LeadingAge New York Adviser Fall 2015 Vol. 1 | Page 23

Alphabet Soup for the Soul(s)
Based on two
conference programs
entitled:

DSRIP
&
SEVEN
LESSONS
LEARNED
FOR FUTURE
SUCCESS WITH
MANAGED
CARE

T

his article is based on two sessions presented at the LeadingAge New York Annual
Conference and Exposition. Seven Lessons for Future Success with Managed Care by
Andy Edeburn and DSRIP Update by Meghan McNamara, Esq. and Jonathan Gilleman,
Esq. of Hinman Straub.
What does the future look like for healthcare? No one really knows but the one thing
everyone can agree on is this: value plus volume will equal success. The care you provide
to the “souls” in your facility will establish their satisfaction, which will be reflected in their
survey responses, which will be a determining factor in the reimbursement you receive
for those souls. The Delivery System Reform Incentive Payment (DSRIP) program has
begun. We are in the early stages but this can be your path to success in the future. Your
planning, partnering and Prospective Payment System (PPS) will determine whether you
succeed or fail.
The Board of Directors at LeadingAge New York adopted a proactive approach early
on and now LeadingAge New York has a seat at the proverbial planning table. We have
already had input on the roadmap outline of how the State plans to achieve Value Based
Payment (VBP) by 2020. It’s all about value and if you are able to protect your reputation as
a value provider, your ability to improve quality and outcomes will be rewarded. Value and
volume must go hand-in-hand. Shorter lengths of stay are inevitable but if you increase the
access points into your facility with partnerships, you will have a greater volume to offset
those shorter stays.
How do you do this? Where do you start?
Pay attention to new providers in your market. When you are negotiating with them
understand your outcomes and value. You must offer a robust Continuous Quality
Improvement (CQI) program to be able to negotiate your best deals.
Evaluate your existing business model. Can you develop new operations that include
assisted living, transitional care or Hospice? Start it now. Your director of nursing and
business office staff need to be rock stars. They are your frontline to meeting the
requirements of your negotiated contracts.
Decrease hospital readmissions and increase patient satisfaction. This is critical to your
value. You may see a reward and incentive benefit from keeping people out of hospitals.
The Managed Long Term Care (MLTC) plans are the dominant players across the
country. They will initially partner with many providers. It won’t be that difficult to begin
these relationships. The key to success will be in your ability to retain the partnership
by demonstrating long-term value. When you are negotiating you must understand your
environment, your competition and be able to show how to tie solutions to problems. By the
fifth year of implementation the transition will be to value-based relationships and MLTCs
will be looking for the best and the brightest as they develop permanent partnerships. The
contracting window will be brief. Be ready to negotiate and show your value. Start your
“soul-searching” now so you can succeed!

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