FREQUENTLY ASKED QUESTIONS
What is the Indiana Health Services Network (IHSN)?
Members of LeadingAge Indiana have created a separate organization, (IHSN), 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 Indiana Network members can better serve Medicare and Medicaid enrollees. IHSN will be governed by a board elected by its members.
Why do I need to work with health plans?
Skilled nursing facilities and other post-acute housing and service providers need to work more closely with health plans for the following reasons:
- Over 33.4 % of seniors in Indiana 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 Medicare Advantage product will likely 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.
- The state of Indiana is experiencing the 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 LTSS 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
- Health plans have expressed a strong preference to working with collaborative organizations, such as IHSN, rather than with individual facilities.
What are the benefits of joining IHSN?
- Joining IHSN 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.
- 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.
- 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.
- 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 IHSN provide?
IHSN 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.
What will be my responsibilities as an IHSN member?
- Adhere to contracts negotiated by the Network, including compliance with billing, payment and data reporting responsibilities.
- Submit necessary credentialing information required by the health plan; also meet or exceed IHSN’s application requirements.
- Submit claims pursuant to health plan requirements.
- Submit cost and performance data as required by Network to promote best practices across organizations.
- Participate on Network’s board/committee structure as needed and participate in educational and training opportunities.
What is the cost of joining IHSN?
The Network’s expenses have been limited to support only those activities that can directly benefit its member organization. The two tiered 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/or unit costs as approved by the Board. For the first year, the annual user fee would be $50 per nursing home bed based on census as of 12/31 of the prior year and a flat $250 fee for AL. For example:
|Fee per Unit||# of Units||Example:
|SNF Facility Fee||$1,000||n/a||$1,000|
|SNF Bed Rate||$50/ bed census||100 with census of 85 beds||$4,250|
|Assisted Living (RCF)||$250 flat fee||n/a||$250|
|Home Health Agency||n/a||n/a||n/a|
This fee structure allocates a proportional share of total fees to larger organizations that will have greater use of health plan contracts. Non IHSN 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.
What are the potential cost benefit /return on my investment for joining IHSN?
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.
IHSN 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.
For Example, following the Ohio managed care model, they realized a 5% increase on their bed rates through their network efforts. So, if an Indiana SNF has a $162/day bed rate and the network negotiates a rate that is at least 5% higher, the new rate would be $173.25/day ($8.25 increase). At the examples above, the facility would need 2-3 beds at that rate to make back their fees for network membership.
How do I join?
Facilities need to submit an Operating-Participation Agreement and submit the necessary documentation verifying the criteria for membership to the IHSN offices.