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 […]
Category: Medicare Advantage
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 […]
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 […]
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 […]
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 […]
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 […]
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: […]
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 […]
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 […]
Conventional wisdom holds that Medicare Advantage saves the government money by bringing a private-sector insurer’s focus on efficiency to the more freewheeling federal Medicare program. But that progress may have way more to do with the types of people who elect Medicare Advantage coverage — and much less to do with the cost-cutting strategies of […]
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 […]
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 […]
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 […]
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 […]
The Centers for Medicare & Medicaid Services (CMS) this week announced a 2.5% boost to overall Medicare Advantage payment rates — but the news isn’t likely to bring relief to skilled nursing operators struggling with low MA reimbursements. That 2.5% rate gain in 2020 represents a bigger gain than the 1.59% increase that the agency […]
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 […]
Skilled nursing operators saw static occupancy between the third and fourth quarters of 2018 — a notable, if moderate, bit of good news for an industry that had seen four straight years of declines. The nation’s nursing homes were approximately 82.4% full during the fourth quarter of last year, according to the most recent set […]
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 […]
Skilled nursing providers actually saw across-the-board gains in Medicare margins between 2016 and 2017, but the effects were mitigated by a familiar foe: Medicare Advantage plans. The average provider saw a profit of $102 per patient day for residents covered under Medicare Part A in 2017, according to a new analysis from accounting and advisory […]
Every industry gathering has a theme, whether it’s an intentional move by the organizers or not. But the most illustrative conference experiences come when attendees and those in charge both can’t stop talking about the same subject — as was the case this past week at the National Investment Center for Seniors Housing & Care’s […]