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The Medicare Advantage Factor in Assisted and Senior Living Facilities

Summary

Avalere's founder and president, Dan Mendelson, recently sat down with Senior Housing News editors to discuss opportunities for senior living providers to leverage data to facilitate synergistic partnerships with payers.

The discussion focused on two major themes: the use of data in solving the problems around caring for seniors and opportunities to partner with Medicare Advantage (MA).

Using Data to Solve Caring for Seniors Problems

There is now a greater availability of patient-identified Medicare data on all patients in systems, which means that we are now able to track the patient from the hospital to the nursing home. These data can also tell us whether they have had an experience with home health or went into hospice care.

Despite the influx and detail of Medicare data, most assisted living facilities do not have the kind of data feeds that a MA plan would want. With that said, it is possible to create the appropriate data feeds, and Avalere is ready to provide these services to clients.

Additionally, Avalere has created analytic models to help plans determine the best way to care for a patient with a certain clinical presentation. We pull in all the clinical data for the patient, and then we run that through a set of algorithms, which tells the plan the most cost-effective care setting for that particular patient. These algorithms are useful to providers in engaging with plans and other at-risk partners.

Senior living providers, particularly assisted living providers, should invest in data and technology platforms. By doing so, they can serve as a foundation for building potential future relationships with plans and providers that want to engage with them in that way.

Opportunities to Partner with MA

Over the last 20 years, there has been a rapid increase in MA plans. Currently, 35% of seniors are now in MA plans, and enrollment growth is expected to continue. This upward trend in MA plan enrollment is leading more providers to approach established MA plans. The administration is also making a concerted effort to continue the trend in MA enrollment. Because of this shift, more MA plans will have large service agreements and a more acute-needs patient mix, which could lead more plans to engage with senior living to better serve this population.

We are also seeing that more MA plans and assisted living facilities have aligned goals. Both are trying to keep patients healthy at home, and independent for as long as possible. They are also looking to defer or eliminate medical expenses.

Additionally, new dynamics in the healthcare system are blurring the lines between providers and plans. Should an assisted living facility have a relatively acute mix of patients, and these patients already have MA coverage, there is a major benefit to having that MA plan engage.

Read the full interview.

For more content on assisted living and MA engagement strategy, connect with us.

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