Geriatric Care – The Race to Value Podcast™

In the Race to Value, we must recognize that quality of life is the ultimate currency of healthcare, and this aim is all the more important in senior living facilities.  Transforming health outcomes for skilled nursing and senior living populations is not just a goal; it’s a commitment to providing the care and dignity our elders deserve.  This week, we profile a leader in the value movement who leads a company on a mission “to improve the health, happiness, and dignity of senior living residents”. We are joined by Mark Price, CEO of Curana Health – a leader who lives by the mantra that “extreme passion” is the single most important ingredient to reform the American healthcare system.

Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics.

In this episode, you will learn about how to transform health outcomes for skilled nursing and senior living populations through extreme passion.  We cover such topics as how to leverage APMs such as MSSP and ACO REACH in the senior living setting, the performance results of Curana Health across their value-based portfolio, technology innovation, palliative care, the state of the nursing home industry, and future trends in the shift to home-based care delivery.

Episode Bookmarks:

01:30 Introduction to Mark Price, CEO of Curana Health.

03:45 An estimated 27M more people are aging into the 75+ cohort through 2050, resulting in rising age and higher health acuity levels of residents moving into senior living.

05:00 Curana Health has achieved a 39% reduction in 30-day hospital readmissions and a 37% reduction in total hospital admissions among Medicare Advantage I-SNP members.

06:00 “There are many subsectors in the industry where value-based care can succeed.  The important thing is ensuring that your people have an extreme amount of passion for making it work.”

07:00 Founding story of Curana Health based on how we would want our loved ones to be cared for at the end of life.

08:45 The majority of Americans will spend some time in senior living or skilled nursing in the final years of their life.

10:00 Elite Patient Care ACO performed in the top 1% of ACOs in its first year of operation, achieving PBPY savings amount of $2,235—the highest PBPY for any first-year MSSP ACO since 2012.

11:30 Curana Health also has one of the top performing ACO REACH and risk-based MA I-SNP programs in the country.

11:45 “Our core business is not a payment model. It is a clinical model that produces health outcomes which, in turn, enables affordability as well.”

13:00 Developing a population health playbook for the senior living space.

14:00 Success in developing a level of clinical integration within a senior living facility that is now owned by the company.

15:00 MA Institutional Special Needs Plans (I-SNPs) are designed to meet the needs of people living in long-term care settings such as long-term care nursing, skilled nursing facilities, and inpatient psychiatric facilities.

16:45 Facilities are taking an ownership position of MA plans for senior living and skilled nursing residents.

17:00 Mark provides perspective on I-SNPs and how the Curana Health clinical model is achieving results to improve clinical outcomes.

18:30 Performing well by recognizing the commonality between MSSP, ACO REACH, and Medicare Advantage.

20:00 How CMS and CMMI is incorporating innovation to value-based payment models (e.g.SNF 3-Day Rule Waiver).

22:00 Building a technology enablement ecosystem within a high-touch, integrated care model for senior living communities.

23:00 Value-based care technology adoption starts with the input from the clinical care teams.

24:00 Seeking technology enablement for both common and specialized challenges.

26:00 Developing technology partnerships with intentionality. Augmenting those partnerships with internally-developed customized analytical and educational solutions.

28:45 A survey by Leavitt Partners and NAACOs shows that only a 10% of ACOs selected palliative care as a top priority for improving efficiency and lowering costs.

30:00 Mark provides perspective on the importance of palliative care and advanced  care planning in their senior-focused care model.

33:00 Many nursing home providers operate on thin margins and have been squeezed tighter as they’ve struggled with occupancy.

34:00 Chapter 11 bankruptcies among nursing homes and senior living operators continue to increase and show no signs of abating going into next year.

35:30 The impact of the pandemic on the senior living industry.

36:30 The workforce challenges faced by nursing homes.

37:00 Financial impact of rising variable interest rates on nursing homes attempting to service their facility debt.

38:00 CMS-imposed staffing mandates on Skilled Nursing Facilities.

38:45 The impact of aging baby boomers on distressed SNFs and senior living facilities.

40:45 Collegiality and information sharing is important to advance value-based care transformation across the country.

41:30 Skilled Nursing and Senior Living communities traditionally ignored value-based care (and how they are now waking up!)

43:30 Success in the future requires us to think differently than we did in the past.

44:30 Up to $265 billion worth of care currently delivered in traditional facilities for Medicare FFS and MA beneficiaries could shift to the home by 2025.

