Insurance Corner <p><span class="ms-rteForeColor-2" style="">ADVERTORIAL</span></p><p>“When you take over a family business, there is a lot to think about. What was important to me was that Senior Housing Managers carried on the knowledge and legacy of smart decisions that was started by Chris Mason, our founder. <br></p><p>One area we needed to make new smart decisions was in managing our staffing challenges. We currently have 510 employees serving 600 beds. But several years ago, despite our best efforts, our turnover numbers were high, and we needed help.<br></p><p>After meeting Nick at the AHCA/NCAL Convention, we decided to partner with Compass Total Benefit Solutions. Our goal was to improve our employee retention rates. But, as many in our industry—including Nick—understand, it can be difficult to design a benefits package that is robust enough to retain employees without being burdensome for the employer.<br></p><p>Nick helped us through everything. He worked with our needs and helped us create a benefits solution that has truly helped Senior Housing Managers to improve our turnover numbers. On top of that, Nick identified several employer retention credits during the pandemic that will result in nearly $3 million dollars being returned to our business in cash.<br></p><p>I would recommend Nick and his team 100%. They go above and beyond the specific needs, and our partnership has exceeded our expectations for three years in a row.”<br></p><p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/Compass_CarlMason.jpg" alt="Carl Mason" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;156px;" /><strong>Carl Mason</strong><br>Chief Operating Officer<br>Senior Housing Managers, LLC <br><a href="mailto&#58;carl.mason.shm@gmail.com" target="_blank">carl.mason.shm@gmail.com</a> <br></p>2022-09-01T04:00:00Z<img alt="" src="/SiteCollectionImages/logos/CompassTB.jpg" style="BORDER&#58;0px solid;" />QualityIt can be difficult to design a benefits package that is robust enough to retain employees without being burdensome for the employer.
A Model of Quality Care During Transitions<p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><p>The Continue Care transitional care management program, created by PharMerica and BrightSpring Health Services, aims to address the gaps in care that exist when an individual is transitioning from a skilled care facility to their own home. Though the program officially launched in May 2022, its development has been underway for much longer, gaining evidence of its impact on the quality of care offered to individuals during critical times of transition. <br></p><p>At its core, Continue Care integrates seamlessly into a facility’s discharge planning process to extend care management into the home by offering a dynamic set of services and solutions that promote medication therapy optimization and nurse engagement at all levels of care. These include 44 days of medications provided post-discharge with most providers, including an initial 14-day supply of medications at the time of discharge; weekly check ins from a nurse starting within 48 hours of arriving home; in-home visits from nurse practitioners (NPs) where available; and 24/7 virtual nurse and pharmacist support for residents and families.<br></p><p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/ElizabethBurns.jpg" alt="Elizabeth Burns" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />Conceptually, the Continue Care transitional care management program has gained support from key industry leaders. To add more demonstrative proof of its impact on quality care, PharMerica partnered with Avamere, a leader in&#160;post-acute&#160;and&#160;senior&#160;living, to pilot Continue Care’s transitional care management program. Under the leadership of Dr. Elizabeth Burns, Chief Medical Officer at Avamere, the company launched Continue Care’s pilot program to support its goal of increasing quality care and the patient experience. <br></p><p>“One of the core missions of Avamere is to pursue innovation, not emulation,” said Dr. Burns. “That mission made the decision to join the Continue Care program an easy one.”<br></p><p>Like many centers, Avamere was seeking solutions to address key areas of quality care, including reducing hospital readmissions, improving medication adherence at home, preventing emergency hospitalizations, and&#160;providing&#160;care&#160;in the home for those who need a higher level of assistance. <br></p><p>“Our&#160;goal is&#160;to improve the&#160;quality of seniors’&#160;lives,” said Dr. Burns. “That requires that we&#160;set each person in our care up for success whether they are staying at one of our senior living facilities or discharging from our&#160;post-acute care centers. The Continue Care program breaks down barriers for safe and effective transitions in the home while improving the well-being and experience of patients and residents.”