New model of care starting to evolve via innovative operator

LONDON: An innovative new model of care has been introduced to the marketplace by a long standing provider.

SCAN Health Plan’s new institutional special needs plan (I-SNP), coined “Embrace,” covers multiple parts of the care continuum: skilled nursing, home health and assisted living.

A subsidiary of SCAN Group, the Long Beach, Calif.-based SCAN Health Plan announced its new model of care last week. “Embrace” will launch in Los Angeles and Orange counties in January, Dr. Payam Parvinchiha said, with the intention of expanding to other counties and possibly new states toward the end of 2022.

Parvinchiha is vice president and medical director for integrated care at SCAN.

“LA and Orange County are massive markets with a lot of seniors,” said Parvinchiha. “We want to refine the product offering and be able to go outside of the county with data, with actual outcomes.”

SCAN is in contractual conversations with 30-40 different SNF, home health and assisted living operators, and “deeper” conversations with five to six SNF and assisted living operators that have multiple locations, Parvinchiha added.

Between the “shock” of the patient-driven payment model (PDPM), coupled with the pandemic, the nursing home industry is ripe for a revolution in how to manage the I-SNP population, he explained.

“They’re realizing they need clinical models that aren’t generic, they don’t need doctors and nurses coming to their building, rounding on their patients and leaving. They need a program that aligns with their values,” said Parvinchiha. “We’ll be a partner to them, to achieve clinical outcome goals to, God forbid, you know if there’s another pandemic, we’ll work with them around how to navigate it.”

Founded in 1977, SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 220,000 members across its footprint. Traditionally focused on California, the organization recently announced it would be offering new health plans in Arizona and Nevada in 2022.

Traditionally, I-SNPs were designed for MA enrollees that need institutional-level care for 90 days or more, or those living in nursing homes, Parvinchiha said.

“Over the years, you know, IE-SNPs, institutional equivalent SNPs, have flexed towards this more broad population of frail seniors; [they] have become more popular,” said Parvinchiha. “The industry is recognizing that more and more people who traditionally used to live in nursing homes that were the I-SNP population are now living in assisted living, living at home.”

“Embrace” plan developers are currently working to overcome the challenges of delivering the same level of care in different settings, especially in the home health sector where doctors, pharmacists and other specialists may need to be brought on site.

“I think everyone’s been trying to deliver the same model of care to these people, but obviously there’s a lot more complexity when these frail seniors live anywhere outside of a nursing home where they have access to, you know, the care resources that nursing homes have,” Parvinchiha added

“Embrace” will be made available to individuals in assisted living and skilled nursing first, as it’s more difficult to build out the required infrastructure around in-home care.

Parvinchiha believes SCAN’s community-based, nonprofit focused mission will help grow the broader plan in the right way, separate from quarterly financial pressure that a for-profit might face.