46:45 Post-acute skilled care will increasingly move to the home in the future.

48:00 The significant demand for senior resident models in the future.

49:30 Mark discusses why technology won’t disrupt the senior living space like it will other sectors in care delivery.

52:00 CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030.

53:00 Americans aged 65 and older will more than double over the next 40 years —  reaching 80 million in 2040.

53:45 Parting thoughts of optimism on the imperative for value-based care transformation in the country.

As the healthcare industry moves towards achieving CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030, we must focus on patients in institutional settings. For long-term care patients, better care and better health means ensuring patients receive advanced care planning and regular wellness visits. And it also requires providers and facilities to work together in preventing avoidable hospitalizations and unnecessary SNF and hospice utilization. Unfortunately, the needs of geriatric patients in an institutional setting are often overlooked as compared to other populations in the vast environment that falls within the influence of value-based care. LTC ACO — the first ACO in the country focused specifically on the special needs of Medicare beneficiaries residing in long-term care facilities — is changing that narrative. The mission of LTC ACO is to dramatically improve the quality and cost of healthcare delivered to these Medicare beneficiaries, rewarding participating providers for achieving these outcomes. Using this approach, it is their vision to revolutionize the way healthcare is provided to Medicare beneficiaries residing in long-term care facilities.

Joining us this week in the Race to Value is Jason Feuerman, the President and Chief Executive Officer of LTC ACO. In addition to leading one of the only ACOs that is dedicated exclusively to management of long-term care facility residents, Jason supports managed care and strategic value-based initiatives for Genesis HealthCare, the biggest post-acute care operator in the country. In this episode, you will learn about LTC ACO implemented a program in the traditional Medicare population that mirrors Institutional Special Needs Plans (I-SNPs). He discusses how the ACO engages and incentivizes providers and facilities and has operationalized a data infrastructure to drive care interventions. They have woken up an entire ecosystem with their approach to value-based care and have generated well over $40M in Shared Savings throughout their lifespan. By focusing on improving care outcomes and engaging providers, they have become the industry-leading exemplar for improving patient outcomes in long-term care!

Episode Bookmarks:

01:30 Introduction to Jason Feuerman and LTC ACO, the first ACO focused specifically on the special needs of Medicare Beneficiaries residing in long-term care facilities.

03:00 LTC ACO was launched by Genesis Healthcare, the biggest post-acute care operator in the country, with significant experience in MA risk and bundled payment models.

06:00 Lessons Learned from MA: How Institutional Special Needs Plans (I-SNPs)provided an operational thesis for LTC ACO in the Medicare Shared Savings Program.

07:00 By improving quality and driving down unnecessary costs, LTC ACO returns the Shared Savings earned to LTC facilities and the physicians who support them.

08:00 “Waking up the ecosystem” by providing outcomes data to long-term care providers.

10:00 Achieving capital efficiency in a model where there is no downside risk.

12:00 How capital requirements for delegated Medicare Advantage differ from the MSSP model.

13:00 Less than 15% of residents in long-term care facilities are in a MA plan. (Limited business opportunities in Medicare Advantage)

15:30 Applying the same tenets of I-SNPs to a Medicare ACO (e.g. aligning providers and providing rewards with surpluses)

16:00 “Waking up an Ecosystem”:  Most LTC providers do not know what happens to their patients once they leave the long-term care institutional setting.

17:00 How data can be used to inform long-term care providers how their patients are doing across the continuum.

18:30 The use of AI for population-based predictive analytics to identify potential health risk (see recent Press Release regarding ClosedLoop AI partnership)

19:00 “Long-term care providers gravitate towards population health data and how they can contribute to bending the cost curve.”

21:00 Alzheimer’s dementia is the only top-10 cause of death that cannot be prevented, cured or slowed.  We spend $200B on Alzheimer’s and Dementia care (more than Cardiology and cancer care combined!)

22:00 Jason discusses the potential implications of Alzheimer’s/Dementia in value-based care.

25:30 The impact of hospitalization on a LTC patient can include more time in bed, which can result in increased blood clots, pressure ulcers, muscle atrophy and loss of function.

26:30 Using data from EHRs and pharmacy utilization (Medicare Part D) to predict the risk of hospitalization.

28:00 “Our goal is to reduce hospitalizations and the need for skilled care using predictive analytics.”

29:00 How primary care physicians can become the “true quarterbacks of care” by empowering them with data.

29:30 How LTC ACO is approaching pharmacy utilization to better care for their patients.

