Thinking about tapping into Medicare payment models to deliver healthcare to senior living residents? One expert has some rather stark advice.
“Everyone seems to have a hard time just getting started. Cut the crap. Just get started,” Sachin Jain, MD, MBA, president and CEO of SCAN Health Plan, said during a National Investment Center for Seniors Housing & Care Spring Conference session on Friday looking at trends and opportunities in Medicare.
Healthcare, Jain said, is the next big growth frontier. But instead of value-based care, which he said is a financial model, he said the focus should be on values-based care, which is more about doing the right thing for people.
“Rather than thinking that healthcare needs to get more national, I think healthcare needs to get more local, more community-based, more focused on where people live, with the national infrastructure supporting it,” Jain said, adding that states also have an opportunity to transform their Medicaid experience by partnering with local entities.
Where to start
Jain said that senior living providers need to start with a clinical model and determine what experience they want to deliver to residents. Then, follow that up by thinking about the financing mechanism and the creative partnerships that need to be in place to turn that vision into reality.
“Healthcare delivered in facilities can be the next frontier for the whole industry,” he said. “But it has to be done with the right intent, the right purpose and the right model, and you have to start with the model first.”
He said to look at the community and determine which services and partnerships are necessary to deliver care, whether that’s reducing falls or chronic disease management. Whatever can’t be done in-house, he said, can be achieved by partnering with companies or entities that specialize in those areas.
One of the biggest challenges independent living and assisted living operators have with offering healthcare to residents is just getting started. Jain said a lot of strategic planning and joint venture discussions go nowhere because everyone is afraid to get started.
Forget the pilot projects and innovation centers, he said. Find creative partnerships with entities that specialize in whatever area your community needs to focus on, and look locally for better service and a culture of caring.
The best partners, Jain said, are community-based and can make the small micromovements that make a difference. Regional health plans, he added, are the best partners to turn to to get started because they have the resources and the autonomy at the local and regional levels to get things done.
Jain’s advice is to start partnering with a health plan to deliver “compassionate, patient-centered care” where older adults live. Health plan medical teams, he said, can be an extension of a senior living community’s operating team in helping to take care of residents.
Marrying housing and healthcare
Having a fully integrated experience of housing and healthcare means that a senior living community can offer a healthcare experience that is “far superior to anything the healthcare system is delivering right now,” Jain said. Hospital at home and primary care at home programs are moves in that direction — providing care for older adults where they live, he added.
Providers, Jain said, partner with local health plans to provide institutional special needs plans, I-SNPs or IE-SNPs, so that Medicare Advantage-eligible individuals — in this case, residents — to receive healthcare services.
“One of the amazing opportunities you have when you actually are providing care to older adults in this boutique way that we do through our I-SNP programs, is that you actually have that close one-to-one relationship with patients, with families,” Jain said. ”You’re there with them in their most critical moments, and you’re able to support them through some of the most challenging situations in their lives.”
The conference, in San Diego, ended Friday. See additional coverage under Related Articles, below.
