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The Future of SNF Value-Based Payment (VBP) Programs: The Optum I-SNP Care Model



The Optum I-SNP plan is a model of care that provides enhanced care in the nursing home with advanced practice clinicians (i.e., nurse practitioners and physician assistants). These on-site clinicians coordinate and deliver care in conjunction with I-SNP members’ primary care physicians, facility staff, and other providers at no additional cost to the facility or the patient. They are responsible for establishing a comprehensive plan of care for each I-SNP member, which is shared with all members of the care team. They provide primary, acute, and preventive care for I-SNP members, including biannual visits for comprehensive assessments and monthly visits for routine assessments. If the member develops an acute illness, the visits occur daily until the member has stabilized. Additionally, the advanced practice clinician facilitates family care conferences to help address medical, behavioral, and social needs; establish goals of care; coordinate care with specialists; and manage various therapies. Under the Optum I-SNP model, the 3-day qualifying hospital stay requirement for Medicare Part A benefits in a skilled nursing facility (SNF) is waived. This waiver allows for skilled services within a SNF to be covered without a qualifying hospitalization. In addition, this program identifies and treats a patient’s change in condition early via appropriate medical management overseen by the I-SNP’s advanced practice clinicians, combined with the coverage of SNF services not otherwise available under traditional Medicare fee for service. A new study by Harvard Medical School researchers found that members of an Institutional Special Needs Plan (I-SNP) using the Optum care model had lower rates of emergency department (ED) use, inpatient use and hospital readmissions compared with traditional Medicare fee-for-service (FFS) nursing home residents. Reduce transfers and save money by caring for members in place. The study of the Optum I-SNP model showed:

  • 38% fewer hospitalizations

  • 51% fewer ED visits

  • 45% fewer re-admissions

  • 112% higher rate of SNF use[i]

OPTUM I-SNP healthcare delivery framework focuses on quality of service and patient health outcomes while incentivizing facilities through a value-based shared saving program.

" The Right Care, The Right Time, The Right Place"

To speak with representatives from Optum I-SNP or to schedule an introductory meeting, do not hesitate to contact Diane Kubala at dkubala@covenanthealthnetwork.org .