Debbie Stadtler: Superior clinical outcomes for residents, increased family trust, and better metrics for your facility? That's the promise of value-based care in assisted living. Learn how to get started with Irene Borgen in this episode of Perspectives in Long-Term Care.
Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Health Care Association and the National Center for Assisted Living.
I'd like to welcome you to this episode of Perspectives in Long-Term Care, a monthly podcast produced by AHCA and NCAL. Each month, we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long-term and post-acute care profession. My guest today is Irene Borgan.
Irene serves as vice president of innovation and clinical partnerships at Sunrise Senior Living. She is a registered nurse, a licensed nursing home administrator, a board-certified nurse executive, a certified professional in health care quality, and a fellow of the American College of Health Care Executives.
Welcome, Irene. Thanks for being with us.
Irene Borgen: Thank you, Debbie. Thank you so much for having me.
Debbie Stadtler: Well, let's start at the beginning. Tell us about your career journey. What led you to get started in long-term care?
Irene Borgen: I joined Sunrise just over three years ago after spending more than two decades in the broader health care industry. I started my career as a clinician and gradually moved into hospital administration and executive leadership with an increased focus on operations, quality and safety, care transformation, population health, and most recently, value-based care. Over the years, I've worked across hospital, home care, skilled nursing, ambulatory, and health insurance settings, and have been very fortunate to bring that experience with me to Sunrise.
Today, I have the opportunity to help advance Sunrise's strategy around innovation and clinical partnerships, and to think about how we can apply value-based care principles within senior living while continuing to strengthen our person-centric holistic approach to wellness.
Debbie Stadtler: So Irene, tell me about your organization.
When did value-based care first come onto your organization's radar, and what made you realize this was something that assisted living could not afford to ignore?
Irene Borgen: Let me start with a bit about us and how this fits in a much bigger ship. Sunrise is one of the largest senior living operators in the US with some communities in Canada.
We have around 240 communities currently. We offer independent living, assisted living, some skilled nursing, and are serving around 20,000 residents. Wow. And we've always been an organization focused on hospitality and wellness. That's in our DNA, and it's the promise we make to residents and families. But I would frame the value-based care itself as bigger than one company's decision.
It's an industry-wide inflection point. Since the introduction of the Accountable Care Act in 2010, also known as Obamacare, the US health system has been shifting from paying for volume, also called fee-for-service To paying for quality and improved health care outcomes. And that shift continues to reshape every care setting, including senior living.
In other words, value-based care movement aims to help people stay healthier longer, prevent unnecessary hospitalizations, improve overall health care outcomes, and contain escalating health care costs. And senior living is really uniquely positioned in that shift. Our teams don't just provide services, they truly know our residents.
They notice when someone isn't quite themself, whether it's a change in appetite, energy level, participation in activities, just overall well-being. We know it long before those changes would be visible in a traditional health care setting. Those everyday observations, combined with close partnerships between our care teams, families, our clinical providers, create really unique opportunities to intervene earlier and support better health care outcomes.
In many ways, senior living has always played an important role in helping older adults stay healthier and avoid unnecessary hospitalizations, whether we have formally described it this way or not. And families and residents have already been pointing the industry in this direction through decisions they make when they choose a community.
They're actually telling us how much access to health care and wellness matters. Increasingly, we see that they're looking for communities that can help their loved ones maintain their health, independence, quality of life, not just to provide a place to live. So value-based care wasn't something we had to be talked into.
Our mission, the evidence, and our residents and families really all pointed in the same direction. It felt less like a trend and more like the natural next chapter in how senior living can support residents.
Debbie Stadtler: I think that's a great point, that this was something that generally you were already doing, and this just formalized it and really gave it a name and a direction, but you were already providing that better life for longer, better health for longer kind of thing.
As you began exploring value-based care, what convinced you and your leadership team that this was something your organization needed to embrace? How did you know your organization was ready to take the first step?
Irene Borgen: Honestly, in addition to the feedback from residents and families, the peer-reviewed published evidence did a lot of the convincing.
There's a really large and growing body of recent peer-reviewed research linking primary care to longevity. Most recently, in 2025, a study was published by Harvard Medical School and the Harvard School of Public Health that included nearly 11,000 of older adults aged 65 to 84, and they found that access to primary care was associated with roughly two additional years of life expectancy.
That reframes primary care from a nice-to-have into a genuine longevity lever When the evidence shows access to primary care adds years of life, then the conversation stop being, should we? It becomes, how fast can we? The other thing that made us ready was recognizing that this wasn't a pivot for us. It was a natural extension of what we were already doing, an organization where we have our wellness-first mission, culture, and the infrastructures to support it.
