Assisted Living Provider Champions Health Care Partnership Model

“Health care partnership” has become a catch phrase of late in senior living, as providers seek ways to align their missions with local organizations that provide health care to senior living residents.

Many are talking about the potential offered by Accountable Care Organizations, or ACOs, the first of which are showing success, according to measures from the Centers for Medicare & Medicaid Services (CMS). The agency essentially offers shared incentives and returns to those ACOs that demonstrate more coordinated health care.

Pure senior housing operations have notably been left out of the ACO conversation, say those providers that have tried to join ACOs without success. There are technology burdens that exist currently, preventing senior living from tracking metrics and “talking to” acute care partners, as well as a lack of understanding about the services senior living provides across the health care spectrum.

But for some innovative providers, health care partnerships already are standard practice and have measured results, proving their success. Such is the case for Bloomfield, N.J-based Juniper Communities, which across its 20 properties has defined its operational practices through data and outcomes for more than a decade.

Laying the groundwork

“[One reason] we’ve been successful is we have been on an electronic operating system, which includes an electronic health record (EHR), for a very long time,” says Juniper Founder and CEO Lynne Katzmann. “We know data makes a difference and having everyone with real time access has moved us light years forward.”

Navigating the EHR landscape—even for those that are considerably more “up to speed” than the average senior living community—can be difficult, given there are numerous EHR formats and little alignment among providers as to which system they choose.

For Juniper, which uses PointClickCare as its EHR platform, that’s one of its partner requirements. Juniper’s internal high-tech platform, Connect 4 Life, is the underlying basis for those partnerships with PCC being the common language for partners to communicate.

As an integrated model of health care, Connect 4 Life uses metrics to drive outcomes and involves physicians as well as other partners in collecting, analyzing and using those metrics to drive performance forward and improve care for residents. Having a single platform, then, for the different components to communicate becomes an important element.

“It’s high tech, high touch,” Katzmann says. “The high tech piece is the electronic operating system. We tell our providers: ‘If you want to play, you have to use our system.’”

Juniper works with post-acute and rehab provider Genesis as its rehabilitation partner. Genesis also operates on the PCC platform, which provided an incentive, Katzmann says. The company does the same with physician partners, pharmacy partners, and all of its partnerships across the continuum of care.

The Juniper model

As the basis for Juniper’s partnerships, Connect 4 Life operates on three fundamentals: intentional use of data and outcomes to drive quality, define performance and guide operations; integrating physicians directly into assisted living settings; and cultivating wellbeing through therapy-driven physical wellness programming and access to other services through strategic partnerships and alliances.

The three-pronged approach and embrace of technology puts Juniper “light years” ahead of some of its counterparts, Katzmann says.

“Integrated care is the way of the future,” she says. “Everyone would agree it has to happen. It’s not just about health care reform, but quality of care and service for our population.”

Metrics are a key component of the system, however, and Juniper tracks roughly 90 of them across five domains. They might include things like urinary tract infections, falls, wounds and changes in resident status that can signal a need for action to the care providers, Juniper included. The system uses cross tabulation comparisons to track changes in outcome measures so that “rather than anecdotes or speculation, community and regional staff drive to the root of problems and create proactive corrective actions,” the company says.

Integrating physicians into the care model is another essential component. Juniper has done this by affiliating with Redwood Health Partners, a primary care organization with clinic settings that are based in Juniper’s communities. Through office hours kept in the clinics and training that is geared toward senior living residents, the physicians can provide care in a lower cost setting than a common doctor’s office or a high-cost hospital environment. Government efforts to reduce readmissions are also a consideration as care provided on site can serve as a preventative and corrective measure toward that end.

Physicians’ actions and metrics are integrated with those tracked by Juniper via its Connect 4 Life system.

Expanding and improving the one-stop shop

Adapting to the new system is not easy or cheap, but it will become necessary, Katzmann says, the more widely health care reform is adopted. Part of a streamlined, effective approach means ensuring all partners are on board with the integration.

“Anyone who provides services in our building has to be a part of this,” Katzmann says.

That means all partners must agree upfront. Genesis is working with Juniper currently with success, as are service providers in other areas, but it does rule some partners out.

Patients and/or residents, too, must opt in to the program.

“It’s like like one-stop shopping,” Katzmann says. “If they don’t like the provider, they can always opt out, but then they don’t get the coordination. If the information isn’t in our system, it’s much more difficult to get it.”

Health care reform will drive change whether providers adapt now or wait for EHR and other requirements that will come from CMS, but are currently a choice. Katzmann sees an opportunity for providers that are smaller to act now and differentiate themselves.

“We are not Brookdale in scale or scope,” Katzmann says. “What we do have is the ability to be quick and innovative, and we have a very strong corporate culture that supports innovation and collaboration. The combination of the two has allowed us to move ahead and develop and implement Connect 4 Life, and in our view integrated care is a key to a healthy future.”

Written by Elizabeth Ecker