<br></p><p>While the pilot overall has been a success thus far, three specific areas of Continue Care’s program are supporting Avamere’s goals of setting patients up for long-term success&#58; <strong><br></strong></p><p><strong>Primary Care Hub&#58;</strong> Where available, the Primary Care Hub offers NP-led care within the facility itself to partner with staff to develop a proactive care path.<br><strong>Clinical Nursing Hub&#58;</strong> The Clinical Nursing Hub offers care navigation into the home, monitoring, and triage tools designed to address risks and improve outcomes in real time.<br><strong>Pharmacy Packaging&#58;</strong> Continue Care provides convenient multi-dose pillow packaging of prescription medications organized by administration time, synchronized into 30-day cycles with clear instructions to increase adherence and reduce confusion.</p><h3>Primary Care Hub </h3><p>Honoring Continue Care’s goal of creating a model that positions individuals for the best care possible along all stages of the care continuum, Continue Care integrated aspects of BrightSpring’s home-based primary care services into Avamere’s trial through the Primary Care Hub. This in-facility service is a patient’s initial interaction with a care team, beginning the day of admission and continuing through discharge. From this early interaction, care providers can spend time getting to know the patient, their medical diagnoses, and complications, and better understand what the best proactive care plan should be for that specific individual. <br></p><p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/ArifNazir.jpg" alt="Arif Nazir" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />“This partnership between home-based primary care and Continue Care is being developed to offer all care providers a great understanding of a patient,” said Dr. Arif Nazir, Chief Medical Officer, Primary Care, at BrightSpring Health Services. </p><p>“We’re focused on proactive care, which relies a lot on communication between care providers as well as taking time and resources to better educate patients about their own medical care.”<br></p><p>Based on initial observations, BrightSpring’s proactive care models within the Continue Care program can help better identify specific medical issues that need attention before they require reactive care. This is particularly important in the Continue Care program, where patients will have complex co-morbidities. While certain technological components are still being developed, BrightSpring’s team-based process requires collaboration between in-facility care teams and the transitional care management teams of Continue Care, as well as educating the patients themselves.<br></p><p>The Primary Care Hub overlay includes&#58;<br></p><ul><li>A NP-led care program to partner with facility staff.</li><li>A risk-stratified, proactive care path-based model to meet individualized medical and psychiatric needs.</li><li>NPs/physician assistants (PAs) supported by care navigators to assure care path compliance.</li><li>Weekly grand-rounding processes to enhance staff competencies and to promote team learning.</li><li>Integrated, high-quality 24/7 call center to answer staff and family questions and prevent hospitalizations.</li><li>Timely outcomes reporting for all stakeholders.</li><li>Chronic disease management and behavior health integration programs.</li><li>Advance care planning on admission and then periodically.</li><li>Polypharmacy optimization and deprescribing.</li></ul><p>“Incorporating home-based primary care is what makes this model incredibly innovative in advancing the care delivery upon discharge, wherever you call home” said Dr. Burns of Avamere. “The Primary Care Hub with Continue Care allows a successful transition to home where patients will get the highest level of care at the right place at the right time along their care journey.”<br></p><p>The pilot program at Avamere is still on track, providing critical data points that will help other centers around the nation successfully integrate Continue Care into their facilities. For more information about the Continue Care transitional care management program, visit <a href="http&#58;//www.pharmerica.com/ContinueCare" target="_blank">www.PharMerica.com/ContinueCare</a>. <br></p>2022-09-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/ContinueCare_PharMerica.jpg" width="1248" style="BORDER&#58;0px solid;" />ManagementContinue Care integrated aspects of BrightSpring’s home-based primary care services into Avamere’s trial through the Primary Care Hub.
