Can We Be Friends?

Senior living providers are figuring out how to forge successful partnerships with hospitals and other healthcare providers. 

 By Jane Adler

Amid a government push to improve health outcomes for frail elders and reduce costs, forward-looking senior living providers are reaching out to form new partnerships with healthcare organizations eager to adjust to the new reality. 

Independent living and assisted living communities are creating novel programs and alliances with physician groups, hospitals and ancillary healthcare service providers such as hospice and home health companies. 

Skilled nursing facilities — already part of the healthcare continuum — are fine-tuning their approach, adding specialties such as chronic disease management. 

In April, nonprofit health system ProMedica announced that it would acquire skilled nursing home giant HCR ManorCare in a partnership with real estate investment trust Welltower (NYSE: WELL). 

A lot of experimentation is underway, and partnership models between healthcare and housing providers are still evolving. 

Analysts are also watching a Medicare Advantage rule change that could allow some reimbursements for services to assisted living properties. The Centers for Medicare & Medicaid Services (CMS) is expected to provide more guidance before Medicare Advantage plans must submit their program designs for 2019.

The impact of today’s emerging healthcare models, such as bundled payments and managed care, can vary greatly from one community to another. No single approach works best. 

Meanwhile, some senior living companies have taken the potentially risky step of launching their own health insurance plans (see sidebar).

Success stories are starting to emerge. Senior living providers are leveraging healthcare partnerships to boost occupancies and lengthen the stay of residents by keeping them healthy. 

Here a few short case studies of how senior living and care businesses are profiting by partnering with healthcare organizations. 

Juniper Communities: 

Connect4Life Program

Over the last several years, Juniper Communities has pioneered the Connect4Life program, which adds healthcare services to a traditional private pay assisted living model. Juniper operates 24 buildings and owns most of them. The company recently launched a third-party management division. 

The Connect4Life program contains three components:

1) Primary care and other ancillary healthcare services are delivered onsite. 

2) Electronic health records are used to give care team members up-to-date information on test results and medications, and to provide a means to communicate about resident issues. Each Juniper community documents more than 90 health measures to identify trends for early intervention. 

3) An on-site coordinator, or navigator, connects the resident and healthcare providers and also acts as the communication coordinator among providers. 

Juniper took the extra step in 2017 to document the results and resident outcomes of the Connect4Life program. The company retained Anne Tumlinson Innovations, a consulting firm based in Washington, D.C., to compare Connect4Life outcomes for more than 450 residents in 10 separate assisted living buildings with the broader Medicare population. 

The results showed that the hospitalization rate for Juniper residents was about 50 percent lower than the wider Medicare population. The study also examined readmissions, a measure for which hospitals can be penalized. Juniper’s rehospitalization rate per 100 admissions was 80 percent lower than a similar Medicare population. 

The study results also revealed that the length of stay among Juniper residents was 12 percent higher than it was before the program was implemented. 

“We are putting together information that we can deliver to hospital discharge planners so they know what we can offer,” says Lynne Katzmann, president & CEO at Juniper based in Bloomfield, New Jersey. 

Best advice: Collect data on outcomes and educate local health systems about the results.

Elmbrook Management Company: 


Physician-led accountable care organizations (ACOs) can make good partners, according to Tom Coble, president of Elmbrook Management Co. Based in Ardmore, Oklahoma, Elmbrook owns and operates six skilled nursing facilities and one assisted living building.

Elmbrook focuses on physician-led ACOs because they’re interested in cutting costs, and specialized skilled nursing facilities can offer a low-cost alternative to the hospital. “ACOs have found that we are good partners,” says Coble. 

Two Elmbrook skilled nursing facilities in southern Oklahoma are participating in a partnership program with a local ACO. Elmbrook’s strategy is to accept admissions during off-hours, at night and on the weekends — a service not always offered by skilled nursing buildings. 

In his experience, Coble says offering off-hour service builds confidence among referral sources, which leads to more admissions during regular hours. “It opens the door to higher census,” he says. 

Elmbrook is also staffing up to handle very sick elders in the ACO program who would have otherwise been sent to the hospital or emergency room. The company is hiring nurse practitioners to assess incoming patients.

Staffers are being trained to handle complex medical cases. Clinicians can make referrals directly to the skilled facility. “We will take direct admissions from the community,” says Coble, adding that he expects the practice which is now relatively uncommon to become more widespread.

Best advice: Talk to ACOs, and listen to what they want.

