Paul Bergeron​The long term health care industry’s move to population health management and value-based care is not slowing down. This monumental change is happening steadily, and providers (and their residents) who learned and benefited from taking this approach to health care during the pandemic have a step ahead of those who are waiting and wondering.

The American Health Care Association (ACHA) and National Center for Assisted Living (NCAL) hosted the Population Health Management Summit in National Harbor, Md., on Dec. 7-8, 2022, to look inside and look ahead on what all players can contribute to moving forward.

“Value-based care through the population health management model is the most exciting thing I’ve had the chance to be a part of in my 30 years in the industry,” Mark Parkinson, president and CEO of AHCA, said during opening remarks.

Mary Ousley, president, Ousley and Associates, and past chair of AHCA and NCAL, said, “The first step is to read, study, and understand this model,” she said. “This is the future of how health care will be carried out.”

Parkinson said AHCA/NCAL brought the best of the best to the Summit “to prove this model is possible and to share innovations and ideas about how we can get better.”

In fact, panelist Tom Haithcoat, president, Ceptor Consulting, encapsulated the atmosphere, saying the conference’s top benefit was that “so many people have similar but unique situations, and we are all here to learn from each other.”

The message is sinking in. One operator who reflexively was opposed to change, told a panel, “Sounds like it’s coming. Looks like I need to get on board.”

Brian Fuller, CEO, Integrated Care Solutions, said that with skilled nursing facilities (SNF), “it’s a no-lose strategy to invest in your clinical capability. Increasing your clinical training, adding specialized clinical programs, creating greater clinical presence via physicians, nurse practitioners, etc. is a ‘no-lose’ because you win under fee-for-service and value-based care with this strategy.”

‘Accountable Care’ Definition in New Light

Mark McClellan, M.D., Ph.D., director at the Margolis Center for Health Policy at Duke University, was the opening keynote speaker of the Summit.

He shared the updated definition of accountable care in that it “centers on the patient and aligns their care team to support shared decision-making and help realize the best achievable health outcomes for all through equitable, comprehensive, high quality, affordable, longitudinal care.”

He said that this revised definition centers the patient, “recognizing that care teams need to come together over time and across areas around each patient’s needs. It recognizes that the care team must be supported in going beyond traditional medical services to improve outcomes and equity—with a stronger focus on advancing health equity.”

Most importantly, he said this definition “recognizes that accountable care requires payment reform to sustain these person-centered care approaches, but also that it’s about more than payment reform.”

A Kaiser Family Foundation report suggests that it will get done. The forecast for Medicare Advantage enrollment is projected to surpass traditional Medicare by 2025. During multiple event sessions, it was estimated that currently the country is at about 60 percent to 70 percent enrolled and its goal is to reach 100 percent by 2030.

Progress on Accountable Care Must Increase

McClellan said, “you’re probably doing the math, and concluding—like all of us involved in this effort—that progress on accountable care must increase as we come out of the pandemic and face both more pressures to make progress as well as challenges in doing so.”

“This will be a challenging next couple of years, also given the industry’s workforce issues and that Capitol Hill is looking to make cuts,” McClellan said. “Organizations that did value-based care during the pandemic performed better than those that did not. They experienced more revenue stability and more overall financial stability. They are at an advantage because they already have data systems in place, social pharmacy, and telehealth.”

Population health management is about not just getting the treatment but getting the right treatment of the right person, McClellan said.

The Essence of Care

Rick Grindrod Jr., CEO and president, Provider Partners, said most SNF operators use electronic medical records (EMRs) and do a good job of documenting all that transpires with a resident at their facilities. What challenges their staffing is the continuity and communication of care from one shift to the next.

He said one solution to this problem is the implementation of a data-mining system that captures the patient condition information in the EMR every day or even every hour and looks for triggering indicators of a potential change in condition.

Grindrod said this can lead to “the essence of success” in value-based care: being treated well while avoiding unnecessary hospitalization.

For example, if symptoms are in the EMR that match a resident’s chronic issue, a data mining system can knit the information together using an algorithm and send an alert to a primary care provider or the facility clinical leadership that this resident is having a flare-up of a chronic disease. Then, the nurse or physician can assess the patient’s medical needs and address them.

By identifying the change in condition early on and treating the issue, the health care system cost is $15 to $20 for medicine plus a fee to be seen by a nurse practitioner rather than spending thousands of dollars or more for a hospital stay.

One Michigan-based operator said that when health care staff joins a facility, they think, “now, this is what I went to school thinking health care is.”

But prior, it wasn’t, the operator said. “It was following a book of regulations. This way, the health care providers can work intuitively and not have to just check boxes on a list they are given.”

I-SNPs Dominate Panel Discussions

Many panelists during the education sessions focused on how creating programs such as Institutional Special Needs Plans (I-SNPs) through Medicare Advantage will help to reduce resident trips to the hospital and thus save money for the facility operators, beneficiaries, and the system.

Maureen Cahill, administrator, Spurgeon Manor, was one of several panelists who said having a nurse practitioner drove better quality care, service and patient outcomes, and better survey outcomes.

“By provided value-based services, this lets communities better communicate their value and performance to prospective residents and their families,” Cahill said.

Shelby Barnes, nurse consultant, HealthCARE of Iowa, manages an I-SNP. She said operators can manage their residents’ hospital-visit volume by having more care options available in their own building.

Phil Fogg Jr., CEO and president, Marquis Companies, said that when operators provide physicians’ care at their facilities and align their goals, “you can drive change in how you deliver care. It becomes a ‘we’ issue, instead of everything working individually—which makes it hard to drive change.”

Dave Chensvold, executive chairman, HealthCARE of Iowa, will begin his new population health management program on January 1. He said that by partnering with a health plan company allows the partner to take on 80 percent of the initial and ongoing work, which is a relief to Chensvold’s executive director.

“This helps tremendously with buy-in—along with the general concepts of an I-SNP, which is great for the resident,” he said.

“With the executive director understanding the concept and involvement of [our partner], it gives them confidence that it won’t be such a significant change and/or disruption than they originally perceived.”

“In this model, you are responsible for your own success,” he said. “By proactively managing quality outcomes by collaborating with clinicians and the resident, the provider can share in the cost savings as well as the benefit of a longer length of stay.”

Priti Jindal, M.D., CMD, chief medical officer, Transitional Care Physicians of America, said the two main reasons for move-outs are death and a lack of higher-level care.

“By using population health management models, this is very much under your control,” she said. “We want the residents to age in place and value-based care achieves all the factors that help to reduce hospital visits.”

Paul Bergeron is a freelance writer based in Herndon, VA.