To show the importance of population health management, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has created a new entity called the Population Health Management Council. 

The goal is to convene and support long term and post-acute care (LT/PAC) providers engaged in population health management initiatives, be they health plan start-ups, accountable care organizations, or participation in bundled payment programs. But, most often the focus is on providers exploring a move into the payer side of the health care business.

The council’s work can take the form of providing representation and advocacy before policymakers and regulatory agencies, offering technical assistance to existing plans, supporting data integration and analysis that demonstrate the provider-owned value proposition, and acting as a forum for collaboration and best practice dissemination, according to the advocacy group.

First Step, Transform Culture

Jill Sumner, vice president, population health management, AHCA/NCAL, says LT/PAC providers interested in becoming involved in population health, most likely in the form of a Medicare Advantage (MA) Special Needs Plan (SNP), must first transform their culture.

Being a MA plan is not just a matter of getting regulatory approvals or meeting all the financial requirements, but rather the process starts with the transformation of the entire organization to a new way of doing business, a new way of delivering comprehensive person-centered care with the support of a health plan platform. Integration of the new health plan into the organization and staff buy-in are necessary to achieve success, she says. From that foundation come other challenges such as proper staffing, attracting enough enrollment, forming a robust network of providers to care for plan participants, and the pressure to provide the high-quality care that will limit trips to the emergency department.

There is also the necessity to find the right partners for building the plan, such as collaborating with fellow providers looking to offer insurance as well and finding a good fit with the third-party administrator to manage back-office administrative tasks, Sumner says.

The Advantages

On the flip side, opportunities are in abundance for a provider willing and able to implement a health plan, she says. The attributes of a provider that may be successful in offering a MA plan are to have access to advanced clinical professionals for preventive, regular, and urgent care; the ability to effectively implement large-scale change; and the ability to align incentives among providers for improved quality and responsiveness. 

Sumner says MA plan participants are likely to express increased satisfaction with their care after enrolling, as will their families. Offering a MA plan also differentiates a provider in the crowded marketplace, increases lengths of stay, and allows the ability to keep residents healthy longer.

And, the financial impact of installing an insurance product can over time increase supplementary revenue streams and trigger potential cost offsets. It can also permit providers to tap into new data to make informed decisions for resident care, improving outcomes and setting a framework for future care management, she says.