The senior housing and care providers of today have been working like a team as more and more are getting into the Medicare Advantage program.
The twin cities make a good example, for instance, 10 individual providers pulled together with a care management organization consisting of geriatric medical practice, and a health insurer to launch one of the very few plans in the country for special needs. Which is referred to as the Medical Advantage Solution Partner Care.
The approach taken is necessary due to a large amount of support needed for the plan to go forward and because of the Medicare Advantage program being so complex. It is a health plan in which the federal government funds payments to the private insurance companies. The benefit packages is being put together by the insurer’s, including managing services. They have an underlying principle of having the ability to bring in revenue at the same time they are providing care that is more efficient.
The initiative of the Twin Cities Medical Advantage program success depends on how well the relationships with senior living providers build-up in their local markets, including how well plan ownership is aligned and financial interests.
Putting Together A Team
The collaboration of the Twin Cities goes back to the non-profit days when Presbyterian Homes and Services (PHS) was a senior living provider. It was an organization based in St. Paul, Minnesota. They have around 7,000 units that spread over 15 different communities, with 27 different independent living quarters, and a total of 3 nursing homes. This puts it in fourth place for being the largest multi-site in the United States for rankings in 2019 coming from the LeadingAge & Ziegler.
In the past, the Presbyterian Homes were well known for manage care. For nearly 20 years had partnered up with three more senior care providers and began a health plan that eventually expanded with around 1,500 members, according to what the CEO Dan Lindh of Presbyterian Homes had said to Senior Housing News.
Due to changes in rules, Centers of Medicare & Medicaid Services (CMS) providers sold the plan to UnitedHealth, an insurance giant, in the early part of the 2000s. However, their manage care space continued evolving while the health care system of the United States was undergoing drastic changes, some related to the Affordable Care Act. Lindh started to see the opportunities, and Presbyterian Homes were watching the changes closely. Furthermore, during April of 2018, CMS made a statement saying that the Medicare Advantage plans would provide more flexible benefits. Included in the benefits were care services that were generally delivered in senior housing communities.
Lindh had said, “By the time the CMS had begun thinking of broader applications and at the time was extremely interested.”
Presbyterian Homes decided to create a special needs plan and approached Minnetonka, Minnesota-based Medica and Genevive on working together. The collaboration which could provide a plan that would be tailored just for those who were in long term care, living in senior settings. However, it became difficult for the organization to pull together the medical providers needed for the plan to become viable.
Lindh stated that “providers were not offering good deals, and at times would deny access.”
As more conversations had with health insurers, opportunities were presented. For instance, the opportunity to buy 50% stake within the organization (known as Genevive) whom are specialists in case managing and giving care to seniors living in the Twin Cities and surrounding areas, including some who live in senior housing communities. A transaction that was introduced during October of 2018. The other 50% of Genevive is owned by Health System Allina.
Around 3,500 individuals in were in that contract with and over 2,000 staying in assisted living and homes for single families made up the beneficiaries of Medicare Advantage who were going through Genevive.
Health plans are provided by the non-profit organization to individuals, employers, Medicare and Medicaid markets throughout nine different states and have approximately one million plan members, with annual revenue of about $5 billion dollars.
The SVP of Medica, Tom Lindquist, and general manager of government programs, told SHN that working with hospitals, skilled nursing facilities, in assisted living settings, and physicians, is Medica’s long term goal, and to make services available to the populations that are vulnerable. In fact, Presbyterian Homes made a proposal that matched these goals.
Lindquist continued, “It was merely an extension in philosophy, and the strategy included was already being practiced.” The work involved in order to bring the plan to market was difficult. With Medica having experience in pricing, plan design and interfacing involving CMS, and Presbyterian Homes, Genevive, and Allina combined providing a model on the care and services for the potential beneficiary of the population. Whereas, Presbyterian Homes is taking a risk of facing the ups and downs in losses.
However, the team building expanded more than anticipated for the plan and PHS was able to get nine other providers in the Twin Cities to join. Walker Methodist was one of the nine providers to join in. In earlier years Walker Methodist was a collaborator for managed care plans but eventually had been sold to UnitedHealth.
The CEO of Walker Methodist Scott Riddle made a statement to SHN saying that, “we jumped aboard when this opportunity was passing by. The partnership feels comfortable, so does the individuals involved with the network, and there is true potential here for helping the residents.”
A plan that is tailored especially for senior living residents may include powerful benefits that meet their special needs and improve the end results. Included is the partner Care plan which waives the qualifying hospital stay for up to three days intended for skilled nursing facility care. It also includes vision, hearing, dental, transportation, among other useful benefits.
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