Advocating for Value-Based Care and I-SNPs<p><em>Population health management (PHM) aims to improve the health and quality of life for a targeted group of patients through care coordination, data analytics, risk stratification, and interventions targeted at the individual, group, and community levels. Here four members of the AHCA/NCAL Population Health Management Council explain why PHM is important and how more providers can transition to provider-owned institutional special needs plans (I-SNPs).</em></p><p><strong>Participants&#58;</strong><br></p><ul><li><strong>Rick Grindrod,</strong> chief executive officer, Provider Partners Health Plan</li><li><strong>Marc Hudak,</strong> chief growth officer, Longevity Health Plan</li><li><strong>Amy Kaszak, </strong>president special needs plans, AllyAlign Health</li><li><strong>Hank Watson,</strong> chief development officer, American Health Plans<br></li></ul><p><em><strong>Provider</strong></em><strong> Magazine&#58;</strong> <strong>Why do you consider your involvement with the Population Health Management Council so crucial?</strong><strong><br></strong></p><p><strong><img src="/Topics/Special-Features/PublishingImages/2022/RickGrindrod.jpg" alt="Rick Grindrod" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;100px;height&#58;125px;" />Rick Grindrod&#58;</strong> We appreciate AHCA/NCAL facilitating the Council and all the work that goes into creating value for its members. Provider Partners Health Plan prioritizes its involvement with the Council to create a more unified voice in advocating for skilled nursing facility (SNF) providers in a value-based payer and regulatory environment, particularly to CMS. It is also important to become a more unified voice in advocating for a more value-based approach to our SNF provider colleagues. <strong><br></strong></p><p><strong><br></strong></p><p><strong><img src="/Topics/Special-Features/PublishingImages/2022/MarcHudak.jpg" alt="Marc Hudak" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;100px;height&#58;125px;" />Marc Hudak&#58;</strong> Longevity Health Plan joined the Council to collaborate with and to establish mutually beneficial working relationships with SNF operators who are committed to successfully transitioning to value-based care. Over the past three years, we’ve worked hand in hand with the Council and its members to deploy critically important lobbying strategies that meet the unique needs of provider-sponsored I-SNPs, to share best practices and support SNF operators who are new to I-SNPs, and to build new alliances and partnerships.&#160; <strong><br></strong></p><p><strong><br></strong></p><p><strong><img src="/Topics/Special-Features/PublishingImages/2022/AmyKaszak.jpg" alt="Amy Kaszak" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;100px;height&#58;125px;" />Amy Kaszak</strong>&#58; AllyAlign Health (AAH) is one of the original supporting partners of the Population Health Management Council. Our mission is to improve the health, happiness, and dignity of seniors. Working with the Council supports these aims, both through advocacy for policy changes that directly impact how seniors living in senior housing access and pay for health care, and through sharing best practices for improving the quality of life on senior living campuses. <strong><br></strong></p><p><strong><br></strong></p><p><strong><img src="/Topics/Special-Features/PublishingImages/2022/HankWatson.jpg" alt="Hank Watson" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;100px;height&#58;125px;" />Hank Watson&#58;</strong> The word transformative tends to be overused in the long term care (LTC) space. But the transformative potential of nursing home owners owning the development and operation of Medicare Advantage I-SNPs is real. The creation of the Council was an early recognition by AHCA/NCAL of not only the potential of this model, but also the significant learning curve the industry faced to refine the model to best serve the residents and facilities. Over the years, the Council has demystified the process and operation of provider-owned I-SNPs. This effort has supported the provider-owned I-SNP becoming ubiquitous. </p><p><strong>PM&#58; What goals are you hoping to achieve by serving on the PHM council?</strong></p><p><strong>RG&#58;</strong> We need to protect the existence of population health models including I-SNP and accountable care organizations (ACO)/Reach. We need to advocate for reasonable regulatory changes. We need to propose and promote model changes that allow the SNF and LTC sponsors of population health companies to better serve SNF and LTC residents (i.e., allowing attribution of entire SNF/LTC populations or designation of all SNF patients as high needs).</p><p><strong>MH&#58;</strong> We are highly motivated to continue as a council partner to serve as both a catalyst and an enabler to skilled nursing facilities and assisted living operators who are looking to succeed in the future of value-based care. </p><p><strong>AK&#58;</strong> From our founding in 2013, AAH has worked to ensure that senior living operators—SNFs, assisted living (AL), memory care, and Life Plan/continuing care retirement communities (CCRCs)—have a voice and a “place at the table” when CMS and other payers are developing value-based care models impacting seniors living in senior housing. PHM is an important ally in our campaign to educate the senior living industry on the importance of value-based care solutions and in advocating for payment and policy solutions with CMS that benefit residents and support senior living operators. </p><p><strong>HW&#58;</strong> By serving on the Council, I hope that the provider-owned I-SNP model expands across the sector as more providers embrace it. My goal is that providers shift their mindset from “should I own an I-SNP?” to “how do I optimize my I-SNP for my residents and facilities?”