Seniors Housing Business

JUL 2018

Seniors Housing Business is the magazine that helps you navigate the evolution of the seniors housing industry.

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Page 27 of 40 27 July 2018 n Seniors Housing Business because they're interested in cut- ting costs, and specialized skilled nursing facilities can offer a low- cost alternative to the hospital. "ACOs have found that we are good partners," says Coble. Two Elmbrook skilled nursing facilities in southern Oklahoma are participating in a partnership program with a local ACO. Elm- brook's strategy is to accept admis- sions during off-hours, at night and on the weekends — a service not always offered by skilled nurs- ing buildings. In his experience, Coble says offering off-hour service builds confidence among referral sources, which leads to more admissions during regular hours. "It opens the door to higher census," he says. Elmbrook is also staffing up to handle very sick elders in the ACO program who would have other- wise been sent to the hospital or emergency room. The company is hiring nurse practitioners to assess incoming patients. Staffers are being trained to han- dle complex medical cases. Clini- cians can make referrals directly to the skilled facility. "We will take direct admissions from the community," says Coble, adding that he expects the practice which is now relatively uncommon to become more widespread. Best advice: Talk to ACOs, and listen to what they want. Sunrise Senior Living: Road Home Program After the enactment of the Affordable Care Act, Sunrise Senior Living saw an opportunity to help hospitals reduce readmis- sion rates to avoid costly penal- ties. The senior living operator that manages more than 320 properties retooled its temporary housing, or respite program, to meet hospital requirements. Sunrise is based in McLean, Virginia. Sunrise's Road Home Program is based on the 30-day window for readmissions that hospitals must avoid. The company created a 30-day, all-inclusive housing and care package. Sunrise also helps coordinate any needed therapy "The program provides continu- ity and coordination of care that results in successful outcomes," says Jessica Phaup, vice president of business development at Sun- rise. Her office is in Columbia, South Carolina. Phaup adds that the program also provides time for the family to put in place any support services needed when the elder returns home. The program is not a traditional rehab stay reimbursed by Medi- care. Patients pay out of pocket for the service. Each resident is assessed prior to admission. Rates are based on local market rents, the level of care required and the cost of medication. The program also acts as a pipe- line for new residents. Elders in the program sometimes decide to move into the building perma- nently, says Phaup. Referrals come from hospitals, typically when an elder does not meet the criteria for skilled nurs- ing because they do not need around-the-clock supervision. The program is also seeing an uptick of referrals from skilled nursing facilities in cases where elders have completed a course of rehab but are not yet ready to return home. "We offer a nice value proposition," says Phaup. The Road Home program is available throughout North Amer- ica. Ten major markets account for about 75 percent of all admissions generated through the program. A designated Sunrise team member works with local hospi- tals. The goal is to educate hospital case managers, discharge planners and C-suite executives about the The Next Big Idea: Insuring Residents In a sign of what's ahead, a handful of senior living owners and operators are mov- ing into the health insurance business. The plans allow providers to access the resi- dents' healthcare premium dollars and man- age their care, leading to the possibility of new revenue streams, higher occupancies and bet- ter outcomes. But providers also take on the financial risk associated with health insurance, opening questions about what business senior living companies are really in. "This is a time of change," says industry consultant Anne Tumlinson, CEO at Anne Tumlinson Innovations based in Washing- ton, D.C. "The incentives for providers are changing." The health insurance plans are a type of Medicare Advantage Plan limited to certain groups — referred to as a Special Needs Plan (SNP). Medicare Advantage plans have been grow- ing rapidly and now insure about 33 percent of the Medicare-eligible population. Medicare pays private insurers a monthly rate, and they are responsible for care and treatment. There are different types of SNPs. The one most commonly used by senior living pro- viders is the Institutional SNP (I-SNP). It cov- ers long-term residents of a nursing home, assisted living facility, or those who require nursing care at home. Some senior living providers getting into the insurance arena partner with established Medicare Advantage programs. Erickson Living, headquartered in Catons- ville, Maryland, offers "Erickson Advantage" through UnitedHealthcare. Sunrise Senior Liv- ing, based in McLean, Virginia, recently rolled out "Sunrise Advantage" in partnership with a managed care company. Other senior living companies are starting their own insurance companies. In 2015, Tom Coble and Mike Bailey launched American Health Plans, an insurance company that man- ages Medicare Advantage I-SNP plans. Coble, who started working on the insur- ance idea about 13 years ago, is president of Elmbrook Management Company. Based in Ardmore, Oklahoma, Elmbrook owns and operates six skilled nursing facilities and an assisted living community. Bailey is president of American Health Com- panies which owns Tennessee Health Manage- ment, an owner and operator of 28 nursing homes in Tennessee and one in Alabama. American Health Plans insures about 300 nursing home residents in Oklahoma. The program was recently introduced at facilities in Kansas, and discussions are underway to offer the program in Kentucky, Missouri and Tennessee. Insurance premiums vary based on the ben- eficiary's health profile. Benefits are the same, however. "It takes a while to ramp up," says Coble. He figures about 450 insured residents is the breakeven point for an I-SNP plan, but the more insured members the better. "Insurance is the law of large numbers," adds Coble, a former oil executive. In 2017, Marquis Cos. created its own insur- ance company to offer "Ageright Advantage," an I-SNP plan for residents. Marquis operates 19 skilled nursing facilities, five assisted liv- ing communities, one memory care facility, a home healthcare company, and pharmacy and therapy businesses. Marquis owns 22 of the 25 buildings it operates. Insuring residents has several advantages, says Steve Fogg, CFO at Portland, Oregon- based Marquis. The insurance plan generates the revenues needed to hire nurse practitio- ners, who are better able to anticipate and resolve resident health issues. This helps to boost occupancy by detecting problems early and improving the resident experience, he says. Another plus is that clinicians at the facil- ity can coordinate services through one insur- ance plan, rather than manage paperwork for a number of different plans. Lynne Katzmann, president and CEO of Juniper Companies is putting together a consortium of seniors housing providers to launch a Medicare Advantage plan. Juniper, which is based in New Jersey, operates 24 buildings and owns most of them. The con- sortium will create an insurance company to offer several types of SNP plans. The advantage of owning the insurance company is that senior living providers can tailor the benefit packages for residents and reinvest any savings that accrue back into the care and services for those residents, explains Katzmann. She expects to have participating companies lined up by July. Juniper's Connect4Life pro- gram will be introduced to coordinate resident healthcare at participating buildings in 2019. After government approvals, the plans should be active in 2020. "I think we can make it work," says Katzmann. "It will benefit society and resi- dents, and it will be good for the industry." —Jane Adler

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