Since
the creation of institutionalized Special Needs Plans (I-SNPs) with the
Medicare Modernization Act of 2003, nursing homes have viewed I-SNPs as a
potential reimbursement vehicle for the work they already do in avoiding acute
events, transfers to the emergency room and hospital admissions, industry
experts tell AIS Health. But the trend of provider-sponsored I-SNPs has only
begun to gain traction in the last few years and is likely to pick up even more
now that SNPs have been permanently authorized, sources observe.
"There
are many organizations that are considering or are entering this marketplace
and one way or other finding the wherewithal to get the job done, but the
challenges they face are greater than we anticipated," observes Stephen
Wood, a co-founder and partner with Clear View Solutions, LLC.
Within
the small I-SNP market, five of the top 10 plans are sponsored by nursing home
chains or other long-term care/skilled nursing providers. And providers that
choose to sponsor I-SNPs can do so in several ways.
Of the
companies that have consulted with Clear View on launching an I-SNP, about half
have opted to work with so-called "aggregators," or outside firms
that may contribute private equity funding, share in the risk, handle licensing
and other front-end pieces needed to launch a plan, or some combination of all
three. Others opt to "go it alone," says Wood.
Considering
the upfront investment of starting an MA plan, the ongoing costs of operating
one and the unknowns of reaching enrollment targets, potential I-SNP sponsors
must look at this as a long-term investment, points out Wood. And the greatest
financial challenges tend to fall on the administrative side, where plans are
constrained by medical loss ratio requirements, adds actuary Kirk Twiss at
Clear View. The biggest challenge, however, is getting enrollment, "and
you need the economies of scale with bigger enrollment" to offset those costs,
he points out.
No comments:
Post a Comment