</p><p><strong>PM&#58; What opportunities do you see for the long term care provider-owned space?</strong></p><p><strong>RG&#58;</strong> There is a huge opportunity for SNF operators in this space. Value-based care will reward operators that improve care and reduce cost. The facilities see enhanced revenue opportunities; the SNF/LTC residents receive higher quality, more timely care, and a better overall experience; and the government achieves their goal of reducing per capita cost.</p><p><strong>AK&#58;</strong> Even amid a staffing crisis, rising inflation, and increased labor costs, long term care operators have the opportunity to take the lead in value-based care models for their residents. Provider-owned Medicare Advantage SNPs are one way to do this, but AAH also sees other models, including provider-centric SNPs and new ACOs as opportunities for more senior living organizations to participate in a meaningful way with managed care. In AAH plans, partner communities can expect to see per-resident revenues increase by as much as 30 percent, while preventive primary care models reduce hospital readmissions by 39 percent, all while achieving a high satisfaction rate with plan and ACO members. These models can extend value-based care participation to communities in AL, memory care, senior affordable housing, and Life Plan/CCRC.</p><p><strong>MH&#58;</strong> We are clearly headed in the direction of more innovative care models and rewarding providers for improved health outcomes. Longevity has demonstrated that we are uniquely positioned to create customized partnership models that enable our partners to materially improve clinical outcomes and to succeed in this rapidly evolving value-based care landscape. We believe there has never been a more important time to make this transition and we could not be more excited with the opportunity to serve, innovative, and collaborate with existing and new partners to thrive as leaders in this space.​</p>2022-07-26T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/senior_woman_nurse_1.jpg" style="BORDER&#58;0px solid;" />Population Health ManagementMembers of the AHCA/NCAL Population Health Management Council explain why PHM is important and how more providers can transition to provider-owned institutional special needs plans.
A View from the Field<p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/MatthewBarrett.jpg" alt="Matthew Barrett" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteThemeForeColor-5-4">​“COVID-19 relief dollars provided by both federal and state government have been nothing short of a lifeline for our Connecticut nursing homes hit hard by the pandemic and now on a pathway toward recovery, but a longer bridge or recovery period of support to the other side of the pandemic is needed beyond what was initially forecasted. Occupancy recovery is now the main issue in the elongated pandemic, and how staffing shortages are hindering occupancy recovery is the same issue at both the federal and state level.”</span><br><span class="ms-rteFontSize-1">—&#7;Matthew V. Barrett, J.D., M.P.A., President and CEO, Connecticut Association of Health Care Facilities and Connecticut Center for Assisted Living</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RobertVandeMerwe.jpg" class="ms-rtePosition-2" alt="Robert Vande Merwe" style="margin&#58;5px;width&#58;125px;height&#58;125px;" /><span class="ms-rteThemeForeColor-9-4">“I believe the greatest challenge both in Idaho and nationally is the workforce crisis. We always knew that there would not be enough workers to support the Baby Boomers after 2030, but the pandemic has brought that crisis eight years earlier as millions have left the workforce.”</span><span class="ms-rteFontSize-1"><br></span></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Robert Vande Merwe, Executive Director, Idaho Health Care Association</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/BrendanWilliams.jpg" alt="Brendan Williams" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteThemeForeColor-7-4">“The predations of national staffing agencies threaten to destroy long term care in New Hampshire and nationally. Having a staffing agency in your building is like inviting in a vampire.”</span><br></p><p><span class="ms-rteFontSize-1">&#160;—&#7;Brendan W. Williams, M.A., J.D., President and CEO, New Hampshire Health Care Association</span></p><p><br></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/CherylHeiks.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;125px;height&#58;125px;" /><span class="ms-rteThemeForeColor-10-3">“The pandemic represents the greatest threat to the industry in its history. But with every threat, there exists the chance for opportunities. The crisis should be the clarion call to stakeholders beyond the industry who were already painfully aware of staffing shortages. The lack of supply of health care professionals in the country because of increased competition, the aging of the existing workforce, and traditionally lower wages and health benefits in the long term care industry will add to the challenge.”