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 […]

I-SNP Developer AllyAlign Closes $10M Round Led by McKesson Ventures

AllyAlign Health on Tuesday announced the closure of a $10 million strategic funding round led by McKesson Ventures as the developer and administrator of Medicare Advantage eyes growth. The Richmond, Va.-based firm partners with long-term care providers to launch and maintain Medicare Advantage special needs plans, helping them future provider-sponsored managed care plans. SNFs have […]

Tech Providers Optimistic That Medicare Advantage Plans Will Embrace Telehealth in SNFs

Implicit in the government’s decision to allow Medicare Advantage plans to cover telehealth services with federal dollars is a question: Just because insurance plans legally can do it, will they? At least in the early going, multiple providers of telehealth tech to skilled nursing operators have said yes — and the promise of plan savings […]

Partnering with ‘Frenemies’ Can Help SNFs Navigate Medicare Advantage Pressures

Big-picture thinkers in the skilled nursing space have increasingly talked about the need for operators to band together in the face of reimbursement pressures and new payment models — an urge that goes against the competitive nature of the health care industry, particularly in markets saturated with multiple post-acute options. But according to Plante Moran […]

CMS Finalizes Expanded Medicare Advantage Telehealth Coverage

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized new guidance that will allow Medicare Advantage plans to expand coverage of telehealth services. Beginning in plan year 2020, Medicare Advantage providers can include telehealth services as part of their basic benefits to enrollees, moving remote doctor visits from an optional add-on to a […]

PDPM’s Effects Could Stretch Far Beyond Medicare for Skilled Nursing Facilities

On paper, the Patient-Driven Payment Model (PDPM) will only affect one pillar of the payment equation for skilled nursing facilities. But as players start to unpack the coming rule changes, PDPM’s reach begins to extend far beyond Medicare. Medicare Advantage and Medicaid frequently base rate calculations on the existing Medicare structure, a pair of experts […]

Hager: Shift from SNFs to Home Has Run Course, Therapy Costs to Drop 10% to 15% Under PDPM

Large-scale efforts to shift post-acute residents from skilled nursing facilities to the home health space have largely “run their course,” Genesis HealthCare (NYSE: GEN) CEO George Hager said Tuesday, while also predicting serious cost savings under the new Medicare payment model. Though industry leaders have long worried about payers’ growing preference for the lower-cost home […]