‘Drive to Home,’ Medicare Changes Are Creating More Integrated Senior Care

In years to come, cross-continuum collaboration and the formation of integrated care delivery models that keep people away from hospitals will be the main catalysts for lowering U.S. health care spending. For senior housing, assisted living and independent living providers, in particular, that makes establishing relationships with home- and community-based partners all the more important.

Post-acute care experts from the National Investment Center for Seniors Housing & Care (NIC) and Anne Tumlinson Innovations (ATI) discussed the value — and increasing business imperatives — of cross-continuum collaboration during a Tuesday webinar co-hosted by Home Health Care News.

While the future health care landscape is likely to lead to increased collaboration, it’s also primed for a ramping up of providers taking on financial risk sharing, according to Anne Tumlinson, CEO of Washington, D.C.-based research and advisory services firm ATI.


“In the coming decade, almost all providers, to some degree, will be collaborating with other providers — and they’ll be taking risk,” Tumlinson, who is also the founder of online community Daughterhood, said during the webinar. “When serving Medicare beneficiaries, the best way to get at high costs and improve value is when care is integrated. It will require non-medical capabilities and working together.”

One of the big reasons senior housing providers should consider partnerships with home- and community-based care organizations: their ability to manage populations with functional impairments.

Functional impairment is broadly defined as a condition or status that interferes with one or more basic life activities, such as bathing, eating or dressing. Medicare beneficiaries with both multiple chronic conditions and functional impairments are twice as expensive to the Medicare program compared to individuals who have multiple chronic conditions alone, ATI data suggests.


“We’re beginning to realize just how important personalized plans of care are that tap into whatever services are needed to result in the best outcomes,” Tumlinson said. “Non-medical supports and services are often related to the ability to deliver high-value on health care.”

Besides home- and community-based organizations, other “enablers” senior housing providers should consider working with include primary care groups, technology vendersand home health care agencies, she said.

Cross-continuum collaboration and ‘the drive to home’

“Home” is typically pictured as a private residence, a place where a person has lived for years with his or her family. But that’s not an entirely accurate view, experts argue, as “home” for many older adults is a senior housing, assisted living or independent living community.

These senior living providers have a tremendous opportunity to reduce health care spending by providing robust services to their residents, but only if they work in integrated models with partners “who aren’t bound by the four walls of a facility,” Tumlinson said.

Communication and responsiveness are essential in those collaborative relationships.

If senior housing owners and operators aren’t open to collaborations as health care shifts from hospital to home, they risk falling behind their competitors, NIC founder Bob Kramer said during the webinar.

Annapolis, Maryland-based NIC is a nonprofit organization that works with investors and providers working in the senior care space by supplying data, analytics and other insights. As part of its mission, NIC tracks and reports on senior housing and care data across more than 14,000 properties within 140 U.S. metropolitan areas.

“I think the drive to home, first of all, is a move away from a health care delivery system that’s revolved around or has had its apex or center as the acute-care hospital,” Kramer, who served as NIC director for more than a quarter of a century, said. “Increasingly, the drive to home [means] whatever in terms of health care that can be done or delivered at home will be.”

Consumer desires, technology and payers are leading the drive to home, he said.

With senior housing providers currently facing industry headwinds in the form of oversupply, tight labor markets and rising interest rates, they’re trying to find ways to increase net operating income. This may further incentivize them to partner with home- and community-based care providers to offer new service lines, NIC Chief Economist Beth Mace noted.

Medicare’s massive transformation

There’s a massive dismantling of the fee-for-service Medicare model and shift toward value-based care, bundled payments and risk sharing, Tumlinson said. Simultaneously, more Americans are signing up for Medicare Advantage (MA), with an enrollment of about 22.6 million beneficiaries expected for 2019.

And MA beneficiaries are now starting to mirror fee-for-service Medicare beneficiaries as well.

About 38% of the MA population and about 35% of the fee-for-service population is older than 75, ATI data shows. Meanwhile, 47% of the MA population and 45% of fee-for-service beneficiaries have three or more chronic health conditions. MA and fee-for-service are nearly identical along the lines of cognitive impairment and functional limitation demographics too.

With this as the backdrop, recent MA policy changes have opened up the possibility of benefits packages to cover non-medical in-home care. This has the potential to make MA an increasingly important payer for senior living providers and private duty home care agencies.

The private sector insurance companies that administer MA benefits are highly interested in offering such benefits and having a greater influence on home-based health care, as they too have noted the “drive to home” and are accelerating it.

Indeed, Health plans and MA players have made finding out what goes on with members at home a priority. In some cases, they’ve even made deals to become “payviders” themselves, such as insurance giant Humana Inc. (NYSE: HUM) acquiring a stake in Kindred at Home with two private equity groups.

That’s likely to continue, Kramer said.

“Health care will come to frail seniors where they live, rather than our taking them to health care,” he said. “That has enormous repercussions for us as providers who are either provide home each day — or who go into people’s homes each day.”

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