ADVERTORIAL

​Provider Partners is a value-based care (VBC) company singularly focused on nursing homes, assisted living facilities (ALF), and personal-care homes. Provider Partners offers services in three lanes: I-SNP, IE-SNP, and ACO-REACH. From my perspective as the founder of Provider Partners, the VBC model creates a real opportunity to better align the wants and needs of residents, their families, nursing home operators, the health plan, and CMS. That’s a tough combination of constituencies to please at the same time.

What Makes VBC Models Work?

Models of care that align success metrics with outcomes create powerful incentives to keep individuals well and reduce the need for costly services. A typical inpatient hospitalization costs Provider Partners $8,000 - $15,000. A complex stay, such as with a trach and ventilator, can cost over $100,000.

VBC models are successful when they identify and deal with issues early. It certainly costs a lot more to provide the staffing and enhanced level of intense services that can identify ailments as they are germinating, yet still minor. We employ a team of nurse practitioners and RN case managers who supplement those services provided by the attending physician, specialists, and nursing facility team. It’s an expensive proposition to hire, train, teach, and monitor the activities of this large group. We don’t bill for their services and their activities do not conflict with those of a primary care physician.

Trying to monitor every individual to achieve early detection and intervention requires close attention to leading indicators of changes of condition. A tool that is essential to this oversight is one that delivers targeted data analytics, such as Real Time Medical Systems. Obtaining clear concise data in real time is a key early warning signal that helps us reduce admissions and readmissions in skilled nursing facilities.

What Does This Accomplish?

Frequent hands-on interaction that complements and enhances that of the primary care team provides a dramatically greater opportunity to catch those changes in condition early before they reach critical mass. Our model doesn’t revolve around decisions about whether to approve services—it focuses on making many high intensity services unnecessary by dealing with illness at that earlier stage.

This approach has been proven by Provider Partners and other VBC entities to improve outcomes and quality of care. Nursing home and ALF residents and their families experience much higher satisfaction for two simple reasons—greater interaction with the clinical team and fewer urgent trips for emergency services. Overall costs are significantly reduced. Not only are direct medical costs reduced but so are the affiliated costs such as transportation expenses. All of this is measurable.

What Are Some Challenges?

Provider Partners is owned and managed by former owners and operators of nursing home and assisted living facilities. We partner with facilities as a true value-added service. We must communicate and coordinate with the facility operator, primary care physician, administrator, director of nursing, and medical director.  This is our true secret sauce. Building rapport at all levels and really knowing our members is what makes this work. That requires training, reinforcement, and support from the facility and Provider Partners leadership.

What About Non-Hospital Services?

Trends in nursing home care over the past decade clearly demonstrate a need for non- hospital services that can be provided, when possible, in the facility. Nursing home administrators and directors of nursing covet relationships with behavioral health providers, wound care specialists, and therapy vendors. Those vendors want to attain a certain level of service utilization to make it worth their while to come to a facility. 

One of the challenges to managing a VBC model is attaining a balance between “routine” follow-up visits and reasonable medical necessity criteria. There is a significant degree of excessive “routine” specialty visits for nursing home residents who are quite stable or have disorders that would no longer benefit from ongoing regular follow up. Efforts to address these “affordability” issues create the ongoing need for monitoring and engagement by VBC health plans. This process greatly reduces the frequency of Medicare fraud, waste, and abuse issues.

Summary

Experienced clinicians working in the value-based care environment are fully committed to creating a high standard of care for our most vulnerable populations. We strongly believe that this model provides the best opportunity to align incentives in order to do right by our members. Provider Partners is dedicated to working with long term care providers to improve quality and allow them to participate in the share of savings that is created.

Learn more at partnerwithpphp.com or reach us at info@pphealthplan.com.

Scott Rifkin, MD, is the founder of Provider Partners and has 30 years of long term care experience as a medical director, attending physician, and as an owner of 23 skilled nursing facilities. He has spoken extensively at conferences on the topics of value-based care and regulatory issue reduction. Dr. Rifkin has served on the boards of the Pennsylvania Health Care Association, The Health Facilities Association of Maryland, and Maryland’s LifeSpan.