32:00 LTC ACO has achieved well over $40M in Shared Savings during its lifespan.

34:00 Jason provides an industry-leading example of how to align providers and facilities in the ACO’s value-based care strategy.

35:30 Most ACOs incentivize SNFs by just providing them with them the promise of referrals.

36:30 LTC ACO recently distributed $1.5M to providers and facilities from its most recent Shared Savings event.

37:00 Balancing both cost and quality initiatives of the CMS program to achieve Shared Savings.

37:30 The “feel good” aspect of independent providers working with the ACO beyond bonuses earned (e.g. lowering unnecessary SNF and hospice utilization to improve care).

38:30 “Our goal is to get as much money into the hands of providers as possible. This is not about holding back dollars so the ACO can make money.”

41:30 Jason describes the impact of COVID-19 on LTC ACO and the overall long-term care segment of the industry.

43:00 How social isolation with the pandemic created a high increase for inpatient rehabilitation needs.

44:00 The trauma of the pandemic on the healthcare workforce that comprises the LTC ACO network.

44:45 How hospitals learned a lesson to “care in place” during the pandemic (instead of referring patients to a long-term care facility).

47:00 The number of Americans aged 65 and older will more than double over the next 40 years —  reaching 80 million in 2040.

47:30 Did CMS contemplate the institutional population when developing its goal to have all patients in an accountable care relationship by 2030?

49:00 Jason describes the importance of the value-based movement in improving care for the geriatric population.

50:00 ACO REACH focuses on communities (not institutions!)

51:00 “Most people not being addressed in value-based care are in institutional settings.”

52:00 How CMS will continue to move the needle on VBC, in partnership with private industry innovation, will benefit the entire geriatric population.

53:00 LTC ACO, with six years of experience as an ACO, is driving industry-leading results in improving care outcomes!

In health care, we excel in addressing problems in the human body that are fixable.  However, with regard to the two main un-fixables in life — aging and dying— we often inflict therapies on patients that shorten lives or increase suffering before death. These heroic measures result in wasteful costs in the healthcare system: of $700 billion a year spent in Medicare, it’s estimated that about one-quarter of that spending goes to the 5% of Medicare beneficiaries who are in their final year of life, without knowing which of those dollars are actually adding value to the patient.

While many healthcare organizations are struggling to develop risk-based population health management strategies, geriatric care models, focused on high-risk, high-need patients, can be valuable resources for healthcare organizations hoping to improve care and reduce costs.

In this episode, Carrie Coumbs, an expert in geriatric care models, shares valuable insights in caring for seniors, covering topics of senior housing, rehabilitation, home health, home-based care, hospice care, re-hospitalization avoidance, home care collaboration, as well as Alzheimer’s and Dementia care. Carrie is an exemplar in building a legacy of care for seniors.

5:07       How Carrie found her calling to care for seniors by hearing their life stories

8:38       An administrator telling a nurse that there is not enough time for a patient that is running out of time

11:45     The importance of communication and empathic listening in the healing journey

13:00     Honoring the preferences and values of a patient defines health care quality

17:30     The importance of educating our youth on “real” life expectancy

19:13     Incorporating assisted living, independent living, and memory care into the medical school curriculum

21:33     Learning from other countries how to educate our society about aging

28:24     The influence of Dr. Bill Thomas on geriatric medicine and eldercare

27:15     Providing home care to a patient makes someone whole again, just like providing a prosthetic to an amputee

29:02     A patient that fell one mile short of receiving palliative care support due to a benefit coverage limitation

29:28     Current hospital landscape prevent physicians from being a part of their community (referencing Charles Martin)

33:21     How ACOs can improve transitions of care from hospital to PAC

35:25     Just achieving ACO Shared Savings is not the true measure of success

39:00     Senior housing and assisted living

41:40      An example of a senior housing community-saving Medicare nearly $4M (Juniper Communities’ Connect4Life)

46:40     The ever-increasing shift to ambulatory care and newly-emerging home-based care models

48:00     The growth of telemedicine and remote patient monitoring

49:23     The growth of community medicine, senior housing, and in-home care support

52:37    Ideas about getting seniors to embrace technology as a way to improve health and wellbeing

57:34    Vision for a coordinated care network (CCN) model (referencing ACLC whitepaper)

1:02:36       It’s not OK for seniors to accept being invisible.  Society needs to change.  We can learn from seniors, and they should walk proud.

1:06:04       The importance of the ACLC in expanding the conversation on aging