Older adults are moving into senior living communities with more chronic conditions and healthcare needs than ever before, presenting challenges — as well as opportunities — for continuing care retirement / life plan communities to deliver healthcare through a variety of models, according to experts speaking at a Thursday webinar.
During the ATI Advisory webinar, “The New Healthcare Agenda for CCRCs and Life Plan Communities,” ATI Managing Director Fred Bentley led a panel of operators and experts in a discussion on service delivery and payment models and potential strategies for the future.
The biggest challenge facing CCRCs, Bentley said, is the difficulty in navigating Medicare and Medicaid reimbursement rates, which he said are not keeping pace with labor costs.
The elephant in the room, according to HumanGood Senior Vice President of Healthcare Services Phil Chuang, is Medicare Advantage, or MA, plans. The Medicare market has shifted, and now more than half of beneficiaries are in MA plans, he noted.
“Healthcare is local. You have to look at the market you’re in,” Chuang said, adding that organizations have to determine what they can offer sustainably. “Operating under Medicare Advantage is challenging.”
MA plans carry much administrative overhead, authorizations and pressure, related to both utilization and reimbursement, Chuang said, adding that it’s one thing to get paid less but another to have to manage shorter lengths of stays, more teams and greater resident needs.
He said the Centers for Medicare & Medicaid Services is beginning to look more deeply at MA plans and whether utilization control and authorizations are appropriate, but that type of regulatory change takes time. Providers need to look at what they need to do over the next five to 10 years and determine what makes sense for residents and the business, Chuang said.
In the short term, LeadingAge is making progress advocating to “move the needle” on those challenges, according to LeadingAge Vice President of Integrated Services & Managed Care Nicole Fallon. In the long term, payment issues will remain, however, she said.
Although partnering with MA plans can be challenging for operators, Chuang said, it is possible to develop beneficial relationships. Streamlined administrative processes, collaboration on case management and fair compensation can make such relationships advantageous for everyone, he said.
Opportunities in home- and community-based services could be compelling for CCRCs that want to move into the greater community to serve a different population, Bentley said. Some senior living providers, he noted, now are serving middle-income older adults where they live — in their homes in the greater community.
HCBS could be a good opportunity for CCRCs for a variety of reasons, Fallon said. People want to stay in their homes, but they often need supports. Evolving models related to managed care or accountable care organizations, as well as other risk-based models, provide a better opportunity for operators to negotiate payments and deliver care in a different way, she said, adding that providers that can find a way to package services and follow the person home can do better financially.
“Our members are providing good, positive outcomes, good-quality care, good staffing levels. Why not get paid for that?” Fallon asked. “There are a lot of opportunities once you start diversifying your portfolio.”
Chuang said that the power of CCRCs, and the power of senior living more broadly, is that such communities have more touchpoints for the functional and social needs of older adults — something plans and medical providers still haven’t figured out.
“We bring a lot to the game,” Chuang said. “The challenge is that reimbursement piece.”
CCRCs and other senior living providers, he said, are best served by partnering with healthcare providers rather than trying to create their own model for healthcare delivery. But he said senior living providers need to “touch enough people” to get a seat at the table with a plan. He suggested partnering with another provider that has scale or with other colleagues in the market to achieve scale.
CCRCs have an opportunity in the accountable care organization or managed care space because they have assisted living, independent living and nursing facility residents who can enroll in MA plans, Fallon said. Those residents provide a leverage point for a different type of discussion to help accountable care and managed care organizations manage or spread risk better, she said.
Ultimately, Chuang said, providers need to venture into healthcare for the right reason.
“We want, first and foremost, to provide better access to care,” Chuang said. “Capturing more of the healthcare dollar is great, but I think that the counterbalance to that is making sure that we’re ultimately doing it in service for our residents and trying to drive better health outcomes and better quality of life. If we’re able to pull all of those threads together and get paid for it, that’s a win for everybody.”
