By Tim
Mullaney | September 29, 2019 RoboToaster for Aging Media Network
In a move that will further integrate senior
housing within the Medicare Advantage landscape, real estate investment trust
Welltower (NYSE: WELL) has formed a partnership with Anthem (NYSE: ANTM)
affiliate CareMore.
The partnership aligns with Welltower’s
ongoing push to move senior housing and care into a more central role within
the overall U.S. health care system. The initiative also dovetails with the
business strategies of Houston-based Belmont Village and San Diego-based SRG
Senior Living, the first two Welltower operators involved.
The participating organizations anticipate
that the initiative will lead to improved health and wellness for senior
housing residents, which in turn will reduce hospitalizations and other costly
interventions and increase length of stay.
Toledo, Ohio-based Welltower also views the
partnership as a way to gain upside from Medicare Advantage trends without
exposing the company and its shareholders to much financial risk, Senior Vice
President of Business Strategy and Health System Initiatives Mark Shaver told
Senior Housing News.
For Cerritos, California-based CareMore, the
immediate business opportunity is to gain more revenue by increasing the number
of people that the company serves. But the organization has much bigger
ambitions. Namely, to change the current, fragmented health care delivery
system and allow people to meet goals such as aging in place.
“There’s an opportunity for us to put all the
pieces together and reinvent how health care is delivered in this country,” Dr.
Sachin Jain, CareMore’s president and CEO, told SHN.
Reaching for scale
CareMore’s “Touch” model is to bring
interdisciplinary teams of medical professionals such as physicians and nurse
practitioners into people’s homes — including senior living communities — to
provide more rapid and coordinated services. CareMore receives payment for
these services via health plans, including Medicare Advantage plans, which view
coordinated care as a way to increase beneficiary satisfaction and reduce
hospitalizations and other expensive episodes.
CareMore is affiliated with Anthem — one of the
nation’s largest health insurers — but is part of the company’s Diversified
Business Group. So, there is a firewall between CareMore and the insurance side
of Anthem, and CareMore partners with both Anthem-operated health plans and
those offered by competing insurers, Jain told SHN.
For over a decade, CareMore has worked with senior living providers on a
facility-by-facility basis, bringing services to residents enrolled in
partnered health plans. Results were positive, and CareMore began to think
about how to gain a greater foothold in the fragmented senior housing space.
“As we started to think about how we could
make an even greater impact on American health care and further refine this
model, we started to look for broader national partners,” Jain said. “Welltower
was an obvious choice.”
Working with Welltower makes sense for anyone
looking to make a large-scale impact in senior housing: The REIT has a
portfolio of about 1,300 U.S. properties across its triple-net and operating
portfolios.
Furthermore, CareMore’s value proposition
aligns with Welltower’s strategy under CEO Thomas DeRosa. DeRosa and his
leadership team believe that as health care increasingly moves away from hospitals and other high-cost
settings, senior housing communities will become increasingly important and
integrated care delivery sites.
With this in mind, Welltower has engaged in transactions
that bring senior housing into closer relationships with health systems and
payers.
For example, the REIT forged a joint venture with nonprofit
health system ProMedica to acquire the large HCR ManorCare portfolio of skilled
nursing facilities and senior living communities. ProMedica leaders believe
that by more closely managing the health and wellness of people living in these
buildings — including residents enrolled in ProMedica’s Medicare Advantage plan
— the health system can achieve cost savings and other upside.
Connecting CareMore with operators in its
portfolio is another way to drive this type of vertical integration and make
senior living more important within the overall health care system, Shaver
said.
“We believe this will make our sites of care
more consequential,” he said.
In terms of what this will look like on the
ground, the presence of CareMore’s clinicians will bring more robust on-site
care to independent living and assisted living, while CareMore also will help
coordinate with nearby health care providers. On the payer side, residents may
opt to join Medicare Advantage plans that cover CareMore services — including
but not limited to Anthem-operated institutional special needs plans (ISNPs).
