Ten senior living and care organizations in the Minneapolis / St. Paul area will offer a new HMO institutional special needs plan to their residents effective Jan. 1 in what plan collaborators believe is one of the largest rollouts of an I-SNP in the country and could lead to a national model of care.
Medica Advantage Solution PartnerCare, a Medicare Advantage plan offered through a collaboration with geriatric medical practice and care management organization Genevive, nonprofit health plan Medica and the long-term care companies, will be available exclusively to the approximately 5,500 qualifying assisted living, memory care and skilled nursing residents living in 78 communities operated by:
- Benedictine Health System,
- Cassia (Augustana Care / ELIM Care affiliation)
- Catholic Eldercare,
- Episcopal Homes of Minnesota,
- Goodman Group,
- North Cities Health Care,
- Presbyterian Homes & Services,
- Saint Therese,
- Volunteers of America and
- Walker Methodist.
“This is a mission-focused collaboration,” Presbyterian Homes & Services President Dan Lindh said in a statement. “It helps us meet the societal need for a value-based care model in a focused structure. Senior care organizations provide housing and services that represent a significant portion of the determinants of overall health.”
Genevive, founded in 2003 as a division of North Clinic called Geriatric Services of Minnesota, is co-owned by Allina Health and Presbyterian Homes & Services as of Jan. 1, after Presbyterian Homes & Services bought North Clinic’s 50% share. The organization will provide primary care and care management services and act as the contracting agent on behalf of Medica.
“Genevive has demonstrated success in bringing exceptional care to older adults through its unique combination of primary care home visits, care management and value-based contracting,” Lindh said. The standalone healthcare organization consists of more than 120 staff members, including physicians, nurse practitioners, nurses, social workers, care coordinators, specialist providers, a pharmacy consultant, an anticoagulation team and ancillary service providers, all of whom will be connected to each resident’s local care team at his or her assisted living community or skilled nursing facility.
Medica, founded in 1975 as Physicians Health Plan, has designed and offers the health insurance plan, which includes coverage for prescription drugs, transportation, dental, vision and hearing care. Medica-participating providers will provide hospital services subject to appropriate placement based on clinical considerations and patient choice.
“By taking financial accountability through this value-based contract with Medica and Genevive, senior care providers can expand wellness and other supportive services for a growing number of older adults, many of whom cannot afford the services and supports that lead to better living and have been proven to reduce the rate of unwanted invasive medical care,” Lindh said.
Of the 78 settings, 49 are assisted living communities and 29 are skilled nursing facilities, Christine Reiten, senior director of state public programs at Medica, told McKnight’s Senior Living. Approximately 60% of plan-eligible adults are assisted living residents, and approximately 40% are skilled nursing residents, she added.
The I-SNP is designed expressly to meet the often complex health needs of older adults living in such settings, according to the partners. The entities began discussing potential partnership opportunities in late 2017, submitted to the Centers for Medicare & Medicaid Services a notice of intent to apply for a new product in November 2018 and then began to build the new product, Reiten said.
“This collaboration is an incredible opportunity for us to partner with Medica and 10 premier senior care providers to further develop what will likely be a national model of care to simplify and align the best possible quality of care for older adults with complex needs,” Genevive CEO Amanda Tufano said.