</span></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Cheryl Heiks, Executive Director, Delaware Health Care Facilities Association</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/KevinWarren.jpg" alt="Kevin Warren" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteForeColor-6">“I believe nationally, the greatest issue facing long term care is a true lack of understanding of the economic and societal role the nursing home profession serves in communities (urban and rural) across the country. They are the support for a disappearing safety net as the population over 65 grows faster and the availability of family caregivers declines. In communities across the country, nursing homes are among the top employers, nationally generating billions of dollars in labor income, state and local tax revenues.</span><br class="ms-rteForeColor-6"></p><p><span class="ms-rteForeColor-6">“The biggest short-term issue facing long term care in Texas is the inevitable expiration of the federal public health emergency and the end of Medicaid add-on in place that has served as a lifeline for long term care. Long term, the biggest issue in Texas is the lack of a predictable Medicaid policy that pays for actual costs of care, adjusts to the growing acuity needs, and ensures the availability of resources to provide the highest quality of care our residents/</span><br class="ms-rteForeColor-6"><span class="ms-rteForeColor-6">patients deserve.”</span><br></p><p><span class="ms-rteFontSize-1">—&#7;Kevin Warren, President and CEO, Texas Health Care Association<br></span></p><p><br><span class="ms-rteFontSize-1"></span></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/PattiCullen2.jpg" alt="Patti Cullen" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span class="ms-rteForeColor-1">“Workforce availability is the biggest issue—it has always been a small concern, but current labor market competition, suppressed wages, and a decreasing number of eligible workers have created a workforce crisis that is not easily resolved. Simply legislating or regulating workforce standards does not solve this problem; rather, significantly increasing wages and benefits to entice workers to join and stay in the long term care profession as a valued career is essential to avoid collapse of this sector.”</span><br></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Patti Cullen, CAE, President and CEO, Care Providers of Minnesota</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RachelBunch.jpg" alt="Rachel Bunch" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;125px;height&#58;125px;" /><span class="ms-rteForeColor-9">“The biggest issue facing our sector nationally is funding, which affects all areas of a quality delivery service, especially access to care in rural America. The biggest issue facing our state is workforce, in particular the shortage of nurses.”</span><br></p><p><span class="ms-rteFontSize-1">—&#7;Rachel Bunch, Executive Director, Arkansas Health Care Association and Arkansas Assisted Living Association</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RickAbrams.jpg" alt="Rick Abrams" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span style="color&#58;#ff9900;">“No question that in Wisconsin and nationally the biggest issue is workforce. Our members are continually challenged to maintain adequate staff coverage in all operational areas so that they can continue to deliver the high quality care that our seniors and folks living with disabilities expect and, indeed, deserve.” </span><br></p><p style="text-align&#58;right;"><span class="ms-rteFontSize-1">—&#7;Rick Abrams, CEO, Wisconsin Health Care Association/Wisconsin Center for Assisted Living</span></p><p><br></p><p><img src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/ZachShamberg.jpg" class="ms-rtePosition-1" alt="Zach Shamberg" style="margin&#58;5px;width&#58;125px;height&#58;143px;" /><span style="color&#58;#0099ff;">“At both the state and federal level, the biggest issue facing the long term and post-acute care sector will be securing a seat at the table for policy, regulatory, and legislative discussions. As we continue to see new reform after new reform introduced by CMS and state legislatures throughout the country, we’ll need to ensure long term care providers can share their expertise and experience to help shape policy. Otherwise, the future of our industry will be dictated by those who never spent a single day on the front lines of the COVID-19 pandemic and who couldn’t possibly understand the challenges we face.”</span><br></p><p><span class="ms-rteFontSize-1">—&#7;Zach Shamberg, President and CEO, Pennsylvania Health Care Association</span><br></p>2022-06-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/State%20Execs/RobertVandeMerwe.jpg" style="BORDER&#58;0px solid;" />Caregiving;ManagementAHCA/NCAL State Executives and leaders weigh in on what they see as the sector’s biggest challenges and what issues they are facing head-on in their local communities.