Genesis HealthCare Announces Value-Based Initiatives11/12/2015
(Kennett Square, PA) – Genesis HealthCare, one of the nation’s largest providers of post-acute care, today announced the Company’s planned involvement in two Medicare initiatives: Bundled Payments for Care Improvement (“BPCI”) and the Medicare Shared Savings Program (“MSSP”). In addition, Genesis HealthCare is seeking ways to work with acute care providers in affected markets relative to the recently proposed Comprehensive Care for Joint Replacement mandatory episodic model. Genesis HealthCare’s commitment to, and involvement in these initiatives reflects a shift to value-based care and the alignment of incentives critical to obtaining better quality outcomes and improved healthcare efficiency.
Genesis HealthCare subsidiaries operate more than 500 skilled nursing facilities, with approximately 50,000 beds nationwide and nearly 100,000 employees. Genesis Rehabilitation Services is one of the nation’s largest rehabilitation service providers in the US, providing rehabilitation therapy in more than 1,700 locations in 45 states, the District of Columbia, and China.
Over the past decade, Genesis has built several unique capabilities that better support its patients, partners and improve quality outcomes, while at the same time favorably positioning Genesis as a leader in the value-based delivery transition. First, Genesis Physician Services (“GPS”), an in-house physician company, has grown to over 350 physicians and nurse practitioners who practice exclusively in select Genesis centers nationwide. Second, Genesis Care Transitions utilizes teams of nurses and social workers to follow patients home after discharge to prevent unnecessary readmissions and help ensure a safe and successful return to the community. If there is a change in condition, the team facilitates the patient’s return to a center, not the hospital, if necessary. Finally, Vitality to You extends Genesis Rehabilitation Services into the community to allow patients to continue therapy in their homes under their Medicare Part B benefit.
“Participation in value-based delivery models expands our knowledge base and skill sets, drives closer collaboration with our partners in both the public and private sectors in better models of care, and is driving us to become a more data- and outcomes-driven organization,” states George V. Hager, Jr., Genesis HealthCare Chief Executive Officer. “Participation also positions us well to respond quickly with post-acute solutions to better support our hospital partners’ objectives as they participate in new Medicare, value-based models.”
Bundled Payments for Care Improvement
In April 2015, Genesis HealthCare entered the BPCI initiative as the Model 3 Awardee Convener of 32 episode-initiating entities. BPCI Model 3 represents the only Medicare alternative payment model that allows post-acute providers to lead care delivery redesign and share in cost savings achieved. By October 2015, Genesis managed nearly 6,000 episodes annually with total Medicare claims of approximately $128 million, favorably positioning the company to leverage its skills and capabilities in Medicare alternative payment models. The 32 participating Genesis facilities are located in Connecticut, Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, Kentucky and Rhode Island.
“Waivers for gainsharing with other providers create the platform for advanced discussions around clinical collaboration and improved care coordination and outcomes and introduces opportunities for joint participation in a new and innovative payment environment,” states Jason Feuerman, Genesis Senior Vice President, Strategic Development and Managed Care.
Medicare Shared Savings Program
Last month, Genesis HealthCare applied to CMS for its Genesis Physicians Services (“GPS”) physicians to begin participating, based on final CMS approval, in the Medicare Shared Savings Program (“MSSP”) effective January 2016. GPS providers make nearly half a million visits annually to both short-stay and long-term patients, helping to reduce unnecessary hospital readmissions by providing after-hours and weekend coverage supplemented by the use of state-of-the-art telemedicine technology. Their services help to create both healthcare efficiencies and better quality outcomes.
The application calls for GPS providers in Pennsylvania, New Jersey, Maryland and West Virginia to oversee approximately 16,000 beneficiaries, long-term care residents, in 2016. The cost of care per beneficiary is risk-adjusted based on acuity.
“GPS providers have experience in caring for highly complex and costly patient populations. We plan to build upon our Company’s successful experience supporting other institutional managed care programs, such as United Healthcare’s Evercare program, to achieve better outcomes at a lower cost for our long-term care patients in our own program,” continues Feuerman.
Comprehensive Care for Joint Replacement
On July 9, 2015, the Center for Medicare and Medicaid Innovation (“CMMI”) proposed an episode-based payment model for major joint replacements with mandatory participation for hospitals in 75 markets throughout the United States. This program, Comprehensive Care for Joint Replacement, puts hospitals at risk for all Medicare Part A and Part B costs associated with acute care, post-acute care, physician services, durable medical equipment, home health and hospice services, and other Part B service costs for a period of 90 days for Medicare beneficiaries following joint replacement surgery.
Genesis operates more than 100 facilities across several of the 75 markets proposed for this initiative and is partnering with hospitals to help mitigate the risk they assume. In addition, a number of proposed markets overlap with those in which Genesis centers are participating in the BPCI Model 3 initiative. In these markets, Genesis is already assuming the risk for major lower joint replacements which takes precedence relative to the proposed rule for the Comprehensive Care for Joint Replacement model.
“We believe that our collaborative approach make Genesis an effective, preferred post-acute partner who can share in the risk through gain share/loss share arrangements under the types of advanced payment models CMMI has introduced,” shares Feuerman.
“All of these initiatives are designed to deliver higher quality outcomes in the most cost-effective setting, to improve the coordination of services and to reduce unnecessary readmissions and the total costs of an episode of care,” shares Hager. “We believe our participation in these initiatives is essential to succeed in a healthcare delivery market with increasing managed care penetration, and where networks of preferred providers are being narrowed by both traditional payers and at-risk provider-based organizations.”
Genesis HealthCare will host an educational webinar to share more about the Company’s value-based initiatives at 9:00 a.m. Eastern Time on Friday, November 13, 2015. Investors can access the webinar by calling (855) 849-2198 or via a listen-only webcast through the Genesis web site at http://www.genesishcc.com/investor-relations/, where a replay of the call will also be posted for one year.
About Genesis HealthCare
Genesis HealthCare (NYSE: GEN) is a holding company with subsidiaries that, on a combined basis, comprise one of the nation's largest post-acute care providers with more than 500 skilled nursing centers and assisted/senior living communities in 34 states nationwide. Genesis subsidiaries also supply rehabilitation and respiratory therapy to more than 1,700 healthcare providers in 45 states and the District of Columbia and China. References made in this release to "Genesis," "the Company," "we," "us" and "our" refer to Genesis HealthCare and each of its wholly-owned companies. Visit our website at www.genesishcc.com.
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.