How to Manage Risk and Bring Value-based Care to Senior Care Settings

How to Manage Risk and Bring Value-Based Care to Senior Care Settings

During a recent discussion, Curana Health's Chief Information Officer, Todd Tyler, and Chief Population Health Officer, Nate Aumock, shared insights into the steps they’re taking to help revolutionize senior care and succeed through value-based care (VBC) programs. As a provider-led organization, Curana Health works with more than 1,600 skilled nursing facilities, assisted and independent living communities, and memory care settings across the country, offering on-site clinical care, Medicare Advantage (MA) Special Needs Plans (SNPs), and participation in Accountable Care Organizations (ACOs).

The following describes the principles Curana uses to manage risk across various VBC programs and how they are utilizing analytics-powered solutions to better leverage data and technology toward that goal.

The Rise of VBC in Senior Care Settings

America’s senior population is growing rapidly, with many individuals living longer and developing multiple chronic illnesses. Yet the number of families that can adequately support seniors in-home is falling, even as the senior care labor force is shrinking. These pressures are helping to catalyze a revolution in senior care focused on better health outcomes and reduced costs.

VBC is tailor-made to meet the needs of senior care and in-home care settings. A number of promising pilots and initiatives have been implemented in recent years to bring value to senior care. These include MA partnerships that integrate housing, healthcare, and social services, as well as many ACOs launched and designed to coordinate care and meet quality and cost-saving measures.

These approaches depend on delivering more holistic and preventive primary care. But to be cost-effective, providers need to deploy resources for high-risk patients who may develop acute conditions or have complex care needs. VBC also requires that care be highly coordinated and supported by social services, that data and information be accessible when needed, that models be flexible enough to deliver care in the most appropriate settings, that patients and caregivers are engaged, and that providers are aligned around shared goals.

Curana Health has been a leader in making value-based care for seniors successful.

A Practical and Hands-On Model

Over 800,000 seniors receive care in assisted living facilities (ALFs), and another 1.3 million reside in skilled nursing facilities (SNFs) and memory care facilities. Care quality can vary widely between facilities, and the vast majority of seniors (95%) have been diagnosed with at least one chronic illness (while nearly 80% have been diagnosed with two or more).

To manage such complex conditions across a range of settings, clinical care and administrative functions must be highly coordinated. Senior residents need effective primary care to prevent chronic conditions and other health concerns from becoming more acute and requiring transfer to a more intense and costly care setting. Doing so at scale is a challenge that companies like Curana have chosen to take on.

Curana’s model is practical and hands-on, leveraging on-site physician-led care teams to provide a concierge-level healthcare experience. Their care teams integrate with a facility’s staff and get to know patients intimately through social events and daily encounters while utilizing technology and advanced analytics to predict the early onset of disease and illness.

Delivering VBC Requires a Shared Mindset

Something Curana’s leaders know firsthand is that delivering VBC in senior care settings (like SNFs) starts with basic block-and-tackling. Providers need a clear understanding of their patient's health conditions before they can treat them effectively, and they must take steps to document activities and quality outcomes thoroughly along the way. That kind of mindset shift is critical for creating a different care culture in facilities that traditionally focused on responding to acute care needs.

Providers also need to be excited about and motivated by the clinical impact they can have on patients. It’s equally important to engage patients in their own care journey and to enlist the support of families, especially when patients are less capable of looking after themselves or making their own care decisions.

Technology Needs to Be Integrated

VBC requires seamless care coordination to succeed. Curana has found that one of its first priorities in taking on new care facilities is platform rationalization.

In senior care, patients see a variety of providers in different settings, and they often undergo multiple diagnostic tests. All of that data must be accessible by doctors at the point of care.

Most care settings involve multiple medical groups and health plans, so the tech stack is typically very complex. A robust interoperability strategy (supported by a technology platform that makes it easy to ingest and aggregate data from multiple sources to provide a 360-degree view) is a must.

Managing Risk Starts Simple

Managing patient risk is fundamental to VBC, and one of the core values followed at Curana is delivering consistent primary care to members.

To achieve this, Curana’s providers spend enough time with patients to understand what’s really going on with them. The providers also have access to up-to-date information about the patient's health so they know what’s changing over time across multiple touch points. That way they can intervene early on, not just after a medical condition has turned into an acute concern.

Curana has also found that risk adjustment models (typically used by the Centers for Medicare & Medicaid Services) are not well correlated to patients in institutional settings. In fact, some patients with a relatively low-risk score will have the same cost of treatment as patients with a higher risk score.

This disconnect presents a challenge, but it can be overcome through a focus on the fundamentals of exemplary primary care (to avoid unnecessary utilization) and thorough documentation of activities and quality measures.

How Does Innovaccer Support Curana in its VBC journey?

VBC is challenging due to the complexities involved in the measurement of numerous quality metrics and outcomes. However,senior care facilities have been slower in adopting such models for more basic reasons. These include:

• Senior living facilities rely on a mix of different commercial, long-term care insurance, and government programs (like Medicare and Medicaid). This creates payment complexities.
• Senior residents often have multiple chronic conditions and acute care needs, which add to the clinical complexity of their care.
• Seniors often transition between different care settings, which involve different provider groups (exacerbating the complexity of information sharing and interoperability).

Despite these challenges, senior care settings represent a tremendous opportunity for delivering better quality care at lower costs.

Curana Health's success has been significantly enhanced with the use of Innovaccer’s platform and advanced analytics-powered tools and solutions (like InNote and InCare).

InNote streamlines data management, ensuring seamless interoperability and enriched data insights for comprehensive primary care. InCare facilitates proactive patient engagement and care coordination, empowering providers to deliver personalized, value-based care.

With these innovative solutions, Innovaccer is helping equip healthcare organizations (like Curana) to overcome the challenges of delivering VBC in complex environments, and ultimately revolutionize the quality of senior care.