Integration between Medicare Advantage and
senior living has been much discussed in recent years. Medicare Advantage
enrollment is growing nationwide, and these insurers have been granted the
ability to cover more services that are commonly offered in senior living
settings.
With these trends and changes in mind, some
senior living providers have launched their own special needs plans or are
working toward that goal. McLean, Virginia-based Sunrise Senior Living — which
is owned in part by Welltower — is among these providers.
But becoming a payer involves steep startup costs and carries
significant financial risk. The CareMore partnership is a way for a potentially
large cross-section of Welltower’s operating partners to tap into some of the
Medicare Advantage upside without exposing themselves to the risks that come
with starting their own plans. Instead, operators can present — within
regulatory parameters — Anthem’s I-SNP to residents and prospective residents,
noting that enrolling would open up access to CareMore services.
There is no financial exchange between
Welltower and CareMore as part of this partnership, and there is no material
startup cost at the facility level, executives with the REIT told SHN.
“From our perspective, it’s an only-upside
agreement to Welltower and provides benefit to our residents, and being
capital-light, it provides us a great return,” said Welltower CFO Tim McHugh.
The initiative has already started in eight
SRG and Belmont Village communities in Los Angeles and Orange County,
California. Plans are already in the works to expand to two large metros in the
Southwest in 2020, with the potential for adding other markets, operators and
care levels, such as memory care, Shaver said.
A platform for
innovation
SRG and Belmont Village have communities in
the California markets where CareMore has a significant presence, making them
natural launch pads for this initiative. Partnering with CareMore fits into the
providers’ long-term strategies, as well.
Both SRG and Belmont Village are
hospitality-oriented providers that operate in the private-pay realm; however,
they also have invested significantly over the years to create robust care
models and believe that further building up their care capabilities is crucial
for the future.
To that end, Belmont Village has struck a partnership with health system Baptist
Health in Florida, to co-develop senior living communities in that state. In
addition, Belmont Village in 2017 opened its first international community,
which is located in Mexico City and is physically connected via a skybridge
with a top hospital.
The CareMore initiative is another way to make
Belmont Village more integrated with the overall health care system, COO Doug
Lessard told SHN.
“This collaboration takes us a step further in
providing a holistic approach for our residents,” he said. “There’s a better
and more consistent interdisciplinary clinical experience when our resident
doesn’t have to pass through ERs, hospitals and multiple care providers
unnecessarily.”
Similarly to Belmont Village, SRG has taken
steps to differentiate itself from the competition by creating more robust
health care capabilities.
Just last week, SRG announced the rollout of a
program called Assure, to create smoother transitions into senior living as
people come out of the hospital, skilled nursing facility or other clinical
setting, with the goals of reducing readmissions and improving resident
satisfaction.
“We are a lifestyle based senior living
company, but we have real care that happens inside these walls, and we’re
trying to be a meaningful, reliable partner to the health care system,” SRG
Vice President of Health and Quality Isaac Hagerman told SHN. “It’s what the
residents want, too.”
Although in its early stages, the CareMore
initiative is going well, Lessard and Hagerman said. They explained a few
operational considerations and early benefits:
— CareMore’s clinicians are working with SRG
and Belmont Village nurses and caregivers to coordinate services. CareMore
nurse practitioners and Belmont Village wellness center nurses routinely share
information, so there is plenty of “opportunity to ask questions and share the
nuances of resident interactions,” Lessard said.
— SRG and Belmont Village are seeing the
benefits of quicker access to X-rays, lab tests and other services. The
CareMore partnership is a way of cutting through the red tape of the health
care system, Hagerman said.
— CareMore is being touted in the sales
process, and prospective residents and their family members are responding
well.
Only time will tell how well the initiative
succeeds in reducing hospitalizations and increasing length of stay, or to what
extent it will scale across Welltower’s senior living portfolio. But ambitions
are big all around, with the REIT and CareMore eager to drive changes in how
health care is delivered to older adults.
“We think this can be the platform for a lot
of innovation,” Jain said.
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