What is the Iowa Aging Services Network (ILASN)?

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Members of LeadingAge Iowa have created a separate organization, IASN, whose mission will be to maximize the health and well-being of seniors in its member communities through innovative, cost-effective care management practices and quality improvement activities through contracting relationships with health plans and health delivery systems so LeadingAge Iowa Network members can better serve Medicare and Medicaid enrollees.  IASN will be governed by a board elected by its members and is only available to full dues-paying LeadingAge Iowa members.

 

 

 

Why do I need to work with health plans?     

 

Skilled nursing facilities and other post-acute service and  housing providers  need to work more closely with health plans for the following reasons:

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1. 25% of seniors in Iowa select a health plan that offers a Medicare Advantage product that includes coverage for skilled nursing home care (SNF-A benefits) as well as home care and other services your organization may provide. This number is growing and will likely continue to grow in the years ahead. It is important to have contracts under multiple plans so that you can serve these patients across your care continuum.

2. The state of Iowa is experiencing movement in several different Alternative Payment Models (APM) such as bundled payments for hip and knee replacements, pay for performance, ACOs and value-based purchasing.These APMs will impact the way we do business as aging services providers. Coming together as a group to leverage our market presence with both payors and hospital partners will ensure our sustainability as the health care system changes.

3. In 2018, the State of Iowa implemented its Managed Long Term Services and Supports (MLTSS) program. Seven health insurers were awarded contracts to managed the Medicaid services for older adults. This coincides with the State’s dual eligible program.

4. Health plans have expressed a strong preference to working with collaborative organizations, such as IASN, rather than with individual facilities.

 

What are the benefits of joining IASN? 

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1. Joining IASN will provide greater leverage in negotiating higher rates and other payment arrangements, such as pay for performance plans, with health plans. Stand alone facilities have less ability to negotiate and influence these rates and plans.

2. The Network will provide educational and other resources to help your facility staff better understand how to maximize the payment components of the contracts, and to learn from other members regarding adoption of best practices and improving performance metrics.

3. The Network will provide opportunities to apply for other types of innovative funding offered via the Centers for Medicare and Medicaid Innovation (CMMI), the state and other private grant opportunities.

4. The Network will expand opportunities to accept more post-acute patients from hospitals as a result of contracts with multiple health plans. Health plans may be reluctant to contract with a single facility, but will be more receptive to a Network.

 

What services will IASN provide? 

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IASN has contracted with Strategic Health Care who will be responsible for contract negotiations, health systems relationships and educational resources for member facilities, credentialing and administrative support.

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What will be my responsibilities as an IASN member?

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1. Adhere to contracts negotiated by the Network, including compliance with billing, payment and data reporting responsibilities.

2. Submit necessary credentialing information required by the health plan; also meet or exceed IASN’s application requirements.

3. Submit claims pursuant to health plan requirements.

4. Submit cost and performance data as required by Network to promote best practices across organizations; adhere to the network quality program as determined by the network, including quality and utilization standards.

5. Participate on Network’s board/committee structure as needed and participate in educational and training opportunities.

 

What is the cost of joining IASN?     

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The Network’s expenses have been limited to support those activities that can benefit its member organization. The fee model is based on SNF member services, regardless of size, paying a flat fee of $1,000 to cover basic administrative costs, and a user fee based on a per bed/unit as approved by the Board. For the first year, the annual user fee would be based on census from the previous year: $75 per nursing home bed. A flat facility fee is added per each additional service by facility: Assisted Living, Supportive Living Facility, Shelter Care, Home Health. For AL and Shelter Care, the fee is $250 if part of the continuum; if stand alone the fee is $500. For other services, the fee is $500 per facility. For example:

 

 

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This fee structure allocates a proportional share of total fees to larger organizations that will have greater use of health plan contracts. Non-IASN networks typically charge a percent of claims processed, which can be considerably more costly to organizations (typically skilled nursing facilities) as they expand their business under Medicare and Medicaid health plans. 

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What are the potential cost benefit /return on my investment for joining ILASN?  

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Senior service health organizations need to contract with health plans to be able to serve residents and patients that are covered under Medicaid or who have selected a Medicare Advantage product for their Medicare benefits. IASN offers a cost-efficient way to contract with these health plans as a network to maximize reimbursement and obtain pay for performance plans. Administrative fees for joining the network can be more than offset through anticipated higher reimbursement rates negotiated by the Network versus a facility that negotiates as a single entity or through other networks that charge a percent of claims. Skilled nursing facilities should also be able to expand their transitional care /short term admissions and increase revenues due to these expanded health plan relationships. Finally, the potential to negotiate payment incentives tied to quality and utilization incentives (e.g. reduced hospital readmissions) will further enhance the ROI to Network members.

 

How do I join?

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Facilities need to submit an Operating-Participation Agreement, completed dues calculator and submit the necessary documentation verifying the criteria for membership to:

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17 South High St. Suite 1000

Columbus, Ohio 43215

 

If you have any questions pleae contact Arlene Jaroscak at Arlene.Jaroscak@shcare.net

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