Monthly tips, tools, information & special offers
June 2021 | Issue 5
Solutions Spotlight
What is “Perpetual” Case Mixing?

On Tuesday, May 11, 2021, the NYS DOH announced their intent to move away from the “frozen” or, “picture date” methodology and move forward with a “Perpetual Case Mix” Methodology. The concept takes away the “on/off” cyclical setting of rates based on two distinct and predictable 92-day windows, and instead uses all assessments during a six-month period to calculate case mix index (CMI) for rate setting purposes. While we believe there is still a ton to be settled before this is truly official, per DOH, the 7-2020 traditional snapshot is currently slated to be the last.
Telehealth Roadmap: A Path to Capture Opportunities in Long-Term Care
Given the opportunity to quickly prove its efficacy and customer appetite for connecting with care providers virtually, telehealth has more than proven the model works and works well. There is also consensus in the industry that the former regulatory and reimbursement barriers that were rapidly removed during COVID will not go back to the old normal. Evidence of this keeps emerging with CMS rulings and clarifications that signal this intent. The question for those in Senior and Long-Term Care who are now looking at their post-pandemic clinical, operational and business environment to make IT strategy decisions is: Where to go next in telehealth and virtual care?
Innovation in Senior Care Models: What’s Next?

Recently, there has been a provisional decline in ADR and denial activity related to the onset of Covid-19 and the pandemic, but Medicare and other regulatory agencies are once again shifting their focus. Claim denials from Medicare, Medicare Advantage, and Medicaid plans are on the rise. Knowing industry trends and taking a proactive approach can reduce loss of revenue for healthcare providers and SNFs across the country. The best way to manage a denial is to be versed in the claims process and to stay vigilant with documentation in order to prevent claim arbitration.
CORE Analytics Releases Medicare Advantage Platform 

The Medicare Advantage Post-Acute eXchange (MAPAX) delivers the industry’s first claims-based intelligence on current SNF-MA reimbursement, outcomes and value proposition. This data does not exist elsewhere, despite Medicare Advantage enrollment exceeding 40% of all beneficiaries nationally. Learn more here!
How to Build Equity Into Your Employee's Health Benefits

The converging crises in 2020 shed light on the lack of access to affordable healthcare for Black and Brown peoples and persons from economically marginalized communities. We all witnessed the crippling compound effect of health inequity shouldered by economically distressed communities - many New York nonprofits responded in turn.
Employee Health Benefits in a Pandemic
One major area where health inequities still exist in the workplace is in employer-sponsored health benefits plan design. Traditional insurance plans—premiums, copayments, deductibles and coinsurance—frequently create barriers to care. They also can exacerbate inequities in healthcare by inhibiting the use of services - such as primary care - that benefit health and wellbeing.
Special Savings from Value First!

Germ free is the way to be - save on COVID related costs!
Using Technology As Part of a Multifactorial Approach to Falls

Revolutionizing care for seniors by reducing adverse events using artificial intelligence (AI), with predictive analytics based on balance and gait analysis to identify deficits and forecast fall risk.
How to Evaluate the ROI of your Dining Program
The landscape of senior living is rapidly evolving. The tastes and expectations of older adults are changing.
Emergent trends and best practices are developing in response to shifting dynamics concerning public health, sustainability, and advancements in technology. This eBook will help you evaluate the ROI of your dining program in relation to key questions and focus areas so you can make better-informed decisions.
PRUCOL: Qualifying Residents Without Legal Immigration Status for Institutional Medicaid Benefits 

Healthcare facilities are often unaware until a resident enters its doors that the individual may have a problematic immigration status that can affect their institutional Medicaid eligibility. Luckily, by filing an application to resolve a resident’s immigration status and/or establishing “PRUCOL” status (i.e. “Permanently Residing in the U.S. Under the Color of Law”), a resident can quickly become Medicaid-eligible, as long as he or she is otherwise eligible for benefits.
International Dysphagia Diet Standardization Initiative (IDDSI)
Presented by: Amy Colella, MS CCC-SLP / Regional Director of Clinical Services

The International Dysphagia Diet Framework will standardize the language and preparation of food and liquids across the globe. 
Nursing Homes Save Money with Community Solar

Nursing homes are typically master metered, meaning one electricity account encompasses the electricity usage for all residents in a building, rather than each resident having their own account. Community solar subscriptions are usually capped at a specific amount of demand (kW) per account. However, master metering allows a customer to circumvent this cap. A common cap for a direct metered account is 30kW. If the account is master metered, the customer can exceed this cap and be granted a subscription several times this amount, depending on the number of residents. With a larger subscription, the customer will see greater savings.
Insurance Marketplace Continues to Harden
For 2021, the insurance market continues to harden with significantly higher pricing. After approximately 20 years of a soft, buyer-friendly insurance market, the past few years have seen a firming or hardening market—one that is less friendly to insurance buyers.

While the effects of this hardening insurance market on long term care will depend on a variety of factors, most facilities will see premium increases for their insurance coverage overall. In fact, most facilities may see double-digit rate increases at their renewal.
Turn Your Program Into a Profit Center
When most companies think about
cybersecurity, they’re considering things
like regulatory compliance, loss prevention,
and qualitative risk reduction – all valuable
facets of a well-rounded program. But with
the right strategies and implementation,
a well-managed cybersecurity program
has a major impact on driving revenue,
reputation, and company growth.

Companies of all sizes are exploring digital
technologies more than ever to build
better-connected audiences, increase
operational agility, and create web-based
ecosystems that offer new revenue
streams. With such a prevalence of digital
services and solutions, opportunities
to extract more value from your
cybersecurity program are ever-growing.
Help Your Employees Be Financially
Prepared for the Unexpected
Today’s workforce is complex, which makes voluntary benefits especially important. While auto and home insurance may not be top of mind for your benefits program, these coverages provide more options for your employees to improve their financial wellness.
Time to consider?

Just like medical, premiums and out-of-pocket expenses for auto and home insurance are going
up. From auto accidents to natural disasters, there has been an increase in the severity and
frequency of incidents. And without the right coverage, an accident or storm can be devastating
to your employees’ financial wellbeing. With MetLife Auto & Home®, you can give your employees
access to the protection they need to stay prepared for the unexpected. And the support they
need to get back on track.