Healthcare – Join the Flock or Fly Solo Lance Horbach

Why does the earth spin?

All in individual silos. YESTERDAY: Healthcare was a “solo” performance by provider-types. All in individual silos.

Yesterday

Today!

Assisted Living Standing Alone

Standing Alone Is GOOD! Absence of Medicare/Medicaid Compliance High Customer Satisfaction Scores Outside of “Institutional” Medical Provider Label No Third-Party Payers Customer Pays!

If Standing Alone Is Good, How Did Healthcare End Up Like This?

Nursing Home Nursing Home Nursing Home Home Care Home Care Home Care

TODAY: New Payer Systems ACOs -Accountable Care Organizations- * Networks contracted to health insurance companies MCOs -Managed Care Organizations- * Networks contracted to health insurance companies. ACO = Healthcare System Driven Network - created from the “top down” MCO = Member Driven Network - created from the “bottom up”

What providers are being “picked” to be on the ACO teams? From the beginning… 1 – Hospitals 2 – Clinics and Specialty 3 – Nursing Homes 4 – Home Care 5 – Hospice (Why not Assisted Living?)

You don’t get paid by the same people!

Continuum of Care - Revenues Government vs Non-Government

Remember this slide? TODAY: New Payer Systems ACOs -Accountable Care Organizations- * Networks contracted to health insurance companies MCOs -Managed Care Organizations- * Networks contracted to health insurance companies. ACO = Healthcare System Driven Network - created from the “top down” MCO = Member Driven Network - created from the “bottom up”

TODAY Tomorrow: New Payer Systems ACOs -Accountable Care Organizations- * Networks contracted to health insurance companies. Health Insurance Provided by Health Systems! MCOs -Managed Care Organizations- Networks contracted to health insurance companies. Medicaid Provided by Health Systems! ACO = Healthcare System Driven Network - created from the “top down” MCO = Member Driven Network - created from the “bottom up”

What’s stopping AL from massive top-down referrals? Assisted Living is not a covered solution by the “payer”!

Continuum of Care - Revenues Government vs Non-Government

….But what if the “payers’” rules change? MCO View on AL: AmeriHealth Caritas – “Gone are the days of needing to use NF placement to activate waiver eligibility and if they expand services, there’s new market opportunities on the horizon for them.” and “…we believe the AL will drive the value needle resulting in increased member outcomes.”

FEE FOR SERVICE

FEE FOR SERVICE You are an eligible participant! Your “payer” is judged by how they pay. No relationship to health outcome. Payment has no relationship with provider experience. FEE FOR SERVICE IS THE ENEMY OF VALUE-BASED STRATEGIES!

VALUE-BASED

Value-Based Systems Reward WINNERS! The ACA’s Value-Based contracts add two new payment guidelines in addition to “bending the cost curve” downward: Outcomes* Patient Satisfaction* Measurements absent the FFS System! * NOTE: Assisted Living scores excel when it comes to “Outcomes and Patient Satisfaction”. Why? Because the payer is the customer, they demand outcomes and satisfaction!

Conflict Third-party payers deem AL as a “luxury”.* Self-payers (Private Pay) see AL as a “preferred choice”. Will third party payers ever change their tune? *Note that I shifted the blame to “third party payers” and forgot to mention politicians?

YES! When Health Sytems Can Profit From AL Providers

Key Phrases Remember the path of nursing homes, home care, therapy, hospice, etc… Medical Providers must preform at their highest risk level to survive. After home, Assisted Living is most desired solution. With slight changes, AL could be a top provider for rehab services. Will rising costs force payers to seek AL alternatives?

What If…. Wellmark had serious competition?

What If…. Iowa’s Health Systems became health insurance companies?

What If…. Assisted Living was added to the continuum of care? Have you noticed the number of nursing home’s adding AL?

What If…. Assisted Living is covered by traditional health plans in the future? Medicare, Advantage Plans, Medicaid, etc…

LANCE’S COMMENTS Assisted Living is in a great spot! Desired by the buyer, private pay, not strapped with multiple payment systems, burdensome pre-authorizations, lengthy insurance paperwork, Medicaid re-ups, etc… ENJOY WHERE YOU ARE AND CHERISH WHAT YOU HAVE…

…. But don’t stand still too long… A major change may sneak up on you… LANCE’S COMMENTS …. But don’t stand still too long… A major change may sneak up on you…

Questions?

Did you ever wonder how Lance Horbach got involved with senior living? Lack of Questions PENALTY SLIDE! Did you ever wonder how Lance Horbach got involved with senior living?