Skilled care providers who want to take risks to long-term profitability need to get creative, warn two industry executives to join payers and care providers in value-based partnerships.
Brian Fuller from Integrated Care Solutions at the 2021 Synergy Summit
Any new payment alternatives offered by the federal government may offer too little and too late to help post-acute providers thrive after the pandemic, Integrated Care Solutions CEO Brian Fuller said Tuesday. Instead of waiting for a lifeline, he urged vendors to find and create shared-risk programs on their own networks.
“Whatever comes out of CMMI (The Centers for Medicare & Medicaid Services Innovation Branch) will most likely either be aimed at the doctor group model, in which you have to control a group of 10 people, which of course most SNSF operators don’t, or it will be a numerical model dressed in uniform, ”predicted Fuller, whose care management company supports a network of post-acute and hospital providers. “If that’s the trend then you say how do we find a way to play? I think it’s some of those creative floor risk arrangements…. Nothing stands in the way of such relationships – you just have to find the right partner. ”
His comments came during the Synergy Summit 2021 Executive Retreat held this week in Utah. Fuller was joined in a “fireside chat” by Eric Tanner, CEO of OnPointe, an experienced nursing staff who has grown into a broader company pursuing value-based options across the post-acute continuum.
Tanner was referring to an earlier Synergy presentation by former CMS administrator Seema Verma, who said the healthcare system was “desperate” for SNSF providers willing to take risks.
“Value-based care is there to stay … If you’re still in the boat with fees for service, you will drown,” said Tanner, also chief operating officer of Arkos Health, a new high-risk medical group integrating managed care, technology and clinical Services. “The value-based care was very difficult for our industry, primarily because the savings, as the CMS administrator mentioned today, are based on post-acute treatment.”
Navigate without strong VBP options
To better position themselves over the next five to 15 years, post-acute providers should focus on local and regional partnerships, which have become even more important as the number of truly national qualified care providers declines, Tanner said. Its companies target specific states, with services that cater to the needs of the local people.
Eric Tanner from OnPointe at the Synergy Summit 2021
Fuller, meanwhile, suggested two specific strategies vendors could use to take risks: reducing length of stay, in part by starting the discharge planning process earlier, which can extend residents’ length of stay by at least a day; and establishment of clearly defined clinical service lines for diseases such as heart failure, pneumonia, sepsis and COPD.
Providers shouldn’t be looking for a bundle to control Medicare or Medicaid dollars in, Fuller repeated. While some providers have been successful in pursuing the ability to control Medicare’s life through institutional special-needs plans, other options remain limited. For example, the direct contract model previously offered a Medicaid managed care option, but CMS will not be accepting applications in 2022.
However, if a track returns with a high need for dual eligibles, it could be “a way forward for SNSF operators to take risks,” said Fuller.
There is growing pressure on and within CMS to offer providers more value-based payment options to ensure they can continue to operate.
CMMI Director Liz Fowler said last week that she expects her agency to rely heavily on values-based care, which increases the possibility of making some models mandatory in the near future.
And a May report by Duke’s Margolis Center for Health Policy found that few VBP models were “specifically developed for SNSFs or with the aim of making targeted improvements to both the quality and cost of facilities.”
“VBP models have the potential to generate more reliable revenue and support high quality care, but more opportunities are needed for SNFs to participate in VBP if that potential is to be realized,” the authors reported. A three-day waiver process could allow more providers encourage participation. “Most of the previous SNSF-focused payment reforms were pay-for-performance models that showed modest results. There may be opportunities for more advanced VBP models such as B. the identification of how SNFs can be part of Medicaid ACO models. Any Medicaid VBP model needs to be carefully designed to attract SNSF involvement as concerns are raised about Medicaid prices for long-term residents. “
Meanwhile, with regard to “Hamilton”, Tanner told vendors that it was important to get into the room where “it” happened. That means providing the right metrics to payers who are more concerned with medical loss rates than MDS data – and then offering to share the risk of caring for costly populations.
Successful execution could provide a cushion against the load that may never fully recover, he added.
“From a performance perspective, if you take some of your risk … you would certainly feel more confident if you had skin in the game and used it more, which is kind of a win-win situation that we seek,” said Tanner . “I believe that you are really standing in front of your payers, the people who have money in their pockets and can put it in yours, and to say that you are willing and able to make a risky arrangement with them, this makes some noise. “
