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 Population Health Management Models Spark Interest

The main goal of MA plans is to enhance the quality of life for beneficiaries in senior living settings.

 

Long term and post-acute care (LT/PAC) providers continue to show an increasing interest in forming specialized Medicare Advantage (MA) plans, or Special Needs Plans (SNPs), for their long-stay residents. To feed this demand and give providers an opportunity to learn more on the issue, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) at press time was scheduled to hold a Population Health Management Summit for Long Term and Post-Acute Care Leaders in Washington, D.C., on Dec. 9 and 10.
 
AHCA/NCAL sources tell Provider that as interest continues to grow among LT/PAC providers in the Institutional-SNP, or I-SNP sector, so does the need for information geared specifically to skilled nursing and assisted living owners and operators.

Jill Sumner“Every population health management conference that comes up seems to focus on how hospitals or health systems can create and manage post-acute care [as SNPs], or focus on how doctors can do so through enhanced primary care,” says Jill Sumner, vice president, population health management, AHCA. “These conferences are never about the PAC provider taking the lead.”

Since Sumner came aboard earlier this year, AHCA has worked to develop the resources and capacity to aid LT/PAC providers in pursuing population health management opportunities, which also made the summit a natural extension of this effort. “There is a strong interest and thirst for knowledge in this area,” she says.

Population Health and SNPs

AHCA/NCAL’s Population Health Management Council started this year with the goal to enhance quality of care and quality of life for beneficiaries in senior living settings by ensuring the sustainability of long term care provider-owned population health models through advocacy, education, and quality improvement data.

At its core, population health management is about bringing efficiencies to how patients are cared for, or in the case of SNPs, how long term care residents are managed in a person-centered, hands-on manner.

And, through the unique world of SNPs, specifically I-SNPs, Dual Eligible SNPs (D-SNPs), and Chronic Condition SNPs (C-SNPs), skilled nursing and assisted living operators are able to offer plan members an even higher level of coordinated care than was previously feasible. This is a result of the reimbursement system and administrative flexibilities available to MA as overseen by the Centers for Medicare & Medicaid Services (CMS).

I-SNPs and I-SNP Equivalents may only enroll those who reside in a nursing facility, or are expected to reside in one for at least 90 days, or meet a nursing facility level of care but live in assisted living or the general community. C-SNPs are for those beneficiaries with a diagnosis of one or more CMS-approved conditions targeted by the plan, and D-SNPs are for those who qualify for both Medicare and Medicaid.

Responsibility Comes With Risk

Under these arrangements, Sumner says, CMS delegates financial risk and responsibility for coverage of Part A, Part B, and Part D to a MA plan. Health plans can thus profit if plan members are as healthy as possible, by avoiding trips to the hospital through better care management and the use of a plan-paid physician’s assistant or nurse practitioner who is on call and present in the facility much more often than in the course of traditional nursing care.

But, if care and administrative expenses are higher than the payout from the government, the downside risk comes into play and a health plan can lose money.

The Population Health Management models continue to become a preferred vehicle for improving quality and outcomes and reducing costs. LTC/PAC providers are taking ownership and looking to lead the way.
 
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