“Institutional Special Needs Plans (ISNPs) Offer Nursing Home Owners and Operators

 An Elevated Position in the Health Care Landscape”

It’s December 2019 in Washington D.C. at the Intercontinental Hotel bar…. Nursing home owners and operators across the country are debriefing after a full day of discussions around Provider-Owned Institutional Special Needs Medicare Advantage Plans. Some were wrapping up their first year of owning a Medicare Advantage Plan, while others were considering wading into those waters. Tom Coble, the 15-year Provider-Owned ISNP veteran and former AHCA President, was offering his experience and guidance to the group. The conversation was infused with an optimism about the opportunities Provider-Owned ISNPs offered nursing home owners and operators, namely an elevated position in the health care landscape, focused on clinical outcomes tied to economic incentives centered on these outcomes and defined by owners of the first dollar premium.

And then came 2020...

Nursing homes pivoted to dealing with the clinical and economic challenges posed by COVID-19. Suddenly there was little opportunity for in-person gatherings and discussions around Provider-Owned ISNPs were diverted. In fact, one of the only pieces put out on ISNPs in recent months was by Optum explaining why providers are not capable of taking a stronger position as an ISNP owner.

What this piece really highlighted is the vacuum of candid and practical information on Provider Owned ISNPs and the industry growth.

Nursing home owners and operators evaluating the pros and cons of becoming owners of Medicare Advantage Plans are looking for real world experience and expertise. the synthesized point of view of a technical writer hired by a $200B insurance company is not going to offer a lot. This is too important.

Our conclusion: let’s put it out there for discussion.

As we’ve developed American Health Plans over the last five years, I’ve had the benefit of discussing (and debating) the ISNP opportunity with nursing home owners and operators across the country. We’ve had discussions with multi-generation independent owners, those who are publicly traded, non-profits, single location owners, as well as those who are multi-state owners. I also have the truly unique opportunity of working with an experienced and successful Medicare Advantage management team every day.   While we cannot claim to have all the answers, we do have a pretty good feel for the most pressing questions:

• Will I have enough members to make this work?
• What is the transition process for members from an existing MA plan or ISNP?
• What is my current long-term care Part A revenue, and how does that translate to a PMPM structure?
• What is my effective per diem per skilled day under an ISNP, and how is it calculated?
• How will this affect my clinical staff relationships?
• What is the presentation the enrollment coordinator will give my resident and my resident’s family?
• What is the best corporate and capitalization structure for a new ISNP?

And on it goes…

Putting these conversations “out there” implies there is a real yearning for better answers to these types of questions. Based on the feedback I receive, there is a need for a dynamic and evolving resource for nursing home owners and operators that aspire to be or are currently ISNP owners - a resource I would have valued when I, and the team at American Health Plans, started down this path five years ago.

My goal with this series is to create that resource. This series aims to offer a nursing home owner and operator a true perspective of the opportunities and challenges of owning an ISNP without bias and with real data. We intend to provide a forum for feedback and conversation around our collective experience, and generally help us all move in a direction that will elevate the industry. Fundamentally, nursing home owners and operators have all stated in some form or another:

“If I had the resources, there is so much more I could do for my residents...”.

Provider-Owned ISNPs put the resources in the hands of the nursing home and their ISNP administrative partners.  The question this forum will help answer: how do we, as nursing home operators, make the most of those resources?

We welcome your feedback, so comment below or reach out directly to HWatson@AmHealthPlans.com