Making the Shift from Volume to Value in Long-Term Care

Justin Border, the Chairperson of the marcus evans LTC & Senior Living Central CXO Summit 2017, discusses how LTC facilities can successfully move from fee-for-service to managed care.

Interview with: Justin Border, Vice President, University Village, Thousand Oaks

'As healthcare organizations move from fee-for-service to managed care, long-term care leaders have to ensure everyone understands what changes that shift will bring about. The care they deliver will have a bigger impact on revenue,' says Justin Border, Vice President, University Village, Thousand Oaks.

Border is the Chairperson of the marcus evans LTC & Senior Living Central CXO Summit 2017, in Minneapolis, Minnesota, October 5-6.

What strategies help in this move from fee-for-service to managed care? What systems and policies have proven successful for you?

It all starts from the people on the frontline, caregivers, support staff and vendor partners being aligned with the rest of the organization, so their interpretation of how they need to change is the same as that of management. We have to make sure we continue doing what we are good at, taking care of residents and patients. This shift will put even more pressure and scrutiny on our care delivery and outcomes.

Secondly, making changes to how clinical and operational data are gathered, and changing the metrics by which teams are evaluated. These sound great in the boardroom but do not get the buy-in when implemented. It is absolutely essential to explain why these changes need to happen, especially to the younger generation of workers who want to know the 'why' behind decisions and what exactly will be done differently.

What makes the biggest impact on quality of care?

The quality of the people on the team, their willingness to learn and their understanding that change is the only constant in healthcare. We have to continuously improve. People need to have an open mind and be prepared to adapt with the times.

How can technology help the process?

Technology is an essential piece for creating greater efficiencies as our responsibilities increase. Predictive analytics and tracking can help us prevent hospital readmissions and major catastrophic events.

What advice can you offer on moving contract negotiation to contract operationalization?

Most managed care contracts contain a lot of boilerplate language, details mandated by individual state law. It is important to take out the elements of the contract that are unique, to focus on what will have a direct operational impact. Completely understanding those pieces and ensuring everyone understands how they impact care delivery is crucial.

What trends should long-term care providers prepare for?

They need to prepare for a few changes that will come very fast. More updated models of contracts. There will be additional elements of care outcomes that will directly impact reimbursement. Second, the need to understand market penetration of each HMO will only increase, not decrease, giving them even better leverage than before. If they do not already have a good handle on their quality outcomes and how they are perceived by members, such as their star rating and health inspection records, then they will not even get their call answered when they try to form a relationship.

Any final words of advice?

Support your team. Do not assume that just because you understand what is happening that the people in charge of operationalizing it understand it too. You have to make sure that they are all aligned in their understanding, that they know what it means if this revenue is not coming in.

Awareness of the basic principles of customer service was important for families, residents and patients, but now they will also be applied to their HMO partners as they will be the one referring patients and signing the check on the back-end. In the fee-for-service times, you could recover from a bad interaction, but with managed care it only takes one bad interaction with the person making a referral for you to get fewer referrals and lower reimbursement for months.


Contact: Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division

Tel: + 357 22 849 313
Email: press@marcusevanscy.com


About the LTC & Senior Living Central CXO Summit 2017

The Long-Term Care & Senior Living Central CXO Summit is the premium forum bringing senior level executives and solution providers together. The Summit offers an intimate environment for a focused discussion of key new drivers shaping the long-term care and senior living industry. Taking place at the Hyatt Regency Minneapolis, Minnesota, October 5-6, the Summit includes presentations on ACO inclusion and hospital partnerships, improving efficiency, growth initiatives, payment model reform and reducing readmissions.

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