Educational session at 2020 NIC Fall Conference highlights onsite service.
Key Takeaways
- Seniors housing is emerging as a key part of the healthcare continuum.
- Keeping residents out of the hospital is a major objective.
- Seniors housing providers are managing healthcare risk onsite for their residents—both for infection and for social isolation/loneliness.
- Health and healthcare must become an essential focus for seniors housing providers—but they don’t have to be the provider of the healthcare.
The COVID-19 outbreak has accelerated emerging trends. Consumers are making more purchases online. Virtual meetings are now routine. Telehealth has gone mainstream in a matter of months.
Likewise, the pandemic is fast-tracking the link between seniors housing and healthcare. Residents not only want a hospitality-type experience but also expect to be protected from infection. Many want access to onsite care, no matter the setting.
Different approaches are emerging.
One example of how to partner with a healthcare provider was presented during Education Week at the 2020 NIC Fall Conference during a session titled: “What Does Senior Living Look Like in the COVID Era: The New Role of Health and Healthcare Onsite.”
Separately, a peer-to-peer discussion on the topic was held during the conference Connections Week. Participants shared their experiences with onsite healthcare.
The educational session was led by Bob Kramer, NIC founder and strategic advisor, and president at Nexus Insights. Participants included Michael Grust, founder and CEO at San Diego-based senior living provider SRG; and Jim Lydiard, staff vice president at CareMore Health, a division of insurer Anthem.
SRG collaborates with CareMore to offer onsite healthcare services, a partnership that has deepened during the COVID-19 crisis.
Kramer provided context, noting that older adults have become more fearful about visits to traditional healthcare settings, such as doctors’ offices and clinics. At the same time, new models of care are emerging, including the use of telemedicine.
“We are at a nexus point as an industry,” said Grust. He explained that the ability to protect the health of residents while creating environments where they can thrive will make a big difference in their decision to leave their homes and move into senior living communities. “We are focused on quality of life,” said Grust.
CareMore’s insurance program—called Touch—provides a full range of medical services to residents who enroll. Many of the CareMore visits by healthcare providers are proactive, which helps contribute to the overall health of residents and improve their quality of life.
The program is meant to compliment the work of SRG’s hospitality and wellness teams. CareMore does not offer dining services or help with the activities of daily living.
Kramer noted the distinction between health and healthcare services. Health is related to prevention and wellness. SRG’s ZEST program, for example, keeps residents healthy and engaged. CareMore provides the actual medical services. “Health and healthcare have to be an essential focus, but you don’t have to do it all yourself,” said Kramer. “Partnerships can deliver benefits.”
Teamwork Succeeds
CareMore works together with the wellness team onsite. They can communicate with CareMore via text, video and phone. “Residents can get help right way,” said Lydiard, which helps keep them out of the hospital.
Residents voluntarily sign up for the CareMore program. Enrollees receive a health assessment and a customized care plan. Regular visits from healthcare practitioners are provided as well as telehealth sessions. Mini clinics, operating three to five days a week, are created on campuses with a sizable number of enrollees.
SRG does not pay a fee to CareMore. The patient’s insurance pays for the service under Medicare, Medicare Advantage or Medicaid. “This does not cost the operator more money,” said Lydiard. He added that the arrangement can help reduce the operator’s costs by eliminating unnecessary healthcare expenses that the operator might incur. Also, residents who enroll in the CareMore Medicare Advantage plan may save as much as $200-$300 a month.
Another plus: The partnership aligns the interests of the insurer and the operator. SRG keeps its residents healthier, often resulting in a longer length of stay. CareMore is motivated to keep residents healthy because it is paid through a capitation contract or risk-sharing model.
Scale matters, however. The ability of CareMore to greatly impact resident outcomes depends on enrolling a critical mass of residents in the program. Membership grows virally after about 20 percent of residents sign up as CareMore’s presence on campus increases and residents see the value of onsite care. “We have to build membership,” said Lydiard.
CareMore handles the marketing of the plan. But the staff at the community is educated on the benefits.
A hurdle to enrollment has been the reluctance by residents to switch insurance plans. They want to keep their primary care doctors, specialists and healthcare networks.
But a big change will make it easier for residents to sign up. CMS is expanding its value-based care model to allow groups like CareMore to enroll residents with a traditional Medicare plan. They can keep their providers and still get the wraparound services provided onsite by CareMore. “This is a game changer,” said Grust.
The panelists agreed that senior living is now a part of the healthcare continuum. “We need to raise our game,” said Grust, noting “We are not post-COVID.” Senior living providers must continue to protect residents while providing an environment where people can thrive. “We have always been focused on the quality of life,” said Grust. “That is our unique selling proposition.”