Among assisted living providers deciding whether to stick with a purely social model or branch out into more of a medical model, Juniper Communities is firmly in the latter camp.
“The Affordable Care Act was clear, at least to some of us, that the readmission penalties were going to change the game,” said Lynne S. Katzmann, Ph.D., founder and president of the Bloomfield, NJ-based company. “And they have, and they will continue to change that game, so I really don’t think we have a choice.”
The provider, with 20 buildings across Colorado, Florida, New Jersey and Pennsylvania, over time brought primary care, rehabilitation, home health, pharmacy and laboratory services on-site to all of its communities through partnerships and alliances. Doing so isn’t necessarily rare in senior living, but what Juniper did next is not as common: the company integrated those services into an electronic health record and operating system.
The resulting program, Connect4Life, is “high tech, high touch,” Katzmann said.
It’s high tech because all providers use Juniper’s EHR when they are on site, and they benefit from the arrangement, although residents never see the technology, Katzmann said. “If someone gets sick in the middle of the night, they know about it when they open their system the next morning,” she said. That knowledge helps improve the coordination of care, and the EHR that offers the proof.
“We can go out to the hospitals with data,” Katzmann said. “We can show them what we’ve done.” Because of those data, Juniper is now considered a preferred provider, she added.
And those data show that implementation of the Connect4Life program has reduced rehospitalizations from 6.6% in 2014 to 2.6% as of the second quarter of 2015. Move-outs due to death and decline, which had been increasing since 2012, now are leveling off as well, according to Juniper.
“Length of stay is up dramatically, and that means big dollars for our bottom line,” Katzmann said.
Social aspects still present
Juniper’s chosen path doesn’t mean that the social aspects of assisted living are a thing of the past for the company, she said. After all, “people want to be in assisted living because assisted living is more homelike; it’s not institutional.”
The company had to adapt to meet the changing needs of residents, however, Katzmann said. “The social model is how we sold, but now we’ve got these sicker people, and we’ve got the ACA, and we’ve got different financial incentives. So we have to do something different. But … we don’t have to do it in a way that compromises our core product,” she said.
That’s where the “high touch” comes in. Helping to coordinate care is what Juniper calls an emcee or medical concierge.
“We realized that people wanted personal care,” Katzmann said. “It’s all about that relationship.” The emcee, she explained, answers questions from providers, residents and family members. “They are essentially the coordinators of that care,” Katzmann said.
The medical concierge program is funded in part through Medicare payments for chronic care management, which total $40 per member per month, she added.
“So we’ve got something different, Katzmann said. “We’ve got what our residents want. We’re able to keep them in place.”
For other assisted living communities considering introducing medical services into their offerings, Katzmann said that it’s crucial to obtain buy-in from company leaders.
“It took me a while to get my leadership team on board,” she said. “I had to … convince people that that was the right way to go and then work down throughout the organization to talk about change. When people aren’t used to medical care on site, and they’re use to a social model, you’ve got to do a lot of talking and a lot of communicating.”
Once the company is committed to integrating medical services, Katzmann said, buy an EHR, and use the EHR to obtain the data needed to form partnerships in the community. Juniper uses PointClickCare, Katzmann said.
Along the way, the checklist and communication tools that are part of the Interventions to Reduce Acute Care Transfers, or INTERACT, program can help reduce unnecessary hospital admissions and emergency department visits, she said. Juniper helped provided feedback to Brookdale Senior Living when it was testing INTERACT tools adapted for assisted living using a $7.3 million grant from the Centers for Medicare & Medicaid Services’ Innovation Center. And now Juniper uses the tools.
Once you have a story to tell, consider the audience, Katzmann said. Juniper promotes the Connect4Life program in two different ways. “Our families and residents hear ‘one-stop-shopping, convenience, on-site care, aging in place,’ ” she said. “Our referral sources hear about outcomes.
“We’re doing the same thing,” Katzmann continued. “But I think it’s really key to understand that the market used to look for the same thing, and now it needs a different message.”
Purple = Ancillary services provided on site
Blue = Services provided off site
Orange = In-house services