One
thing Steve Shain is seeing is smaller, local and regional players coming on
strong.
Many of your clients will eventually use
the arrangements you have helped them make to pay for long-term care services.
Steve Shain may be helping the facilities
or home care services those clients use get paid.
Shain is chief operating officer if LTC
Contracting, an arm of LTC Consulting Services of Lakewood, New Jersey.
Shain helps get nursing homes and other
providers of long-term care services into the networks of managed care plans,
including Medicare Advantage plan networks, commercial major medical networks,
and managed Medicaid networks.
Other divisions of LTC Consulting Services
help facilities get the payers to pay.
Here are some other things Shain talked about
in a recent interview.
1. Payers
Shain’s clients do not get many patients who
have private, stand-alone long-term care insurance.
When patients do arrive with private LTCI, the
facilities usually ask the patients or their families to pay the facilities
themselves, then seek reimbursement from the insurers, because determining what
any given policy will cover can be tricky, Shain said.
Shain’s clients love seeing patients come in
with Medicare skilled nursing facility benefits, and they are comfortable with
taking Medicaid patients.
If Medicare would offer LTC benefits, “I think
that is something they would be ecstatic about,” he said.
Helping patients qualify to get Medicaid
nursing home benefits can take time, but, once people do start getting the
benefits, Medicaid tends to be a steady payer, Shain said.
2. Patient-Driven
Payment Model
In the acute care world, doctors often talk
about “value-based plans,” or “patient-centered care.”
For Shain, the buzzword that matters is
“Patient-Driven Payment Model,” or PDPM.
The Centers for Medicare and Medicaid Services
wants to use the PDPM approach to hold own the cost of skilled nursing facility
care for Medicare fee-for-service enrollees.
CMS hopes to use the PDPM to make payments to
facilities based on each patient’s condition and care needs, rather than on the
amount of care provided.
CMS is preparing to shift to the PDPM approach
Oct. 1.
The approach is part of the CMS “Patients Over
Paperwork” initiative.
3. Medicare Advantage
Long-Term Care Benefits
Carriers may have a hard time adding major
chronic care benefits to Medicare Advantage plans by Jan. 1, 2019, Shain said.
But many providers have contracts that start
on same date other than Jan. 1, he said.
He expects to see issuers start testing
chronic care benefits programs in 2019, and he expects to see some of the pilot
programs start in the middle of the year.
4. Telemedicine
Shain’s company is working with a company that
will be providing telemedicine consultations through kiosks in retail stores
for patients of all ages.
Although many companies and researchers talk
about how valuable telemedicine should be for home health care purposes, Shain
has not run into much in-home use of telemedicine services at his company.
Where Shain has seen active use of
telemedicine in long-term care is in nursing homes, assisted living facilities
and other facilities.
The facilities tend to have the technical
resources to get good Internet connections and telemedicine software up and
running, and they can use telemedicine to enhance the care their own health
care professionals provide, Shain said.
5. Deals
Just a few years ago, big, publicly traded
companies were bragging about all of the long-term care facilities they had
bought.
Now, Shain said, he thinks the dominant
long-term care deal story involves the big, national players selling facilities
one at a time, or a few at a time, to local or regional players.
“Large chains couldn’t maintain the right
level of focus,” Shain said.
Some of the local and regional facility owners
may do well and begin buying other facilities, but “it really can’t revert back
to the way it was,” with large national players buying everything in sight, he
said.
Allison Bell, ThinkAdvisor's insurance editor,
previously was LifeHealthPro's health insurance editor. She has a bachelor's
degree in economics from Washington University in St. Louis and a master's
degree in journalism from the Medill School of Journalism at Northwestern
University. She can be reached at abell@alm.com or on Twitter at
@Think_Allison.
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