Tom DeRosa, CEO of Welltower (NYSE: WELL), earlier this week highlighted a partnership with health system Geisinger as he put forward a vision for how to meet the massive coming demand for senior housing at a middle-income price point.
The Geisinger collaboration can be traced to Welltower’s August 2019 acquisition of a portfolio of Clover Management middle-market independent living communities. Welltower — a Toledo, Ohio-based real estate investment trust — recognized that some Clover communities were in Pennsylvania markets where Geisinger has a large presence. Geisinger is based in Danville, about 130 miles northwest of Philadelphia and 75 miles southeast of Scranton.
The timing was fortuitous for a partnership, as Geisinger had just launched a new concept in senior-focused primary care dubbed 65 Forward, which now is one component of the partnership between the organizations.
“We spend a lot of time talking about how we can make our senior housing and senior apartment assets more consequential to care delivery,” Mark Shaver, Welltower’s senior vice president – business strategy and health systems initiatives, told Senior Housing News. “So, when we acquired the Clover portfolio, we proactively reached out to Jaewon Ryu, the CEO of Geisinger, because we really felt where Geisinger’s been going with value-based [care] and Medicare Advantage was going to align well with what Welltower’s been trying to do across our portfolio.”
As Shaver noted, Welltower’s middle-market senior housing play is not limited to Geisinger or Clover. The REIT is working with other health systems, including Toledo-based ProMedica and Philadelphia-based Jefferson Health, and recently launched a middle-market senior living brand called welltowerLIVING.
So, understanding the partnership with Geisinger could shed light on Welltower’s larger intentions, as the company seeks to make further investments in middle-market senior living to complement its many market-rate and luxury properties. As of Q4 2019, the REIT’s senior housing operating portfolio included 612 properties and its triple-net lease portfolio included 341 properties.
Geisinger is an integrated health system that serves more than 3 million patients across 45 counties in Pennsylvania and New Jersey, including through three hospitals, various clinical sites and via a Medicare Advantage health plan. Data analytics revealed that roughly one-third of Clover residents in the Geisinger footprint were enrolled in the system’s MA plan, Shaver said.
This concentration of beneficiaries suggested that Geisinger, Welltower and Clover should collaborate, and plans were further informed by Geisinger’s launch of the 65 Forward concept.
Geisinger intends to create 65 Forward locations across the health system’s markets, specifically geared toward providing primary care and wraparound services — clinical and more lifestyle-based — that will support seniors’ long-term wellbeing and chronic care management, which should also reduce their associated health care costs.
So far, two 65 Forward locations have been opened, and one of them is located right between two Clover communities in Scranton, Shaver said.
Geisinger’s goals with 65 Forward align with the case that Welltower executives have been making, which is that more proactive and coordinated care for seniors should be a top priority for the U.S. health care system as a whole, in order to lower currently unsustainable costs while improving consumer satisfaction and outcomes.
Leaders with Welltower argue that senior housing owners and operators must be key players in this effort, as they are in an ideal position to efficiently and effectively manage the care for large numbers of older adults — that is, their residents.
In addition, senior living providers have plenty of incentive to participate in health system collaborations, Welltower believes.
For one, length of stay should improve if residents are receiving more tailored attention and proactive interventions. Furthermore, if residents are enrolled in Medicare Advantage plans that provide coverage of and access to robust, senior-centric care, they may spend less out of pocket on health-related expenses, making it easier for them to afford private-pay rents. And by leaning on health system resources such as 65 Forward to meet residents’ health care needs, senior housing operators could have lighter staffing models, which would alleviate operating costs and enable middle-market price points for consumers.
Clover communities are in some ways an ideal testing ground for these propositions. The Clover model is geared toward younger, more independent residents with light care needs, enabling lean staffing and middle-market rents.
“A Clover resident is not likely to be able to afford assisted living,” Shaver said. “So, what we want to be able to do, and we’re doing here with Geisinger, is have partners that could introduce Medicare Advantage programs that usually reduce the out-of-pocket costs to a health care consumer, and then also to be able to bring in, when they need it, on an a la carte basis, programs that are funded through the MA program for home health or home-based primary care or the services that may be needed as individuals age.”
A closer look at 65 Forward
Like other health systems across the country, Geisinger has been pursuing population health initiatives, with a particular eye toward seniors, who often have multiple conditions and suffer from fragmented care across various sites. Geisinger wanted to improve outcomes and lower costs for this demographic, particularly beneficiaries on the health system’s Medicare Advantage plan. This effort gave rise to 65 Forward.
“We wanted to create a one-stop shop approach for patients who are aging … to keep them healthy and manage their diseases,” Juliann Molecavage, associate vice president, quality and primary care services at Geisinger, told SHN.
This one-stop shop is organized around several care principles, including having smaller patient panels for each primary care physician, enabling them to spend more time with patients and help drive a comprehensive and coordinated approach.
In traditional primary care clinics, a physician might have 2,000 or 2,500 patients in their caseload, Molecavage said. Doctors at 65 Forward will see 450 patients at most. And while Geisinger has traditionally had 40-minute appointments, initial visits to 65 Forward are 60 minutes, with 60 minutes also allotted for subsequent appointments as needed.
In addition to the physicians, each 65 Forward location also has nurses, pharmacists, social workers, community health assistants and others on staff to provide a range of clinical and non-clinical services.
“If a patient comes in with three chronic diseases, we’re trying to figure out how they’re managing, who are they at home with, do they have food, their medications, what’s their income situation — are they choosing between food, medication and transportation?” Molecavage said. “Our physicians and nurses are trained to ask those questions and we have the community health assistants … they help patients with resources for things like transportation, medication vouchers.”
The building design is meant to support the care model by facilitating teamwork, while making older adults feel welcome and comfortable. The waiting area in 65 Forward doubles as a cafe with coffee, tea and snacks. A community room provides a space for seniors to do arts and crafts, play games or otherwise interact, and is meant to help alleviate social isolation.
Nurses’ stations, long hallways and isolated offices have been replaced by a collaborative work area akin to a bullpen, to make it easy for different members of a care team to consult with each other and talk with patients together, Molecavage said.
Telehealth is another “big part” of the 65 Forward concept, she added. Telehealth consultations should provide patients at a 65 Forward location with immediate access to a range of specialists across the Geisinger system.
“If the patient has a primary care doctor and three or four specialists caring for them, there are sometimes gaps in care and communication — with this model, we want to make sure the team is communicating,” Molecavage said. “We want to reduce duplicative testing and services.”
Fewer tests and services would keep costs down, while care coordination should also prevent unnecessary emergency department visits, hospitalizations and re-hospitalizations. With just two clinics open so far, early measures are promising, showing high rates of screening, fewer inpatient hospitalizations and less ED use, according to Molecavage.
“Patient satisfaction is one of our biggest goals here,” she said. “We’ve tracked that early, and we’re in the 99th percentile in these two clinics — giving us a good sense we’re doing the right thing.”
Geisinger is aiming to open 15 sites over the next two years, and has locations already underway in communities such as Wilkes-Barre and Hazelton. As 65 Forward expands, Geisinger is seeking out additional partners, including senior housing and care providers, Molecavage said.
The health system is relying on partners as a way to reach out and boost enrollment in Medicare Advantage plans — therefore increasing participation in 65 Forward. But Geisinger also wants to work with providers that offer services that are covered under MA supplemental benefits, so that 65 Forward community health assistants will have more options and resources as they seek to meet the varied needs of patients.
“We can’t do it by ourselves,” Molecavage said.