So bringing value-based care, focused primary care on top of that just felt natural. It fit really well with Sunrise's vision of creating the preferred lifestyle for enjoying longer, healthier, happier lives. And the last piece of readiness is a mindset shift that's available to any operator. You don't need to become a medical group to do any of this.
What you need is the willingness to bring in the right clinical partners, collaborate with them closely, and collectively drive better health care outcomes, and ultimately, greater longevity for our residents.
Debbie Stadtler: I love that. You don't have to have a fancy system or change everything. It's really collaboration and working closely for the best outcomes. That's great.
Once you decided to move forward, where did you start? Walk us through the early days. What were the first priorities? What capabilities did you have to build? And also, what were some of the challenges you encountered along the way?
Irene Borgen: Great question. I think, like always, we started with data because you truly can't manage or prove progress on something you haven't measured. Before you change anything, you establish your baseline. Things like what we looked at was emergency room visits, hospitalizations, 30-day readmissions to the hospital, falls, polypharmacy, multiple medications on res- with residents, the distribution of primary care providers across our communities, and finally, resident and family satisfaction with primary care.
That baseline became what we hold ourself accountable to, and later, it really becomes your proof. From there, it's the care model. At the concept level, it's consistent relationship-based clinical support embedded in the community, focused on prevention and proactive chronic disease management rather than reactive care.
It's predictable, timely access and coverage, so concerns can be identified earlier, can be better coordinated, and resident can continue to thrive in place, at home. One part that I do want to make concrete because families feel it so directly, residents always have a choice of who their primary care provider is.
And even if they choose to stay with their existing provider with whom they have a long-standing relationship, the embedded value-based care focused clinical partner could still cover them for an urgent clinical escalation. So a small change on a Sunday night when their primary care doctor is not available to respond doesn't automatically become a trip to the emergency room.
Our residents and families loved it. Loved it. No one wants to go to the emergency room with mom or dad ever, especially not on a Sunday night, right? And clinical escalations are unpredictable. You never know when this will happen. So that was really something that we learned through the process. Now, I wouldn't pretend that this was all easy, okay?
The biggest challenge was the change, right? Change is always hard for residents, families. Introducing a new primary care provider, it's really personal. People have relationships with their doctors going back years. So we had to lead with choice and let the experience and the results win them over. It is always their choice.
Another important consideration was supporting our teams through this transition. Any new care model introduces new ways of working, new opportunities for collaboration. Our team members embrace the vision, but like any meaningful change, it required thoughtful training, clear communication, ongoing support to help everyone build confidence and consistency over time.
And third, and I'm kinda like coming back to it, was data, right? Standing up measurements and reporting is a little bit harder than it sounds. You have to define your metrics, capture them consistently across every community, and make sure everyone is looking at the same numbers. And the fourth was really finding the right partner.
Really critical point. Not every clinical partner is willing or able to actually meet a high bar, and we were asking a lot on purpose because that's what delivers the best experience and support to our residents. So finding partners who could deliver on all of it really took time and vetting. None of those were reasons not to do it.
They were just work, and working through them is what turned this from a good idea into something real and meaningful.
Debbie Stadtler: I like how you mentioned sort of the different parties and groups that are involved. It's not only the residents, it's not only the staff, it's also changing maybe how you measure your data and metrics, the partner that's involved.
There's really so many pieces, and so working through each piece and getting everybody going in the same direction, I could see how that would be the important part of it for sure. For providers who are skeptical, what's the real business and clinical case for assisted living to engage in value-based care?
What tangible benefits have you seen for residents, families, staff, partners, and your organization?
Irene Borgen: Sure. I think the first thing I would say to a skeptic is that this isn't a trade-off. Clinical outcomes and business objectives move together. In this particular instance, they're not competing goals. Both come out of the same thing: providing holistic, wellness-focused care and a great experience for our residents and families.
On the clinical side, I would speak directionally. Communities with value-based care, outcome-focused clinical support consistently trend towards fewer hospitalizations, fewer readmissions, and fewer emergency room visit- visits compared to their peers. And the model itself is really, if you think about it, concierge-level clinical support without the concierge cost, and we are converging health care and hospitality.
That's our bottom line. We are an amazing hospitality company, and now we're bringing health care to their doorsteps. When you look at people, at various partners like you mentioned, so... Or even everybody who's involved. So if you look at residents stay healthier longer with a clinician who actually knows them and sees them often weekly on-site in their apartments, truly concierge medicine.
Yes. Families, right? Families get peace of mind in one coordinated team instead of fragmented set of providers, and that builds trust, which is everything in our business. Health care system in general is very uncoordinated and fragmented. If you are able to get a partner, a provider who is coordinating care, because that's what they do best, it's incredible.
