How ProMedica Senior Care, Genesis, Principle LTC Envision the Future SNF Business Model

Building partnerships with leaders of different parts of the health care continuum will continue to be a big part of strengthening the industry’s business model, as gaining recognition from other sectors builds credibility, along with referrals and business opportunities.

That’s according to executives from Genesis HealthCare, ProMedica Senior Care and Principle LTC.

Larger corporate organizations like Genesis have looked to build new or strengthen existing relationships, while adopting a small market structure network to better manage facilities in an industry that is incredibly regional.

Melissa Powell, executive vice president and COO of Genesis, said she was brought on last November to further the transition towards decentralized, regional teams that know their market best.

Instead of a whole team of corporate staff members overseeing each administrator, Genesis has created a “small, smart structure” made up of a “macro president,” or administrator, a clinical lead, an MDS coordinator, human resources and business development positions per market.

Kennett Square, Penn.-based Genesis has roughly 250 skilled nursing facilities across 17 markets.

Still, company size doesn’t necessarily dictate a winning model – it’s more about managing assets with clear communication among regional and site-specific staff.

“I don’t think there’s a magic solution that you either have to be small to win, or regional to win, or large to win,” said ProMedica Senior Care President Angela Brandt, while acknowledging portfolio management has always been a key priority for the company. “I think it has a lot more to do with the quality of communication and how those teams are working together, as opposed to whether it’s big or small.”

ProMedica Senior Care, based in Toledo, Ohio, operates 157 skilled nursing facilities across 26 states. The wider ProMedica umbrella includes Paramount Health Plan and acute care health systems.

Still, larger players are able to tap into resources needed to build out business lines much easier than regional operators. It’s oftentimes a trade-off for the nimbleness available to smaller companies, according to Principle LTC CEO Lynn Hood.

“We are a small company and I’ve been with two very large companies. We were able to pivot very quickly during the pandemic, ”Hood said. “When you’re a smaller company, there’s only a group of people that say yes or no. So we’ve been able to pivot a lot on innovation. ”

North Carolina-based Principle operates 45 facilities across three states.

Brandt, Hood and Powell participated in a panel discussion during the LTC 100 conference last month, outlining what their companies are doing to strengthen staffing, census and growth coming off of a difficult two years.

Revamping brand, relationships as business strategy

A big part of the skilled nursing business model moving forward will focus heavily on public image, the panelists said, and that can be internally through staff culture or externally through more transparency between staff and families, and the larger community as a whole.

“There has to be a little bit of a more brutal reality of our image,” Brandt said. “We are clearly not the first place that anybody wants to go. I’m not saying we’re not delivering great care or that that perception isn’t changed once they’re under our care, but we have to have a little bit more of a sense of reality. ”

A way to get out ahead of public perception, Brandt said, is to be better storytellers.

“Moments of excellence” told the right way and with the right platform, she said, or making sure families are leaving with a good experience to tell others in the community, can help boost public perception after pandemic-related headline risk.

“I think we’ve been beaten up for so long. We’ve been at the bottom of the food chain, so to speak, and we haven’t been good at telling the world about all the things we’re doing well, ”added Hood.

One way Principle has been able to shift the conversation is through its clinical trial participation, Hood said, first with monoclonal antibody treatments for Covid-19 and now with trials for an Alzheimer’s drug, both developed by pharma giant Eli Lilly.

Recognizing the power of primary care physicians and utilizing them as another way to get patient referrals can help with word of mouth too, Brandt said.

“Recognizing that that’s not typically how a patient gets into our facility, it’s still a very influential stakeholder in that process,” added Brandt.

While the skilled nursing sector has long viewed itself as the “ugly stepchild” of the health care world, leaders are starting to get more recognition from other sectors – especially on the acute care side.

The attention has potential to change the SNF business model via more strategic partnership, joint ventures or more traditional mergers and acquisitions, Powell said.

“I’m seeing that recognition. The other health systems realize that maybe we’re not the stepchildren anymore, ”added Powell. “I’ve had a lot of conversations with the health systems and the health plans. [These conversations] have really taken a positive direction. ”

Genesis has been approached by two hospital systems in separate parts of the country, Powell said, to form joint venture partnerships around short-term and long-term care.

ProMedica, which has its own hospital business arm, has announced JVs with Emory Healthcare and MetroHealth System, where the systems have asked ProMedica to manage their post-acute care and, in some instances, build new facilities with them and form joint clinical operations.

Brandt said there are about five to six other potential partnerships in the pipeline.

“I think the hospitals are realizing that they have these centers that they weren’t paying attention to, or they even had licenses but they didn’t have the centers open,” added Powell.

This is the case for Genesis’ two opportunities – both aren’t utilizing a long-term care license and now they want to make use of those, she said.

“I think the pandemic, as tragic as it was for our nation… It helped our industry look at ourselves differently,” noted Hood. “We were a solution and the hospitals were begging us to take patients and it’s now our time to go back and say once we have our staff in place, bring on some more because we helped you out.”

Getting back to basics

In terms of initiatives to focus on at this point in the pandemic, all three panelists said getting back to basics was on the list, especially with CMS ramping up surveys.

Powell said Genesis staff are currently reviewing everything from medication passes to dressing changes for wounds.

“The staff members haven’t had surveys in two-and-a-half years, in some places,” added Powell. “There were just a lot of things you know, pharmacy consultant recommendations, things that we always did day-to-day, that admittedly, I can’t say fell apart, nothing fell apart anywhere, but we needed to sharpen our pencils a little bit around the basics. ”

Back to basics means back to more normalized schedules too, and recognizing that the last two years were very difficult and there is a lot of weariness for leaders and their staff, Hood added.

“I think there’s a lot of post-traumatic stress syndrome with our administrators… we’re trying to make sure people take their vacations and get rested,” said Hood. “We have got to care for the people that care for the patients.”

Principle is also continuing efforts to innovate via its relationship with Eli Lilly and Care Access, as a way to further shift public perception of nursing homes. Another study, this time on vaccine hesitancy, will help researchers to really understand what’s behind employee reluctance to get vaccinated.

The North Carolina-based operator’s innovation continues with its shift toward private rooms and the installation of murphy beds. Facilities can still boast private rooms while keeping a second bed in the room.

“We’re designing a lot of private-looking rooms… the beds are built into a cabinet, and they come down electronically,” added Hood.

While Brandt agrees that a back to basics initiative is needed, she added it’s important to “lift your head and think strategically as well,” echoing Hood’s thoughts on innovation.

For ProMedica, that innovation lies in a hyper-focus on data, in order to streamline systems processes.

Data collection is tied into Genesis’ back to basics initiative too.

“We’ve been inundated with so much data from so many different places, actionable data,” added Powell. “That’s one of the things that I’m really teaching through this whole revisiting of back to the basics. We’re going through all of our reporting processes, all of our analytics and saying, what do we use? What do we not use? What does the same exact thing? We’re really making a conscious effort of paring down, finding smart, simple ways to do business. ”

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