Value-Based Care Series: Peter Longo, Managing Partner, Cantex Continuing Care Network

Peter Longo is a senior partner and director of post-acute care provider Cantex Continuing Care Network. He oversees the development and ongoing performance of innovative programs and services for the company, and is responsible for its vision and mission.

Longo led the advancement of Cantex to become a full-service continuing care network from a multi-facility qualified nurse operator.

Through the Value-Based Care series, Longo talks about the pivotal role skilled nursing facilities should play in the value-based care landscape given their unique position to manage risk, and how providers can leverage of their experience in patient care to achieve solid results. He also explains why he thinks the shift to value-based care is happening quite quickly – and notes the tremendous progress that has already been made.

In one sentence, what is your definition of value-based care?

It delivers the best possible patient outcomes in the most efficient way while providing an excellent patient experience.

What does values-based care require to be successful?

Value-based care requires management bandwidth and a willingness to think about old issues in new ways. We need to plan and execute a patient’s care journey in a way that respects both the patient and the resources used.

What do you see as the biggest barriers to achieving value-based care in today’s healthcare landscape?

For many providers, the biggest hurdle is the reluctance to sever ties with the past. They need the time and management ability to redesign processes in a way that responds to value-based incentives. Value-based care seeks certain outcomes and we need to redesign our care around those outcomes to ensure we achieve them. Usually, value-based care is structured so that we succeed financially when we achieve the results we have been asked to deliver.

Do you see any downsides to value-based care?

Value-based care often involves assuming risks based on the program. If providers take risks and don’t perform well, they can lose in the process. I think the potential gain from engaging in value-based care is worth the extra risk.

How do you see technology currently supporting the shift from fee-for-service to value-based care?

A great example is telehealth, and we are actively deploying it in our skilled nursing facilities, as well as telemonitoring in our home care business. Both have remarkable impacts, particularly on rehospitalizations and our ability to prevent the adverse health events that lead to them. Telehealth and telemonitoring have made a huge difference in our ability to succeed in value-based care.

Why do you think it has generally been difficult for skilled nursing facilities to get a seat at the table when it comes to value-based care?

In recent years, some of these programs have been aimed further upstream than us, the payers and the hospitals, which has made it more difficult for us to access the programs in terms of assuming the risk and getting paid to succeed. I think that’s changing, though, and it’s already changed in ways that allow us much greater access to value-based care programs.

Originally, for skilled nursing providers in particular, value-based care was often as simple as meeting some of the goals set by Medicare Part A in order to preserve your Medicare Part A rate or meet the Medicare Advantage plan goals. Today, if you are involved in riskier and more advanced forms of value-based care, the payoff is much greater; Institutional Special Needs Plans (I-SNPs) would be an excellent example for skilled nursing facilities.

If you are able to manage your I-SNP population and membership well, you will first be rewarded in terms of better patient outcomes and reduced rehospitalizations. Second, they can be financially viable programs that contribute to your overall bottom line, and they can help us solve some of the financial challenges of operating a skilled nursing facility today.

What role do you think skilled nursing facilities should play in the value-based care landscape?

They should play a central role as they are in an excellent position to manage risk. Skilled nursing facilities know the population within their four walls very well via historical data and assessment tools. Our knowledge of these patients helps us manage their care journey, facilitating the best outcomes and managing risks well. I think we are a very important and perhaps central player in value-based care programs for this aging and disabled population.

What do you think skilled nursing operators need to do specifically to get a fair financial reward with value-based care?

We need to leverage our experience with these patients to achieve strong results. I think we need to use all the tools in the toolbox, including being open to programs like I-SNPs, which allow us to put more clinical firepower into the facility to achieve stronger outcomes. It’s about honing your skills in assessing and tracking patients, then using new tools to up your game clinically.

Is the shift to value-based care happening fast enough and do you think the pace of policy change aligns with the goals of this transition?

I do. I often hear that things move too quickly for people to understand before taking the risk and trying to design programs that respond to the risk they are assuming. We must therefore take the time necessary for these programs to develop in a healthy way. From my perspective, I feel like we’re moving at a good pace in a rapidly changing landscape, so I think the leading providers are doing very well.

The supplier community as a whole needs to allow time for people to understand how these programs work and how they will successfully implement them within their own businesses. It will take a few more years for these programs to mature, but I think we have evolved a lot in recent years.

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