Stethoscope with medicare form with parts list.
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A new report from LeadingAge looks at the challenges and potential solutions to address the failures of Medicare Advantage. Senior living advocates are looking at it as a learning experience and opportunity to promote the sector’s value.

With almost half of the nation’s Medicare beneficiaries enrolled in Medicare Advantage plans, LeadingAge said, the growing failures of the program are jeopardizing the health and well-being of more than 30 million older adults. 

Although the report doesn’t directly relate to assisted living, it may indirectly affect providers in the sector by influencing the broader healthcare landscape for older adults. 

According to ATI Advisory, Medicare Advantage has gained more than 2 million enrollees in the past year, reaching more than 47% of the Medicare-eligible population. Special needs plans also grew, with more than 1,300 plans serving more than 5 million beneficiaries this year.

Failures offer a learning experience

Juniper Communities founder and CEO Lynne Katzmann, PhD, said that Medicare Advantage plans are starting to understand that assisted living, in certain cases, can support post-acute residents or members.

ATI Advisory CEO Anne Tumlinson told McKnight’s Senior Living that “[i]t’s simply a matter of Medicare Advantage plans waking up to the opportunity to design plan products that offer supplemental benefits and quality improvement programming — as well as value-based contracts with in-house primary care organizations — to reduce the cost of senior living services to the residents, and to offer a higher-value, more comprehensive aging-in-place option.”

Juniper’s Connect4Life care coordination model became the foundation for AllyAlign Health’s Medicare Advantage plan in 2021. Connect4Life integrates onsite primary care, pharmacy and lab services with social supports and residential care in an effort to improve health outcomes and save money.

Juniper and AllyAlign also partnered for the Perennial Consortium, an operator-owned Medicare Advantage network available in Colorado and Ohio that also includes Christian Living Communities, Ohio Living and, as of 2023, Otterbein SeniorLife. Perennial also uses the Connect4Life care model as a foundation for its plans.

Katzmann said she launched Connect4Life in response to the “raw deal” skilled nursing providers received through Medicare Advantage plans being peddled by the larger players in the market. Those challenges — a lack of preferred providers, low rates and problematic contracts — are outlined in the LeadingAge report, which calls for plans to:

  • Make payment rates adequate and predictable.
  • Understand and address challenges with prior authorization. 
  • Bring the vision of high-quality care closure to routine practice by making value-based payments workable.
  • Ensure beneficiaries have a true choice of high-quality providers by addressing MA plan network adequacy.
  • Address transparency concerns by improving data collection and sharing.
  • Actively support beneficiaries’ needs and rights. 

Tumlinson said that “[i]f policymakers are looking for a road map to improve Medicare Advantage for populations with complex care needs, LeadingAge’s recommendations provide an excellent one.”

The LeadingAge report, she said, contains “forward-leaning, but also practical, ideas to test for the future. “I hope the Centers for Medicare & Medicaid Services and the Center for Medicare & Medicaid Innovation take advantage of this resource,” she said.

Skilled nursing’s experience with Medicare Advantage, Katzmann said, can be a greater learning experience for assisted living providers. 

“It’s really the reason we did our work with Connect4Life and started Perennial,” she said, adding that a provider that owns a special needs plan can decide on the benefits and payment rates. “It’s fair to our providers — and oftentimes to ourselves — but that’s part of it.”

Senior living must tout its value

Senior living, Katzmann said, has to understand the value it creates for payers as chronic care managers. Assisted living manages people’s lifestyles and care through assessment and around-the-clock monitoring, enabling providers to intervene early, keep chronic conditions in check and keep residents out of the hospital. 

“That creates huge value,” Katzmann said. “The way Medicare Advantage plans make money is by reducing unnecessary hospital visits. If we do that, we’re creating value to Medicare, payers and, frankly, for our residents.”

In return for that value, she said, senior living deserves adequate payment from Medicare Advantage and a seat at the table. That message is starting to get through, she said, but it’s a slow process.

Several senior living companies have been involved with Medicare Advantage plans. For instance, Erickson Senior Living offers plans to residents through Erickson Advantage. American Health Advantage of Utah partners with Mission Health Services, Cascades Healthcare and Sunshine Terrace Foundation to provide assisted living residents access to institutional-equivalent special needs plan benefits.

Several operators in Minnesota joined together to offer the Medica Advantage Solution– PartnerCare, which enables members to select Medicare Advantage I-SNP coverage if they need or are expected to need the level of services provided in a long-term care facility for 90 days or more. And Toledo, OH-based real estate investment trust Welltower also collaborated with CareMore to integrate CareMore’s clinical programs and onsite care models at Belmont Village and SRG Senior Living independent and assisted living communities in Los Angeles and Orange County, CA. The arrangement introduced residents to Medicare Advantage ISNPs offered through CareMore’s partnering health plans, through which CareMore clinicians deliver and manage care.

Assisted living’s model as a value proposition supporting quality of life and cost effectiveness also was the subject of a white paper recently released by Argentum.