More and more long-term care operators are partnering up with managed care companies.
A number of troubled operators seem to be experiencing this scenario: initial romance, followed by heightened accountability and reduced payments. But if troubled providers thought Medicaid was a tyrant, wait until they tango with managed care.
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In reality, these marriages can work, but be naive at your own risk. Success will correlate with demonstrated quality. And demonstrated quality will largely mean how well post-acute operators reduce rehospitalizations and meet related performance goals.
Many managed care companies will like link carrots and sticks to specific metrics. Also, you will be judged against your peers when potential long-term care partners are being sized up.
As an industry is long accustomed to focusing on census levels and fee pegs, large adjustments will need to be made. Better start now.
Avalere Health estimates that 19 states will expand enrollment in managed care plans between 2012 and 2014.
“Quality measurements are transforming the way healthcare plans think,” said Avalere Health CEO Dan Mendelson. “You will need to measure your quality and prove your quality,” he adds.
California Association of Health Facilities CEO James Gomez noted at a recent NIC regional meeting, that nursing facilities have an excellent chance to demonstrate that they are the best at post-acute care. He also added that it won’t be easy.
“If you don’t know your rehospitalization rate and that of all the other facilities in your ZIP code, get out of the business,” he said. “Quality will be the No. 1 factor of success.”
The path to managed care success should be clear for skilled care operators: discover a strong niche, demonstrate proficiency, and acquire business partners who you can tolerate for the long-haul.
For skilled care operators, the path to managed care success should be clear: find a strong niche, be demonstrably good at it, and get business partners you can live with for the long haul.