Will Go Beyond Money

Forward-thinking skilled nursing providers have increasingly warmed to the idea of starting a special kind of in-house Medicare Advantage plan in order to take more control over their reimbursements in an uncertain environment. But the strategies that operators must adopt to succeed with Institutional Special Needs Plans (I-SNPs) also fit seamlessly into preparations for the […]

Genesis Exec: ACOs May Work Better Than I-SNPs for Skilled Nursing Facilities

Skilled nursing providers, seeking more control over their own destiny and the premium dollar, have been driving the growth of a specific subtype of Medicare Advantage plan designed for the care of patients in the institutional setting. But Jason Feuerman, senior vice president for strategic development and managed care at nationwide operator Genesis HealthCare (NYSE: […]

Medicare Advantage Hasn’t Always Prioritized Skilled Nursing — But That’s Changing

If skilled nursing facilities want to improve their relationship with managed care payers — particularly the ever-expanding Medicare Advantage plans — they have to ensure that they understand the payers’ pain points. And they have to battle the reality that in the Medicare Advantage world, post-acute barely registers on insurers’ radar screens because it’s a […]

With I-SNPs, Nursing Homes Can Thrive Under ‘the Godfather’ of Value-Based Care

As Medicare Advantage continues to gobble up an increasing share of skilled nursing reimbursements, more providers are exploring the idea of launching their own plans — and while the numbers are small, the opportunity can be great. Specifically, SNF providers can launch Institutional Special Needs Plans, or I-SNPs, a specific type of Medicare Advantage plan […]