Strategic Partnerships in Institutional Special Needs Plans (I-SNPs)
Establishing successful Institutional Special Needs Plans (I-SNPs) requires strategic partnerships between nursing home operators and insurance providers, focusing on mutual trust and aligned incentives. Quingan Zhou, Vice President of Growth Strategy and Operations at SCAN Health Plan, highlights the importance of involving providers in benefit design and data transparency to foster trust, though these practices are not widespread among larger Medicare Advantage Organizations (MAOs).
Developing internal I-SNPs poses challenges for nursing home operators, especially in securing staff commitment. Cascadia Healthcare conducted extensive interviews with insurance partners, ultimately choosing American Health Plans to launch a provider-owned I-SNP. Steve LaForte, Cascadia’s CFO, expects membership to grow from 250 to over 450 by the end of the year, emphasizing clinical alignment among the care team, residents, and providers.
Cascadia’s I-SNP has effectively reduced readmissions and improved outcomes, enhancing their star ratings while managing patient lengths of stay. LaForte notes that this approach allows care durations to be tailored based on patient needs, in contrast to other Medicare Advantage plans that often compress timelines.
SCAN Health Plan’s I-SNP, SCAN Embrace, features a comprehensive clinical team that distinguishes it from competitors. As a nonprofit, SCAN reinvests in infrastructure and technology, critical for data transparency and assessing technology impacts on operations. Successful I-SNP contracts require balancing financial models and maintaining open dialogue to address misalignments.
LaForte underscores the necessity of role alignment within operations, from the frontline staff to leadership, to support the care model and goals. Collaborations, such as those with Boise State University for value-based care programs, enhance staff alignment and understanding. Engaging medical directors as integral clinical team members is critical for achieving better outcomes, marking a shift from traditional consultant roles to more active stabilizers of care quality.
Effective I-SNP implementation is expected to drive clinical enhancements and membership growth. A Florida audience member highlighted positive program success and engagement following a change in their medical director. Such alignments and collaborations are essential for success in the market, with education and professional development being pivotal in strengthening operational collaborations and clinical achievements.