‘That’s the Business Going Forward’: Lifespark, Juniper Leaders on Tying Wellness and Payment in Senior Living

Many factors are compelling senior living providers to organize their operations around promoting and extending residents’ wellness, with shifting payment models among the most important drivers of this trend.

At the forefront of this shift are providers like Juniper Communities and Lifespark. The two firms are taking different approaches to arrive at the same goal: improving resident wellness and community health outcomes while maximizing financial upside. 

Juniper Communities is a founding provider of the Perennial Consortium, an effort that allows providers to partner on owning Medicare Advantage plans. And Lifespark forged a variety of partnerships with payers in value-based arrangements, touting its ability to control costs and increase beneficiaries’ wellness through its comprehensive array of home- and community-based care and services. Last year, Lifespark acquired a senior living portfolio, and is integrating these communities into its efforts to deliver whole-person wellness to older adults.

The integration of MA plans in senior living “has to” promote and support resident wellness, Juniper CEO Lynne Katzmann said earlier this month at the Senior Housing News DISHED/WELLNESS event in Orlando.

“The way you make money in value-based care is wellness,” Katzmann said. “It’s all about prevention. If you keep people out of hospitals, you make money…So on the business side and the consumer side, you must think about wellness.”

Thomas also emphasized this idea, saying the entire conversation differentiating value-based care from “value-based reimbursement.”

“We’re in a shift between two historical periods,” Thomas said. “The shift from fee-for-service to value-based reimbursement opens the opportunity to be reimbursed for the value we create. And what’s the value? It’s wellness.”

And senior living providers are in the best possible position to cultivate wellness among frail older adults who are not in a position to live on their own, he stressed.

Putting the pieces together

Katzmann said the best way to prevent chronic illness for residents within a community is through chronic care management and lifestyle services, from holistic culinary offerings to fitness programs blended with primary care.

“It’s bringing all of those pieces together,” Katzmann said. “It’s thinking about a person as a whole person, not just a body, but a body, mind and spirit.”

Through emphasizing health outcomes and lifestyle management of residents through its “wellspan” model, Juniper is looking to provide increased engagement and wellness for residents through individualized “lifestyle prescriptions.” And this approach builds on the integrated health care offerings that Juniper offers through its Connect4Life program, which provides health care-related coordination, technology and outcomes needed to drive Medicare Advantage success.

“We’re intentionally integrating the care into what we do in senior living, but also looking at care services and defining services differently while integrating engagement,” Katzmann added.

To drive home her point, she shared the story of her Uncle Max. Uncle Max had outlived his two wives and a son, and on his 100th birthday, he looked out the window of his New York City highrise apartment and expressed “my life is not worth living anymore.”

“He had lifespan, but he didn’t have wellspan,” Katzmann said. “People not only want more years, they want quality in those years.”

With Lifespark, Thomas has helped create what he says is an “entire health care delivery system” that has very little real estate footprint. This has allowed Lifespark to bring its home-based health care approach to its senior living communities — which, after all, residents consider home.

“We think that’s really going to be the future of this,” Thomas said. “Health is coming home, and value-based reimbursement, the money to support some of these innovations is coming along with it. That’s what makes it really exciting.”

Similar to the goals of Juniper’s wellspan approach, Thomas argued that the “goods” being cultivated in senior living are strength, purpose and belonging, something that Lifespark does by incorporating components of movement, eating, sleeping and healing (MESH) into its communities.

This plays into Lifespark’s ability to “move beyond fee-for-service” models, Thomas said, referencing a value-based reimbursement contract structure that incentivizes a focus on the MESH components.

Improvement on MESH should move residents from an “I can’t” mindset to an “I can” mindset with regard to various activities and other elements of lifestyle, he said.

“I would suggest that to the degree your organization moves people from ‘I can’t’ to ‘I can,’ the more wellness they will experience and the more you will gain under value-based reimbursement and the healthier your organization will be going forward,” he said.

Peering through a ‘pinhole’ for ‘signal detection’

The reasons for senior living to move toward value-based reimbursement are clear, but being able to successfully deliver more proactive and preventive care — while fostering resident wellness — is far from easy.

Technology is key, and there is much room for improvement, Thomas and Katzmann said.

A problem in senior living today is the fixation on the electronic medical record, which Thomas described as looking through “a pinhole” in trying to pursue wellness for residents.

At Lifespark, Thomas said the company worked to create “a sphere of information” around each resident to better understand each person’s history rather than trying to piece together information based on medical records.

“It’s so that we can then be more accurate in predicting in advance any potential changes in their condition,” Thomas said. “Relying on the traditional medical record is simply relying on the barn door being closed after the horse has gone. We want to understand the whole person. And if we can do that, there are technology tools we can use to have better predictive analytics.”

Similarly, Katzmann said senior living companies need a product that creates a “longitudinal record,” or a lifelong picture of the resident.

“It looks at your past, your present and perhaps has some insight into your future,” she said. “I think those things are on the horizon.”

Both Thomas and Katzmann stressed senior living providers need to find new ways to get ahead of resident health problems through something Thomas called “signal detection,” or being able to respond quickly and effectively before health issues become critical and wellness deteriorates.

Katzmann referenced tools such as INTERACT and Stop and Watch, which allow senior living staff to identify when the health of a resident starts to change and respond in an organized and effective way. And with Juniper’s Connect4Life, the company uses software in assisted living and memory care to enter in lifestyle data of residents.

“It bridges what we do in senior living and health care,” Katzmann said. “It’s not very sophisticated, but it’s the base … We have to change our mindset and the tools which we’re going to use in the future, and pull data from many different sources. They normalize that data and they allow that data to be used in a number of analytical exercises some of which may help you today.”

The rise of technology in senior living is nothing new, but Katzmann said the integration of technology within senior living was originally viewed as an “add-on” to a community’s ability to support residents. She contended that technology now “underpins our business model.”

With signal detection and the ability to predict resident health outcomes sooner, senior living providers are at the forefront of being able to provide the best insight into resident health because “we’re there 24/7,” Katzmann said.

Through the Perennial Consortium, Katzmann played a key role in providing a way for more senior living providers to become involved in value-based reimbursement via ownership in Medicare Advantage plans.

And in the near future, Lifespark will be going national, Thomas said, with the ability to go to payers and create a risk pool for all organizations working with Lifespark, including senior living communities.

The question becomes how much financial reward senior living operators will be eligible for if partnering with organizations such as Lifespark, Katzmann noted. Thomas said that providers will be paid in accordance with risk-based models.

“There’s upside and downside risks, and more and more senior living providers are going to be signing up for risk,” he said.

Katzmann and Thomas agreed that the future for senior living lies in wellness-focused operations that have the operational and technological sophistication to succeed in value-based frameworks. Ultimately, it’s all about putting the resident — the person — at the center of the business.

“What we’re saying is, this puts the person at the center; it puts the wellness of the person at the center, and the currency is data and your ability to detect signals, respond meaningfully and effectively, and improve outcomes,” Thomas said. “That’s the business going forward.”

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