In an example of the growing role of Medicare Advantage (MA) in senior living, Silverado is collaborating with insurer CareMore Health. The effort started at Silverado’s Sierra Vista Memory Care community near Los Angeles and has begun expanding to other communities in the last few months.
Silverado’s relationship with CareMore is “very much at the beginning,” but early indications are promising, Silverado’s Senior Vice President of Clinical Services Kim Butrum told Senior Housing News.
Irvine, California-based Silverado is one the largest operators of standalone memory care communities in the nation, with 36 communities as of 2017. CareMore began as a medical group and then restructured to become a Medicare Advantage program in 1997. Today, it serves about 100,000 beneficiaries in eight states: California, Arizona, Nevada, Texas, Iowa, Tennessee, Virginia (including Washington, D.C.), and Connecticut. Through Medicare Advantage, private-sector insurance companies receive federal funds to offer plans as an alternative to traditional Medicare.
Through its CareMore Touch Special Needs Program (SNP), the insurer has a package of benefits available specifically to residents of skilled nursing facilities and assisted living communities. The SNP’s service area includes certain areas of Los Angeles and Orange Counties. The Touch program forms the basis of the collaboration with Silverado.
Essentially, Silverado residents at the Sierra Vista community are being given the option of enrolling in the SNP, which enables them to access services that are designed to increase their wellbeing and prevent costly and unwanted outcomes, such as emergency room (ER) visits or hospitalizations.
These goals have long been important to Silverado, and this type of alignment is crucial if a senior living provider is to have a fruitful collaboration with a Medicare Advantage organization, Butrum emphasized.
“Quality of life matters a great deal for someone with a memory impairing disease, and we’re known for our clinical outcomes—we avoid hospitalizations if at all possible, as people often come back with a decline, even from an ER stay,” she said. “If the MA program is aligned with these purposes and helps us achieve these outcomes, then it’s a good collaboration.”
CareMore’s plan involves clinicians such as physicians and nurse practitioners who come to the community on a weekly basis, providing services such as geri-psych. This type of in-community visitation is not a feature of every MA program, Butrum said. There is also access to after-hours services through CareMore.
“It’s beneficial if you can have that consistent provider who comes into the community and knows your residents, and you can really educate that provider in [the type of care approaches] you like to use,” Butrum said. “That part of the collaboration has worked very well.”
Currently, about 30 residents are taking part in the CareMore program.
“It’s very much the resident’s choice, we’re presenting it as an option,” Butrum said. “What we find is that residents and families are happy with the service, and sometimes that’s the best advertisement for other residents.”
It’s too early to have data on whether the CareMore participants are seeing fewer hospital visits or have longer length-of-stay, but Butrum is confident that the collaboration will prove worthwhile.
“I always say, 22 years ago when we started collecting our clinical outcomes, no one cared about readmissions or length of stay, but in last 10 years, everyone says wow, good quality of life translates to being a good business partner,” she said. “If you can find an MA program that allows you to continue that, even better.”
Medicare Advantage makes inroads
MA Special Needs Plans are not new, dating back to 2006. However, recent policy changes have increased interest in them. Previously, authorization for these plans needed to be renewed by Congress on a regular basis. The budget law that was signed in Feb. 2018 permanently authorized SNPs.
That law also granted Medicare Advantage insurers new flexibility to offer more benefits to chronically ill seniors, even in plans not designated as SNPs. Then, in a call letter released in April, the Centers for Medicare & Medicaid Services (CMS) announced that MA plans will be allowed to cover non-skilled in-home services for the first time, beginning in 2019.
These changes could mean that MA plans will soon be able to offer direct coverage of certain services provided in senior living. Providers have begun to consider strategies to position themselves in light of these developments.
One possible strategy is for a senior living provider or a group of providers to offer their own MA plan, and a consortium of companies is indeed coming together with this in mind. Some operators—including Marquis Companies, Sunrise Senior Living and Erickson Living—already offer their own SNPs and similar plans.
Another strategy is along the lines of what Silverado is doing with CareMore. Namely, demonstrating to existing Medicare Advantage plans how they can work together to more effectively manage costs and outcomes for a population of beneficiaries. As further MA opportunities open up in the future, this could pave the way for more reimbursement to flow from MA plans to senior living providers in their networks.
It appears certain that Medicare Advantage will become an increasingly crucial payment mechanism for senior care, as enrollment tripled between 2004 and 2017, reaching 19 million people. However, there are still major questions regarding the scope of the new benefits that might impact senior living. A Bipartisan Policy Center report issued last week laid out several of these questions, which CMS will have to address.
As for Silverado, the company is by no means putting all its eggs in the MA basket, but is happy with the CareMore collaboration at the moment.
“We are not making it all or nothing,” Butrum said. “We’ve seen it work well in one community, so it makes sense as an option to offer.”
Written by Tim Mullaney
Interested in learning more about the Medicare Advantage opportunity in senior living? Click here to purchase Senior Housing News’ recent deep-dive report on the topic.