This discussion will cover the basic structure and key economic variables in transitioning from a world where per patient day (PPD) drives decisions, to a value based world, where per member per month (PMPM) is king. While taking risk doesn’t require SNF entities to become payors, we will explore how SNFs can better understand and demonstrate their value proposition to a payor, why some operators are choosing to become a payor, and how some operators are partnering with others to take on risk. This session will include a case study that demonstrates the opportunities and risks under an Institutional Special Needs Plan (I-SNP), and highlight a number of risk-based fundamentals that translate to other risk-based payment structures.
At the completion of this session participants will be able to:
• Understand the basic concepts of a Medicare Advantage Institutional Special Needs Plan (I-SNP).
• Recognize the fundamental differences between a fee-for-service Per Patient Day (PPD) environment and a risk-based Per Member Per Month (PMPM) world.
• Identify the levers that drive financial success in risk-based payment models.
Stephen Taylor, CPA, MBA, CLA (CliftonLarsonAllen LLP) and
Kevin Whitehurst, Sr. VP Skilled Nursing Solutions, MatrixCare