An IPA is an association of independent healthcare providers (IPA members) that provide services to managed care, Medicare, managed Medicaid or Accountable Care Organization patients on a fee for service or negotiated risk bearing contractual arrangement while respecting and preserving the individual autonomy of the IPA members.

An IPA is not a new concept among hospitals and physicians; however, an IPA supporting exclusively “ancillary providers / post-hospital providers / post-acute providers” is relatively unprecedented (including: skilled nursing facilities; assisted living facilities; continuing care retirement; communities home health agencies; hospice; durable medical equipment; orthotics & prosthetics and other healthcare providers).

An IPA assembles healthcare providers within a geographic region to set credentialing benchmarks of excellence, and to form collaborative efforts among providers to implement these credentialing benchmarks. Med-Net IPA credentialing benchmarks are based upon current ACO and managed Medicaid participation criteria, best medical practices and expected quality care outcomes supportive of financial incentives.

A limitation of an IPA is that it cannot collectively bargain in a “take it or leave it” manner for its members or bind IPA members into accepting a contract to participate in a payer program.  IPA members, ultimately, decide with which payers they will participate to provide healthcare. Med-Net IPA’s ultimate goal is to contract for risk on behalf of its members and to enable its members to share in the financial incentives afforded to ACOs under the Affordable Care Act.

Our industry’s reimbursement system is changing – swiftly and dramatically. Not only is the landscape for providing care and pharmaceuticals for the aging shifting dramatically in reimbursement methodology but, more broadly, we are experiencing a fundamental change in the organizational delivery of healthcare. Survival demands that providers remain focused on the challenge of contracting for quality of care services, cost-effective pharmaceuticals and appropriate medical outcomes. As every provider knows well, treating the whole person increases quality and efficiency of care while simultaneously reducing the cost of care.

We understand the stress of trying to make sense of these changes, and we have devised a basic survival plan to recommend to skilled nursing facilities, and other healthcare providers. Our particular worry is that many providers, real or perceived, are islands unto themselves: too small and under-appreciated in geographical areas saturated with alternative sources of services for the aging, some of which are “captives” within referral sources’ control and influence (e.g.; hospital systems which own skilled nursing facilities).

What options do skilled nursing facilities, assisted living facilities, continuing care communities, home health agencies, hospice agencies and other healthcare providers have that are likely to lead to survival and success? Financial rates must be high enough to afford to provide the care to which skilled nursing facilities and other health care providers are committed. Traditional negotiation based upon geography and price would not appear, in and of itself, to adequately support this commitment.

Our conclusion is that skilled nursing facilities and other healthcare providers must change the way they deliver quality care. Ultimately a unified message must be conveyed to managed care, Medicare, managed Medicaid and Accountable Care Organizations that skilled nursing facilities, and other healthcare providers are not only focused on negotiating better reimbursement rates but more importantly that they are committed to changing healthcare. We believe that such providers will be persuasive to the degree that they rely on their “strength in numbers”.