SAN DIEGO—“We should expect to see continued growth in managed care.” So said Melanie Bella, independent consultant and former director of Medicare-Medicaid Coordination Office at CMS, at the NIC Spring Investment Forum conference here on Thursday.
“Managed care has an impact on folks that you are serving and is here to stay,” she explained. “The impact means how you work with all those players in new ways to help create value for them.”
In a session titled: Managed Care: Opportunities and Challenges as a Senior Care Provider, panelists reviewed the unique business opportunities and challenges of managed care, including enabling risk management, that operating companies and providers face in the seniors housing, post-acute care, and long-term care markets.
When moderator Michael Torgan, executive of business development and strategy at First Quality Healthcare Group, asked about shifting payment practices specifically, Jason Feuerman, SVP of strategic development and managed care at Genesis HealthCare Inc., said we should be concerned about turning the needle on utilization. “Primarily the industry is still in a fee for service world and has a target on our backs.”
Kurt Hubler, chief network officer of Inland Empire Health Plan, discussed about his company's emphasis on taking the continuum of care and condensing it. “As there is more support services in the home and skilled nursing facility level, it will continue, but there is more consolidating that you can do moving the patients down.”
Will Saunders, CEO of AllyAlign Health, talked a bit about how long-term care providers have unique abilities to be successful and also have some things to think about. “They have a unique relationship with their patients and to control the network. They also have the data. That is the good news.”
He added that “No matter what happens with the desire to drive cost, long-term care providers who have a long trusted relationship with the patient and develops a care model, you can do very well relative to what the reimbursement levels are today.”
He also has seen providers who have not been successful. “Providers underestimate compliance,” he said. “I would encourage you to put some diligence into that.”
As for what providers should be doing right now to address the issues out there? Hubler said the first thing to do is to first get their heads out of the sand and realize MA isn't going anywhere. “They really need to look at how they are spending their money. They need to be able to track their utilization and the impact it is having on payers… All of that is becoming very transparent. They also need to get themselves aligned with the providers that are seeing their patients in their communities.”
As for what this means for lenders, Hubler said it isn't something that can ignored anymore. Until recently, it wasn't something being talked about. “It is a slippery slope out there and changes are really happening. As you are evaluating a portfolio, you are looking at some of the mandatory programs in the marketplace. Take into account the full environment and the relationship that hospitals have with outside facilities.”
Check back with GlobeSt.com for more from the NIC event.
SAN DIEGO—“We should expect to see continued growth in managed care.” So said Melanie Bella, independent consultant and former director of Medicare-Medicaid Coordination Office at CMS, at the NIC Spring Investment Forum conference here on Thursday.
“Managed care has an impact on folks that you are serving and is here to stay,” she explained. “The impact means how you work with all those players in new ways to help create value for them.”
In a session titled: Managed Care: Opportunities and Challenges as a Senior Care Provider, panelists reviewed the unique business opportunities and challenges of managed care, including enabling risk management, that operating companies and providers face in the seniors housing, post-acute care, and long-term care markets.
When moderator Michael Torgan, executive of business development and strategy at First Quality Healthcare Group, asked about shifting payment practices specifically, Jason Feuerman, SVP of strategic development and managed care at
Kurt Hubler, chief network officer of Inland Empire Health Plan, discussed about his company's emphasis on taking the continuum of care and condensing it. “As there is more support services in the home and skilled nursing facility level, it will continue, but there is more consolidating that you can do moving the patients down.”
Will Saunders, CEO of AllyAlign Health, talked a bit about how long-term care providers have unique abilities to be successful and also have some things to think about. “They have a unique relationship with their patients and to control the network. They also have the data. That is the good news.”
He added that “No matter what happens with the desire to drive cost, long-term care providers who have a long trusted relationship with the patient and develops a care model, you can do very well relative to what the reimbursement levels are today.”
He also has seen providers who have not been successful. “Providers underestimate compliance,” he said. “I would encourage you to put some diligence into that.”
As for what providers should be doing right now to address the issues out there? Hubler said the first thing to do is to first get their heads out of the sand and realize MA isn't going anywhere. “They really need to look at how they are spending their money. They need to be able to track their utilization and the impact it is having on payers… All of that is becoming very transparent. They also need to get themselves aligned with the providers that are seeing their patients in their communities.”
As for what this means for lenders, Hubler said it isn't something that can ignored anymore. Until recently, it wasn't something being talked about. “It is a slippery slope out there and changes are really happening. As you are evaluating a portfolio, you are looking at some of the mandatory programs in the marketplace. Take into account the full environment and the relationship that hospitals have with outside facilities.”
Check back with GlobeSt.com for more from the NIC event.
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Natalie Dolce, editor-in-chief of GlobeSt.com and GlobeSt. Real Estate Forum, is responsible for working with editorial staff, freelancers and senior management to help plan the overarching vision that encompasses GlobeSt.com, including short-term and long-term goals for the website, how content integrates through the company’s other product lines and the overall quality of content. Previously she served as national executive editor and editor of the West Coast region for GlobeSt.com and Real Estate Forum, and was responsible for coverage of news and information pertaining to that vital real estate region. Prior to moving out to the Southern California office, she was Northeast bureau chief, covering New York City for GlobeSt.com. Her background includes a stint at InStyle Magazine, and as managing editor with New York Press, an alternative weekly New York City paper. In her career, she has also covered a variety of beats for M magazine, Arthur Frommer's Budget Travel, FashionLedge.com, and Co-Ed magazine. Dolce has also freelanced for a number of publications, including MSNBC.com and Museums New York magazine.
