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​Provider financial returns have long been driven by the quantity of services provided, not the outcomes that were achieved. However, as we journey deeper into the 21st century, it’s becoming clear that this volume-driven approach is no longer sustainable, nor beneficial to patients.

The traditional fee-for-service (FFS) model can negatively impact patient care through a focus on quantity over quality, driving fragmented treatment plans while contributing to shorter clinician-to-patient interactions. This is especially true for seniors, who benefit the most from personalized, holistic care that takes their individual needs and quality of life into consideration.

In response, many skilled nursing facilities (SNFs) and assisted living facilities (ALFs) are making the transition from the traditional FFS model to value-based care: both to better serve their residents’ complex health needs and to share in the savings created by producing better outcomes.

A national leader in value-based care services and innovative payment models for senior living, Curana Health is proud to be at the forefront of health care’s value revolution. We’re also honored to support SNFs and ALFs on their own value-based care transitions.

Understanding Value-Based Care

Value-based care is transforming the health care financing system to prioritize patient outcomes over the number of services rendered, and by 2030, 100 percent of Medicare beneficiaries will be required to participate in a value-based care plan.

“This model is built on a foundational principle that individual patient outcomes should be the ultimate goal of the health care system,” says Jeremy Dressen, president of Curana Health Plans. “Better health and quality of life are often not achieved in the most intensive care settings or through the highest number of billable events. We believe in empowering—and paying—providers to take the extra time to understand their patients’ needs and manage individual care plans that focus on preventive and holistic care, with the aim of keeping patients in their homes longer and avoiding unnecessary hospital visits.”

In addition to enabling better care for senior living residents, value-based models also provide new revenue streams for improving quality and reducing unnecessary costs.

“SNFs and ALFs can unlock meaningful financial incentives by jumping into value-based care,” says Jon Karl, vice president of value-based payment programs at Curana Health. “Investing upfront in data-driven, preventive care and putting patient outcomes first improves patients’ quality of life, reduces avoidable cost and utilization, and rewards providers with shared savings and performance bonuses through partnerships with accountable care organizations and Medicare Advantage plans.”

The Case for Value Over Volume

Transitioning to value-based care offers many benefits, including:

1. Improved Patient Outcomes and Census

At the heart of value-based care is the goal of improving patient health. When payments are made based on outcomes instead of actions, your residents benefit tremendously through:

• Improved management of chronic conditions and medications.
• Reductions in avoidable hospitalizations and unnecessary emergency room visits.
• Enhanced care coordination, ensuring that patients receive the proper care from the right clinician at the right time.
• A strong focus on preventive services.

“Overall, value-based care helps keep residents in their communities longer, something that is both beneficial to operators and the individuals who call the facilities home,” Dressen said. “Various studies have found that 40 percent or more of hospitalizations in the long-term care eligible population were potentially avoidable, which is on-par with the reductions Curana achieves in working with our clinicians and facility operators.”

2. Cost Efficiency

One of the most significant benefits of value-based care is its potential to reduce unnecessary health care costs. In a volume-driven model, the emphasis on performing more procedures and providing more services can lead to excessive and unnecessary spending that often does not improve the patient’s quality of life.

In contrast, value-based care models encourage and incentivize the delivery of efficient, coordinated care that eliminates waste and reduces health care spending long-term. Providers are rewarded through various incentive structures, including shared savings programs (where they receive a portion of the savings generated from reduced health care costs) and performance bonuses (which are awarded for meeting specific quality and efficiency benchmarks).

3. New Revenue Streams

By joining an accountable care organization, SNFs and ALFs collaborate with a network of health care organizations dedicated to delivering high-quality, coordinated care to their patients. This partnership allows participating facilities to earn shared savings by improving quality of care and reducing unnecessary costs for their residents.

By participating in Medicare Advantage plans, facilities can earn additional revenue by meeting or exceeding specific quality and cost benchmarks developed in partnership with the plan. Additionally, senior living organizations ready to dive headfirst into value-based care can develop their own Medicare Advantage plans, receiving the full capitation rate from the Centers for Medicare & Medicaid Services.

4. Decreased Staff Burden

In SNF and ALF settings, value-based care increases the on-site presence of physicians, nurses, and advanced practice clinicians. This is funded by the cost reductions anticipated or achieved through reducing avoidable and unnecessary costs.

“This expansion of resources and focus on reducing unnecessary utilization can decrease the burden on your facility’s existing staff, reducing burnout and allowing for increased support for each resident under your care,” Karl said. “We’ve seen this across the board with our partner organizations. In fact, one of our ALF partners saw more than a 100-percent increase in employee happiness upon implementing value-based care in their facilities.”

The Path Forward for Skilled Nursing and Senior Living Facilities

The transition to value-based care represents a fundamental shift in the health care landscape. By prioritizing quality over quantity, SNFs and ALFs can not only improve their residents’ health, but also increase their revenue.

Today, skilled nursing and senior living facilities have the opportunity to be at the forefront of value-based care—why shouldn’t your organization lead the charge? 

Jeremy Dressen is president of health plans for Curana Health. Jon Karl serves as vice president of value-based payment programs for Curana Health.

Driven by the mission of improving senior living residents’ health, happiness, and dignity, Curana Health is dedicated to advancing the adoption of value-based care and transforming the health care experience for senior living residents. Curana’s medical group offers primary, post-acute, and multi-specialty care to seniors in skilled nursing facilities, assisted and independent living communities, and memory care settings. Curana’s accountable care organizations and health plan partnerships support the medical group’s personalized, proactive, and coordinated clinical care model. Additionally, Curana Health’s owned and operated Medicare Advantage Special Needs Plans make care more accessible and affordable for residents, while also offering skilled nursing facilities and senior living operators enhanced operational capabilities and new financial opportunities aligned to improved clinical outcomes. Currently, Curana’s 1,000+ clinicians serve approximately 175,000 patients annually, spanning 34 states and 1,600+ senior living sites. To learn more, visit curanahealth.com.