What’s the best way to integrate healthcare services into seniors housing and care communities? Two basic approaches are emerging. Owners and operators are launching their own ancillary service lines, or they’re collaborating with established providers. And sometimes, they’re doing both.

Pharmacy, rehab, hospice care and home health are the primary services that can either be outsourced or provided in-house. Which approach makes the most sense depends on market conditions, the depth of management expertise and the availability of time and capital needed to start-up a new business.

“Integration of services is an important strategy,” said Peter Longo, principal and managing partner at Cantex Continuing Care Network, Carrollton, Texas. “Partnership is a positive step.”

Cantex is a fully integrated post acute care network with 34 skilled nursing facilities in Texas. The company is expanding with plans to purchase several other skilled nursing facilities in Texas, and in other states.

Besides its growing skilled nursing footprint, Cantex owns 10 home health agencies (with pending licenses for additional agencies and branches), three hospice agencies and two institutional pharmacies serving its skilled nursing and hospice patients, and it provides in-house a full range of both in-patient and out-patient therapy services to its skilled nursing and home health patients as well as to patients in the community.

The company is also launching a Medicare Advantage plan for residents next year.

By providing ancillary services to its residents, Cantex can better meet the “triple aim” of healthcare, said Longo. The “triple aim” is the framework developed by the Institute for Healthcare Improvement to optimize healthcare system performance. The “triple aim” goals are to:

  • Improve the patient experience
  • Improve health outcomes
  • Improve efficiencies for better value at lower cost

The integrated Cantex business model brings as many service elements as it can under one roof and marries them together, said Longo. “We can achieve better outcomes at a lower cost.”

How to partner

In some cases, partnerships make sense. For example, a number of Cantex properties are located near independent and assisted living properties. The cluster represents a kind of naturally occurring continuing care community, said Longo.

“We are always reaching out to those providers to see what we can do together.”  Examples include co-sponsoring activities and co-marketing to hospitals to demonstrate the comprehensive range of post acute services available in one locale. Another example: Cantex provides home health services to seniors housing residents allowing them to age in place.

It makes sense for seniors housing providers to reach out to nearby skilled nursing operators with home health offerings and work together, said Longo. “It’s a perfect marriage.” An assisted living operator may not be eager to jump into the complexities of skilled nursing reimbursement, regulations and clinical care, he added. “We can export those services to assisted living.”

Cantex is further advancing its integration strategy with the launch of its own Medicare Advantage insurance plan, ProCare Advantage. It is an Institutional Special Needs Plan (I-SNP) which restricts beneficiaries to long-term care residents. The plan will be available to residents of 27 Cantex facilities in Texas, and is being rolled out Jan. 1, 2020.

Though the I-SNP isn’t expected to generate much, if any, profit, it has a number of advantages, said Longo.  The company had been searching for a way to improve care coordination among sites of service throughout a patient’s care journey to achieve fewer hospitalizations and better outcomes.

Patient navigators can help create a smooth patient experience, but those positions are expensive to staff.  The I-SNP provides the premium revenue that can be used to hire patient navigators who are nurse practitioners.  As a result, Longo expects rehospitalitzations to drop, and quality measures and patient outcomes to improve.

Creating an I-SNP is a challenge, admitted Longo. It takes about 18 months and involves developing a model of care, winning approvals by the Centers for Medicare & Medicaid Services (CMS), and finding a wide variety of medical providers.

Cantex is working with AllyAlign Health to help manage the plan development process. Based in Richmond, Virginia, AllyAlign develops and administers Medicare Advantage special needs plans for long-term care providers. AllyAlign will also manage the claims and act as the back office for Cantex’s ProCare Advantage plan.

Longo’s best advice on launching a Medicare Advantage Plan?  Go slow. It’s a big time commitment and a potential distraction from the core business. Set realistic goals. Conduct thorough due diligence. And, he added: “Talk to other providers. They have valuable advice.”

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May 17, 2019
janekadler@gmail.com