Sunrise Senior Living: 

Road Home Program

After the enactment of the Affordable Care Act, Sunrise Senior Living saw an opportunity to help hospitals reduce readmission rates to avoid costly penalties. The senior living operator that manages more than 320 properties retooled its temporary housing, or respite program, to meet hospital requirements. Sunrise is based in McLean, Virginia.

Sunrise’s Road Home Program is based on the 30-day window for readmissions that hospitals must avoid. The company created a 30-day, all-inclusive housing and care package. Sunrise also helps coordinate any needed therapy

“The program provides continuity and coordination of care that results in successful outcomes,” says Jessica Phaup, vice president of business development at Sunrise. Her office is in Columbia, South Carolina. 

Phaup adds that the program also provides time for the family to put in place any support services needed when the elder returns home.

The program is not a traditional rehab stay reimbursed by Medicare. Patients pay out of pocket for the service.

Each resident is assessed prior to admission. Rates are based on local market rents, the level of care required and the cost of medication. 

The program also acts as a pipeline for new residents. Elders in the program sometimes decide to move into the building permanently, says Phaup. 

Referrals come from hospitals, typically when an elder does not meet the criteria for skilled nursing because they do not need around-the-clock supervision. 

The program is also seeing an uptick of referrals from skilled nursing facilities in cases where elders have completed a course of rehab but are not yet ready to return home. “We offer a nice value proposition,” says Phaup. 

The Road Home program is available throughout North America. Ten major markets account for about 75 percent of all admissions generated through the program.

A designated Sunrise team member works with local hospitals. The goal is to educate hospital case managers, discharge planners and C-suite executives about the role assisted living can play in the recovery process. “There’s still a lot of misunderstanding about the well-being programs provided by assisted living,” says Phaup.

Best advice: Operators need to rethink their strategies in era of healthcare reform.

Ocean Healthcare Network: 

Preferred Provider

Ocean Healthcare Network increased its occupancies by becoming a preferred provider for area hospitals. Based in Lakewood, New Jersey, the company owns and operates 13 skilled nursing facilities, two assisted living properties, a handful of other medical facilities, and a hospice service. 

RWJBarnabus Health, a large health system in New Jersey, created a post-acute provider network in 2017 in an effort to reduce hospital readmissions. Five of Ocean Healthcare’s skilled facilities, located near the RWJBarnabus hospitals, were selected to join the network after a screening and application process.

“We had to present data on a whole array of measures,” recalls Joe Kiernan, chief strategy officer and senior vice president at Ocean Healthcare. Data included length of stay in the skilled facility, hospital readmission rates, star ratings by the Centers for Medicare & Medicaid Services (CMS), and quality measures for patient outcomes compared with state and national averages.

“Data is what gets you in the door,” says Kiernan. 

Clinical capabilities were also key, including special programs to handle patients with chronic conditions. The ability to admit patients around the clock was a big plus, says Kiernan. 

To address weaknesses, Ocean Healthcare provided a performance improvement program to show steps were being taken to meet higher standards. “Even if your data is not exactly where it needs to be, you have to demonstrate that you have the knowledge and capability to be a strong post-acute partner,” he says. 

Occupancies at skilled nursing facilities selected as preferred providers for the narrowed network increased because hospital referrals were made only to those buildings. Ocean Healthcare saw occupancies at its buildings in the network hit more than 90 percent within two months. 

RWJBarnabus operates a robust ACO, which also works with Ocean Healthcare. Monthly meetings include conversations about the referral of ACO patients directly to Ocean Healthcare facilities. “It’s another layer of opportunity for us,” says Kiernan. 

Ocean Healthcare is taking other steps to work with medical groups. Electronic medical records are used at all of the buildings. Ocean Healthcare has also introduced a disease management software program by COMS Interactive. It identifies which patients are at most risk of being readmitted to the hospital. 

Nurses and other care providers are alerted which patients need immediate attention, or which ones need certain lab tests or other interventions. The system also allows managers to provide feedback to frontline nurses and adjust clinical recommendations. 

Ocean Healthcare’s assisted living buildings don’t yet participate in the hospital partnerships. “Those opportunities are coming,” says Kiernan. He foresees a day when health systems recognize that assisted living can provide supervised care for less cost than that of other healthcare settings. 

“There are a lot of seniors living at home who do not have enough support for them to stay safe,” emphasizes Kiernan, who recommends that assisted living providers meet with hospital systems. “We have to position our service lines to meet the demands of the market.”

Best advice: Know what drives health system decisions, and strive to become a preferred provider.