Peter Longo is a principal and managing partner at post-acute care provider Cantex Continuing Care Network. He oversees the development and ongoing performance of innovative programs and services for the company, and is responsible for its vision and mission.
Longo led Cantex’s advancement to becoming a full-service continuing care network from a multi-facility skilled nursing operator.
Through the Value-Based Care series, Longo talks about the central role skilled nursing facilities should play in the value-based care landscape given their unique position to manage risk, and how providers can leverage their experience providing patient care to achieve strong outcomes. He also discusses why he believes the shift to value-based care is happening fast enough — and notes the considerable progress that has already occurred.
In one sentence, what is your definition of value-based care?
It’s providing the best possible patient outcomes in the most efficient way while providing a great patient experience.
What does value-based care require in order to be successful?
Value-based care requires management bandwidth and a willingness to think about old problems in new ways. We have to plan and execute a patient’s care journey in a way that is respectful of both the patient and the resources used.
What do you see as the biggest hurdles to achieving value-based care in today’s health care landscape?
For many providers, the greatest barrier is a reluctance to cut ties with the past. They need time and management capacity to rethink processes in a way that’s responsive to value-based incentives. Value-based care is looking for certain outcomes and we have to redesign our care around those outcomes to make sure we achieve them. Usually, value-based care is structured so that we’ll succeed financially when we achieve the outcomes we’ve been asked to deliver.
Do you see any downsides to value-based care?
Value-based care often involves assuming risk depending on the program. If providers take risks and don’t perform well, they may lose in the process. I think the potential for gain by engaging with value-based care is worth the additional risk.
How do you see technology currently supporting the shift from fee-for-service to value-based care?
A great example is telehealth, and we’re actively deploying it in our skilled nursing facilities, as well as telemonitoring in our home health business. Both are making remarkable impacts, particularly on re-hospitalizations and our ability to prevent adverse health events that lead to them. Telehealth and telemonitoring have made a huge difference in our ability to succeed in value-based care.
Why do you think it has generally been difficult for skilled nursing facilities to get a seat at the table when it comes to value-based care?
Over the last several years, some of those programs have been aimed further upstream than us, payers and hospitals, making it harder for us to access the programs in terms of assuming the risk and getting paid for success. I think that is changing, however, and it has already changed in ways that allow us much greater access to value-based care programs.
Originally, for skilled nursing providers in particular, value-based care was often as simple as achieving some of the objectives that Medicare Part A set in order to preserve your Medicare Part A rate or achieve the Medicare Advantage plan goals. Today, if you’re involved in riskier, cutting-edge forms of value-based care, the payoff is much greater; Institutional Special Needs Plans (I-SNPs) would be a great example of that for skilled nursing facilities.
If you’re able to manage your population and I-SNP membership well, you’ll be rewarded first in terms of better patient outcomes and reduced re-hospitalizations. Second, these can be financially viable programs that contribute to your overall bottom line, and they can help us solve some of the financial challenges around operating a skilled nursing facility today.
What role do you think skilled nursing facilities should play in the value-based care landscape?
They should play a central role because they are in an excellent position to manage risk. Skilled nursing facilities are very familiar with the population within their four walls via historical data and assessment tools. Our knowledge of these patients helps us manage their care journey, facilitate the best outcomes and manage risk well. I think we’re a very important and perhaps central player in value-based care programs for this aging and disabled population.
What do you think skilled nursing operators have to do specifically to get a fair financial reward with value-based care?
We have to leverage our experience with these patients to achieve strong outcomes. I do think we have to use all the tools in the toolbox, including being open to programs like I-SNPs, which allow us to put more clinical firepower in the facility to yield stronger results. It’s honing your bread and butter skills for assessment and monitoring patients, then using new tools to up your game clinically.
Is the shift to value-based care happening fast enough, and do you think the pace of policy change aligns with the goals of that transition?
I do. I often hear a concern expressed about things moving too quickly for folks to understand before they undertake the risk and try to design programs that are responsive to the risk they’re assuming. So we do need to take the time necessary for these programs to develop in a healthy way. From my perspective, it feels like we’re evolving at a good pace in a rapidly evolving landscape, and so I think leading-edge providers are doing just fine.
The provider community as a whole needs to allow time for folks to understand how these programs work, and how they’re going to successfully implement them within their own companies. It will take a few more years for these programs to mature, but I think we’ve moved a lot in the last couple of years.
