For skilled nursing facilities, the rising penetration of coordinated care plans signals a meaningful payer mix shift that affects both billing structures and day-to-day care coordination demands. Geographic gaps remain large, but with policymakers actively pursuing integration strategies, facilities in underserved counties should monitor expansion closely and prepare accordingly.
We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care. Two of those plans, Medicare-Medicaid plans and Fully Integrated Dual Eligible Special Needs Plans, are integrated care plans that establish a global budget including Medicare and Medicaid spending. The third, Institutional Special Needs Plans, puts insurers and nursing homes at risk for Medicare spending but not Medicaid spending. Among dual-eligible nursing home residents, enrollment in these plans increased from 6.5 percent of residents per month in 2013 to 16.9 percent in 2020. Enrollment varied across counties but did not vary appreciably with respect to nursing home characteristics, including the share of residents with Medicaid.
— Health Affairs, September 3, 2024
Roberts, Eric T. et al. “Dual-Eligible Nursing Home Residents: Enrollment Growth In Managed Care Plans That Coordinate Care, 2013–20.” Health Affairs, 3 Sep. 2024. https://www.healthaffairs.org/doi/10.1377/hlthaff.2023.01579.
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