It's so helpful. It's somebody who will help me schedule appointments for my mom when I also have a full-time job and other things I need to get done. And they will coordinate among all of the providers, so everybody knows what medications my mom takes and what other clinical conditions she has.
I think it's incredible. Care teams, they gain efficiency and a predictable point of contact, so instead of chasing down multiple physicians during clinical escalation, there's one number to call, one number, 24/7. For referral partners, hospitals, health systems, skilled nursing gain a post-acute partner that help- helps them keep their own outcomes and readmission goals.
Hospitals and SNFs, they are penalized on readmissions, so they know that by sending their resident, their patients to us, we will keep them out of the hospital with, in collaboration with our clinical partners The organization itself, us, we see the metrics leadership really trends, right? Tracks and trends.
We see occupancy improving, we see retention, we see length of stay. So the skeptic's real question, does this actually move the business? To me, it has a very clear answer, and the answer is yes. It improves clinical outcomes and business performance at the same time, because in this model, they're one and the same goal.
Debbie Stadtler: I love that. It's a win-win situation, clinical and business. If you were speaking directly to an assisted living executive who's still on the fence, and you've given a lot of evidence why they should move towards value-based care, what's your elevator pitch? What's your quick speech to convince them?
Irene Borgen: So my elevator speech would be something like, value-based outcomes focused primary care helps residents stay healthier longer, and everything else from, flows from this.
Families have greater peace of mind, care teams have stronger clinical support and coordination, and the operators see the benefits reflected in outcomes they already measure, such as resident experience, retention, and length of stay. Just as importantly, it doesn't require senior living operators to become health care providers themselves.
The opportunity is to build strong relationships with clinical partners that share accountability for outcomes and resident well-being. It is truly concierge medicine without the concierge cost, converging health care and hospitality. The larger point is also that health care is steadily moving towards rewarding improved health care outcomes rather than volume of health care services provided, and the question isn't whether this shift is coming.
It's already here. It is really about how prepared are we to actively participate in it.
Debbie Stadtler: I love that. What capabilities do you think every assisted living provider will need over the next five years, regardless of whether or not they're participating in a formal value-based care arrangement? What do you see?
Irene Borgen: Sure. I think if an operator... even if an operator never signs a single value-based care contract, the ground is shifting under all of us. CMS and payers keep moving toward awarding quality outcomes over volume. So a few things become table stakes. First, data and benchmarking. Every operator will need to be able to track its own outcomes, emergency room visits, hospitalizations, readmissions, falls, polypharmacy, satisfaction, and be able to compare them credibly internally today and against peers over time.
That's the hope. Second, strong clinical partnerships across the care continuum because in the next chapter, the strength of your partnerships will matter more than any single operator's internal clinical capabilities. Third, a workforce equipped to notice. Team members trained to catch subtle clinical changes early and escalate them appropriately.
And here's, I think, the bigger picture that I would love to leave people with. Senior living hasn't yet fully quantified or told the story of the cost it's already helping take out of the broader health care system by keeping residents healthier and out of the hospital. That's a collective opportunity, not a competitive one.
If we can prove it consistently and credibly across the industry, it could open a much broader conversation about how senior living is recognized and valued within the health care system, so that over time, this value is reflected in how CMS care models are designed, so more seniors can access the kind of support that keeps them healthy and independent longer.
Debbie Stadtler: I love that collective, and it really does impact the whole health care system. Avoiding that is so critical. For assisted living providers listening today who may be where you were a few years ago, what advice would you give them?
Irene Borgen: So a few things. I would say first start with data, not a finished model.
You don't need the whole thing figured out to begin. You just need a baseline, and that baseline is both your roadmap and your future proof. Second, don't try to build clinical capabilities internally. Use your scale and the power of partnership to bring in the right partners. Coordinate with them closely and hold them accountable for real results.
Third, expect a learning curve. The early friction isn't a sign you're doing it wrong. It's a sign you are early, and that's okay. Give it time and let your data and your residents' experience show you that what is working. Finally, lead with the mission. This is about helping residents stay healthier at home longer.
When you frame it this way, your team, your families, your leadership all move in the same direction. The business case is real and it's strong, but the mission is what gets everyone around the shared purpose, the rest follows.
Debbie Stadtler: Beautiful. I love that. And then even if you do encounter a couple of challenges or speed bumps along the way, keep going and it's really worth it in the end. Thanks. Thanks again for joining us, Irene. This has been a great conversation.
Irene Borgen: Thank you so much for having me.
Debbie Stadtler: Visit the AHCA NCAL website for more value-based care resources.
And thanks to everyone for listening to this episode of Perspectives in Long-Term Care. Join us each month as we discuss issues that impact the long-term and post-acute care profession. And be sure to subscribe to this podcast wherever you listen to your favorite podcasts.
Take care.