By Jack Silverstein | February
11, 2019
RoboToaster for Aging Media Network
In a bold move that
could give senior housing operators a template for increasing their revenue and
power within the care continuum, four companies are teaming up for a big bet on
Medicare Advantage.
Operators Christian
Living Communities (of Englewood, Colorado), Juniper Communities (Bloomfield,
New Jersey) and Ohio Living (Columbus, Ohio), and managed services partner and
risk management company AllyAlign Health (Glen Allen, Virginia) are joining forces
to form The Perennial Consortium, an operator-owned Medicare Advantage (MA)
network, launching in 2021.
Through the
Consortium, these four organizations will launch MA special needs plans on a
state-by-state basis, and then sell ownership interest to senior living
operators in each state, starting with Colorado and Ohio. The Consortium will
own 51% of the MA plan in a given state, with each of the four organizations
owning an even 25%. The owner-operators in that state’s plan will share
ownership of the other 49%.
“The only way (senior living) can really
capture the value (of providing health care) is to control the health care
dollar, and the only way really to do that is to become an insurer, and the
best way to do that is through the Medicare Advantage program,” Juniper
Communities founder and CEO Lynne Katzmann (pictured above), who is
spearheading the Consortium, told Senior Housing News.
The number of
residents that the Consortium could end up serving is unknown, as it will
depend on the number of operators that buy an owning interest in a given
state’s plan.
Laurence Gumina, CEO
of Ohio Living, estimates that the Consortium will seek 10 operators for the
Ohio plan, for instance. In its first year, the Ohio plan alone could enroll
2,000 to 5,000 seniors.
How the Consortium will move operators upstream in Medicare Advantage
Under Medicare Advantage, private-sector
companies can collect federal dollars in exchange for offering benefit packages
to seniors as an alternative to traditional, government-run Medicare. MA plans
can also include some benefits outside of Medicare, most notably dental and vision.
As of 2019, these plans can also fund certain
types of non-medical, in-home care services, opening up the possibility for
direct reimbursement of some services frequently delivered by senior living
providers.
MA plan providers are
therefore taking on risk as a bet that they can offer better care at lower
cost, thus turning the profit from the premiums into a new revenue stream. The
government gets better health outcomes at lower cost to the system, while
consumers receive better care at a potentially lower cost to themselves, on a
plan that can be tailored to their individual needs.
This is an opportunity
for us to get upstream in the payment model.
Laurence Gumina, CEO of
Ohio Living
While big insurance
companies — including giants such as UnitedHealthcare (NYSE: UNH) and Humana
(NYSE: HUM) — are major providers of MA plans, more senior housing operators
are realizing the value they hold for the system.
Due in large part to
their ability to efficiently manage a patient pool — namely, their residents —
senior living providers perceive that they can play a significant role in
keeping high-risk beneficiaries out of costly settings such as hospitals, while
enhancing their quality of life.
With this in mind,
some proactive senior living operators are making investments in care
management capabilities, including through onsite primary care delivery.
It’s a natural extension
for some senior living providers to not only work more closely with MA plans in
their markets, but become insurers themselves. They typically are doing this by
starting Medicare Advantage special needs plans targeted to beneficiaries
living in their senior housing and care settings. Special needs plans have been
around for many years, but were just permanently authorized in 2018.
“In order for us to
continue to sustain our missions, whether they be for-profit or not-for-profit,
we have to put more of our care outcomes at risk for more of a return,” Gumina
says.
“As a result of our —
and again, I say this respectfully — as a result of the great care we’re
providing, we’re adding balance sheet and P&L (profit and loss) strength to
the insurance companies’ P&L, and not our own. So this is an opportunity
for us to get upstream in the payment model.”
What each organization brings to the Consortium
The four organizations
that will own the Perennial Consortium offer the following value:
·
Juniper
Communities: Five communities in
Colorado and a successful model for providing onsite primary care to seniors,
called its Connect4Life model. Juniper’s
portfolio comprises 22 communities.
·
Ohio
Living: Thirteen life-plan
communities in Ohio (the largest operator in Ohio), with institutional
experience delivering primary care onsite and a certified home health business,
including hospice, all of which brings care and support to about 73,000 Ohio
residents per year.
·
Christian
Living Communities: Nine communities in
Colorado with two under construction. Gumina calls CLC “an Ohio Living-like
organization” with “mirrored values and mirrored outcomes,” such as reduced ER visits and resident turnover.
·
AllyAlign
Health: Deep MA knowledge
and know-how, by virtue of its 19 provider-owned MA plans across the U.S.
Juniper’s Connect4Life
model provides the analytical centerpiece, proving senior housing’s ability to
contribute to the success of MA plans. Since partnering with Redwood Health
Partners in 2015 to bring primary care onsite to its residents, Juniper has
seen staggering results touching on hospitalization and occupancy.
As seen in a 2017
joint report from Juniper and Anne Tumlinson Innovations on Connect4Life:
·
Hospitalization rates
among Juniper residents in the Connect4Life modelhave dropped more than 50% compared to a
similarly profiled population of about 6.5 million Americans
·
Move-outs at Juniper
have dropped 27%
The study shows that
integrating service-enriched housing with chronic care management can reduce the cost to Medicare by $10 billion to
$15 billion a year, if applied to those 6.5 million Americans. That
model will be at the heart of the Perennial Consortium.
To succeed, Medicare
Advantage plans require a critical mass of enrollees; this is one reason why a consortium
approach makes sense for small and mid-size senior living providers that are
looking to launch plans. But there are other reasons why the Perennial
Consortium organizations decided to work together.
“My belief was that a
single company like Juniper doing it on its own did not have not only the
economies of scale, but we would not have as much influence on public policy if
we did it alone,” Katzmann says about the Consortium’s team-first approach.
“My view is that
senior housing really is part of the solution to health care reform, and that
senior housing deserves a piece of that pie to do more of what we do well. And
the only way to make that happen is to do it collectively.”
This article draws
from the new report, “The Primary Care Opportunity In Senior Living.” Click here to access the complete report,
which digs deep into the future of direct primary care delivery in senior
housing, and hears from the innovators moving senior living upstream for
Medicare dollars in 2019 and beyond.
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