LeadingAge Releases Report on the Failures of Medicare Advantage in Post-Acute Services

LeadingAge Releases Report on the Failures of Medicare Advantage in Post-Acute Services

LeadingAge recently released a report, “Fulfilling the Promise: Medicare Advantage”, describing problems and policy recommendations for Medicare Advantage in long term care. According to the report, “one in five Medicare beneficiaries discharged from a hospital will need post-acute care. Those with Medicare Advantage plans may run into significant challenges in trying to access post-acute care.”

ATI Advisory CEO, and Nexus Fellow, Anne Tumlinson, told McKnight’s Senior Living that “[i]t’s simply a matter of Medicare Advantage plans waking up to the opportunity to design plan products that offer supplemental benefits and quality improvement programming — as well as value-based contracts with in-house primary care organizations — to reduce the cost of senior living services to the residents, and to offer a higher-value, more comprehensive aging-in-place option.”

The LeadingAge report includes recommendations such as:

  • Make payment rates adequate and predictable.
  • Understand and address challenges with prior authorization.
  • Bring the vision of high-quality care closure to routine practice by making value-based payments workable.
  • Ensure beneficiaries have a true choice of high-quality providers by addressing MA plan network adequacy.
  • Address transparency concerns by improving data collection and sharing.
  • Actively support beneficiaries’ needs and rights.

Tumlinson said that “[i]f policymakers are looking for a road map to improve Medicare Advantage for populations with complex care needs, LeadingAge’s recommendations provide an excellent one.”

Read the full story at McKnight’s Senior Living.
Read the LeadingAge report on Medicare Advantage.

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NIC spring conference 2023 - Partnering for the Future

Nexus Insights Convene for the NIC Spring Conference

Nexus Insights will be joining senior housing and aging service leaders in San Diego on March 1st for the National Investment Center for Seniors Housing & Care (NIC) Spring Conference. Conference sessions will discuss new opportunities that provide better outcomes of care for older adults through more effective integration of healthcare services and senior housing. Anyone in healthcare or senior housing looking to connect, develop long-range strategic partnerships, and innovate new models of care and housing on behalf of older adults should plan to attend.

“Integrating healthcare services with housing is mission critical for a new generation of senior living,” said Anne Tumlinson, founder and CEO of ATI Advisory, and a Nexus Fellow. “It means better care and quality of life for residents, and rewards operators and investors for addressing healthcare spending.”

Several Nexus Fellows are attending the conference including Bob Kramer, Anne Tumlinson, and Sarah Thomas. Nexus friend and alumna, Kelsey Mellard of Sitka, is speaking on one panel and interviewing Dr. Sachin Jain at the Friday morning keynote session.

Want to attend? Visit springconference.nic.org for more information. Already going and want to meet? Ping us or reach out directly to our Fellows.

Nexus Picks

Sessions you won’t want to miss at the 2023 NIC Spring Conference:

Emerging Value Based Care Opportunities for Seniors Housing & LTC Operators
Wednesday, March 1, 2023 | 4:30pm
Speakers:
Anne Tumlinson, Founder & CEO, ATI Advisory
Grant Severson, Vice President, Optum Senior Community Care
James Lydiard, Chief Strategy Officer, HarmonyCares
Brian Cloch, CEO, Cloch Management
Chris Dawe, Acting President, Curana Health Medical Group
Laurie Schultz, Principal & Co-Founder, Avenue

Taking Your Show on The Road: Bridging Care Gaps by Extending Services Into the Community
Thursday, March 2, 2023 | 1:00pm
Speakers:
Kelsey Mellard, CEO, Sitka
Michael Kurliand, Clinical Quality and Integration, MedWand
Peter Longo, Principal & Managing Partner, Cantex

The Trends and Opportunities in Medicare all Types of Operators Should Be Tracking
Friday, March 2, 2023 | 8:30am
Speakers:
Kurt Read, Partner, RSF Partners
Kelsey Mellard, CEO, Sitka
Dr. Sachin H. Jain, MD, MBA, FACP, President & CEO, SCAN Group and Health Plan

 

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Housing For Middle-Income Seniors

Middle-Income Seniors – The Forgotten Middle

When it comes to senior housing, wealthy seniors can pay their own way and low-income seniors often qualify for Medicaid. The real problem is for those in the middle. They aren’t wealthy enough for private pay, yet they are too well-off for Medicaid. To make matters worse, the number of people stuck in the middle will nearly double over the next decade. Senior housing operators and policymakers have the opportunity to serve this new market, but how and to what extent?

Nexus founder and Fellow Bob Kramer discusses “The Forgotten Middle” with Nexus Fellow Caroline Pearson, senior vice president health care strategy, NORC at the University of Chicago in an episode of Foresight TV hosted by Steve Moran of Senior Living Foresight.

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long-term care infrastructure op-ed in The Hill

America’s long-term care infrastructure: A road to nowhere – Op-ed in the Hill co-authored by Nexus Insights

In a recent op-ed in The Hill, Nexus Insights Fellows Anne Tumlinson, David Grabowski and Robert Kramer, raise an important point that has been missing from recent discussions around transforming long-term care following the pandemic. The Biden Administration has proposed a $400B investment in home- and community-based services (HCBS). We assert this investment is necessary but not sufficient. Without additional spending on services to help families navigate and manage long-term care services, this HCBS investment is basically a “road to nowhere.” We argue for the need to create a network of long-term care service hubs across the country to help families navigate services.

As you know, there have been A LOT of thought pieces around improving long-term care going forward, but we have not seen this point made elsewhere. Thus, we believe it would be an ideal time to make this point as policymakers consider the Biden proposal.

Excerpt:

Long-term care is complex. Few Americans plan ahead and most wait until a crisis pushes them into a frantic search for solutions. It doesn’t have to be this way.

Every day older adults lose their ability to care for themselves. Often, they are discharged from the hospital too weak or confused to be left alone or care for themselves. Now what? Who will take care of them? Is home- or facility-based care the best option? How much will it cost and who will pay? Does Medicare cover it? Does Medicaid? If home care is the answer, how do you find a qualified and affordable caregiver? Where do you even start? Life-changing decisions must be made, and fast.

Read the full op-ed in The Hill.

Anne Tumlinson is CEO of ATI Advisory and the Founder of Daughterhood. David Grabowski is Professor in the Department of Health Care Policy, Harvard Medical School. Robert Kramer is the founder of Nexus Insights, and the co-founder and Strategic Advisor & former CEO of the National Investment Center for Seniors Housing & Care (NIC).

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