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‚Äôs plan will share ownership of the other 49%.
‚ÄúThe 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,‚ÄĚ 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‚Äôs 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.
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 ‚ÄĒ including giants such as UnitedHealthcare (NYSE: UNH) and Humana (NYSE: HUM) ‚ÄĒ 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 ‚ÄĒ namely, their residents ‚ÄĒ 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‚Äôs 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.
‚ÄúIn 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,‚ÄĚ Gumina says.
‚ÄúAs a result of our ‚ÄĒ and again, I say this respectfully ‚ÄĒ as a result of the great care we‚Äôre providing, we‚Äôre adding balance sheet and P&L (profit and loss) strength to the insurance companies‚Äô P&L, and not our own. So this is an opportunity for us to get upstream in the payment model.‚ÄĚ
The four organizations that will own the Perennial Consortium offer the following value:
Juniper‚Äôs Connect4Life model provides the analytical centerpiece, proving senior housing‚Äôs 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:
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.
‚ÄúMy 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,‚ÄĚ Katzmann says about the Consortium‚Äôs team-first approach.
‚ÄúMy 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.‚ÄĚ
This article draws from the new report, ‚ÄúThe Primary Care Opportunity In Senior Living.‚ÄĚ 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.