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 Providers Tout Benefits of Being in the MA Insurance Business

On the sidelines of the first annual American Health Care Association/National Center for Assisted Living’s Population Health Management Summit for Long Term and Post-Acute Care Leaders Dec. 9-10, two providers leading the way in this new space for skilled nursing and assisted living operators say they are seeing positive clinical and operational results from their companies’ efforts to become the standard for Medicare Advantage (MA) insurers in their facilities. 

Mark Scharnberg, executive director, Great Plains Medicare Advantage, The Good Samaritan Society, and Mark Traylor, president, Traylor-Porter Healthcare and board member of MA plan Simpra Advantage, tell Provider the model of care that is allowed by becoming an MA plan sponsor is paying big dividends in what are the early days for each plan. At its core, operating as an MA plan in the long term and post-acute care setting permits providers to become an Institutional Special Needs Plan, or I-SNP for short.

Scharnberg says being an I-SNP allows Good Samaritan to deploy plan member-dedicated nurse practitioners in the facilities, giving the residents the coordinated, patient-centered care that is helping to drive down rehospitalizations and improve staff morale.

“The model can bring more primary care to facilities and allows members access to benefits (like dental and optical, for example) not covered under traditional Medicare, and it is a better reimbursement model, too,” he says.

Traylor echoes those thoughts, saying the way care is incentivized under the I-SNP model as prescribed by the Centers for Medicare & Medicaid Services really puts nursing and all clinical staff in a skilled nursing building in the ball game, allowing for proactive care that aims to treat the whole person. 

As for numbers, Scharnberg says Good Samaritan’s Great Plains plan currently has 1,100 members and expects that number to grow to 1,200 this coming January as it markets the insurance to members mainly based in the Dakotas and adjoining regions. Traylor said Simpra, which is actually a group of 23 providers working under one umbrella, has some 3,000 members, covering every county in the state of Alabama as its base.

The I-SNP model, Traylor says, is not about making a quick buck, but about allowing nursing centers to flex their clinical care and related strengths when it comes to caring for the nation’s frail and elderly better than any other setting.

“I do believe the skilled setting is better than anyone in the care continuum at managing those people with comorbidities,” he says.

The cautionary notes that Scharnberg thinks providers should realize when looking at starting their own MA plan swirl mainly around doing a lot of research into whether the model is right for each operator.

“This is not starting a hospice or some other business line. This is about starting an insurance company, which may be self-evident, but it is a very different business for a provider,” he says. Before jumping in, Scharnberg suggests visiting with a provider who has already made the leap.

He says other challenges may come from having to now manage other providers that are part of the organization’s plan, and making the right investments in infrastructure and people to get it done.

Lastly, there are compliance issues. The health plan sector is heavily regulated, as skilled centers are, but is handled in an entirely different way by state and federal regulators, Scharnberg says. 

For Traylor, capital is the key issue for providers to grapple with before starting in the MA business. Tight margins in the skilled nursing trade do not allow for a lot of extra capital to invest, he says, but that is one of the reasons why Simpra is a consortium of providers and has done well by combining resources and creating valid economies of scale, Traylor says.

Money is not necessarily the reason for doing an I-SNP plan, both providers say, but they both expect to make money off the endeavor in due time and are seeing something even greater as a result. Scharnberg says those residents under the Great Plains managed care plan are seeing 30 percent fewer rehospitalizations and are getting the equivalent of 4.5- to 5.0-Star care.

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