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FAHA H&S Maximizes Member Value with Managed Care Organizations By Dana McHugh, FAHA H&S Consultant
FAHA H&S Maximizes Member Value with Managed Care Organizations
6 By Dana McHugh, FAHA H&S Consultant
Sometimes serving members is about knowing who to call. And that knowledge can yield big results. Recently, a FAHA H&S nursing home member was faced with approximately $450,000 in outstanding Medicaid LTC claims from one health plan.
That is a large amount of outstanding dollars, and the failure to recover them would have had dire consequences for the nursing home. Leadership at this LeadingAge Florida member nursing home asked FAHA H&S to intervene with the health plan on its behalf. It took several strategically placed phone calls over a four-hour period, but in the end, the health plan released the $450,000, which was wired to the nursing home’s bank account the next day.
This is just one of many examples of critical claims assistance that have occurred since FAHA H&S began serving the membership in 2013.
FAHA H&S is a subsidiary of LeadingAge Florida. By forming FAHA H&S, the LeadingAge Florida Board provided its members the opportunity to join a network of missiondriven, quality nursing homes and assisted living facilities with the goal of leveraging the network to drive more positive relationships with managed care organizations.
The initial focus of FAHA H&S was to ensure fair contracts with managed Medicaid long-term care health plans. Since then, FAHA H&S has achieved that goal, and today members have access to Medicare Advantage, Commercial and Medicaid managed care contracts.
Contracting for the network includes all lines of business. As the baby boomers age into Medicare, Medicare Advantage membership continues to grow in Florida and nationally. FAHA H&S members can choose to access Medicare Advantage contracts that historically had not been accessible to them. Further, additional membership benefits include continuing education on managed care policies and processes for all staff levels, as well as important communications via a twice-monthly newsletter. In addition, staff assistance is available to help with claims processing questions, issues, credentialing and other managed care administrative questions.
What’s Next?
FAHA H&S continues to evolve as the requirements of participation and payment mechanisms become more sophisticated. Value-based payment (VBP) will become more prevalent and more challenging. Nursing homes will have managed care contracts that include VBP. The current statewide Medicaid managed care (SMMC) contract between AHCA and the health plans already requires that health plans contract a portion of the network providers, including nursing homes, under value-based payment arrangements.
Medicare Advantage plans’ VBP agreements will become more involved and require a higher level of accountability to be successful. Because of this move toward more complex contracting arrangements,
it is important to own your data and understand how internal processes can affect data and outcomes.
As value-based payment for Medicaid and Medicare become more prevalent, FAHA H&S is negotiating now with health plans to ensure LeadingAge Florida members will thrive in this environment.
FAHA H&S members are uniquely situated to maximize value through value-based payment arrangements. These member communities have existing infrastructures and services in place – beyond the number of skilled nursing beds on campus – that are attractive to managed care organizations. There is opportunity to leverage these infrastructures and services, as well as the population of the campus, to establish positive value-based payment arrangements with managed care organizations.
FAHA H&S can help you establish those positive arrangements.
To learn more about how FAHA H&S can benefit your community, please contact Dana McHugh at (850) 339-2909 or FAHAHS@ leadingageflorida.org.
Join our community of aging professionals as we come together around our common goal – expanding the possibilities for Florida’s seniors.
Let’s make progress together by exchanging ideas and experiences with colleagues, while exploring bold new approaches.
Together, we can.
