2018 Spring Conference Rewind

“Local Markets Performance in Seniors Housing and Care” took a deep dive into market metrics and how NIC MAP data tools can be used to determine which markets offer the best opportunities.

NIC Chief Economist and Director of Outreach, Beth Mace provided an overview of macro-economic conditions. She addressed the factors that impact individual market performance: economic vitality, labor force availability, demographics, and new building supply. “There is an upward pressure on wages and a downward pressure on rents,” she noted.

Audience members were polled on the Forum’s mobile app during the session. In answer to one question, a majority of attendees agreed that labor pressures were the biggest challenge they face.

Highlighting the wide variations in local markets, Lana Peck, NIC senior principal, detailed data on San Francisco, Houston and Atlanta. She also demonstrated NIC MAP tools that can be used to define trade areas, including a new feature that segments markets by drive time.

The theme of the Forum was directly addressed during the second session of the afternoon, “High Performance Networks: How to Partner in a Value-Based World.”

Moderator Jason Feuerman, senior vice president, Genesis HealthCare Inc., led a panel of experts in the provocative and forward-looking session on the critical importance of networks and partnerships in the new healthcare environment.

“Referral networks are transitioning into service networks,” said Peter Longo, principal and managing partner at Cantex Continuing Care Network. The panel urged attendees to seek out a variety of partnerships, expand care coordination, and leverage their position as the place where the elder actually resides.

“As the senior living provider, I own the relationships with the senior,” said panelist Brian Fuller, chief strategy officer, Great Lakes Caring. “That is powerful.” He added that health systems are not going to approach senior living providers. ”You have to be proactive,” he said. “The sector has to get out of its own myopic view.”

Panelist Kelsey Mellard agreed. “Assisted and independent living communities should be the feeding point for care networks,” said Mellard, head of health system integration at Honor, a San Francisco-based provider of tech-enabled home care services.

Panelists also suggested the need for capital providers to “hybridize” their products, offering traditional bricks-and-mortar lending as well as cash-flow loans for senior living operations. “The very same silos in care delivery exist in financing. Where are the hybrid financing options?” asked Longo.

The day wrapped up with two receptions: a first-time attendee power hour; and a welcome reception. NIC CEO and President Brian Jurutka welcomed the attendees, highlighting the opportunity the conference provides to network, access industry resources, and learn about important trends at the educational sessions.

“Seniors housing and care operators will need non-real estate capabilities, noted Jurutka, who added that the Forum’s goal is to explore ways to create value for senior living communities by partnering with other providers.

Jurutka’s introduction provided context for the day’s first general educational session, “Trends in Healthcare Payment and Delivery Reform: The Impact on Seniors Housing, Post-Acute and Long-Term Care.”

A panel of healthcare reform experts offered their candid observations about the transformational process, along with strategies for business success. Several of the main takeaways included:

•  Medicare Advantage plans are growing quickly with 35 percent of seniors already enrolled in the plans. “Understanding how to work with these plans is crucial,” said Dan Mendelson, panel moderator.
• Value-based purchasing for healthcare is here to stay.
• Responsible regulation will require engagement by the industry.

The luncheon general session began with an announcement by Jurutka about the appointment of two new NIC board members, strengthening the link between seniors housing and healthcare: Dr. David Nash, an expert in population health; and Mike McCurry, COO at Mercy Health, a nonprofit health system.

NIC Chief of Research & Analytics Chuck Harry announced several new alliances. Eldermark Software is now enabling clients to contribute data to NIC on actual rental rates, a big step in the effort to increase industry transparency. Also, Harry announced an alliance with PointRight to provide additional skilled nursing quality metrics for NIC Map clients.

Three experienced seniors housing investors participated in a lively discussion during the luncheon general session, titled: “Investment Strategies in the Age of Disruption.” Panel moderator Kurt Read, RSF Partners, asked panelists Rick Matros of Sabra REIT and Arnold Whitman of Formation Capital about interest rates, care delivery, the danger of over leverage, and the critical issue of labor shortages.

Eleven other educational sessions were held during the day. Here’s a sample of the highlights from some of the sessions:

• “Integration of Care Services: How to Partner with Places People Call Home.” Several providers offered their experiences of partnering with healthcare services. Tony D’Alonzo of Bayada Home Health Care noted that 25 percent of its clients are living in seniors housing. In another example, Brandywine Living uses healthcare coordination as a differentiator.
• “Operators and Investors… So Who is Going to Take Care of All Those Boomers?” Panelists addressed the labor shortages facing the industry and the need to recruit and retain good staff. Some of the solutions included hiring older workers and using new technologies to increase efficiency.
• “A Fireside Chat with Equity Players in Senior Care.” A diverse panel of senior care stakeholders discussed the outlook for real estate and non-real estate assets. Moderator Ben Firestone of Blueprint Healthcare noted the strength of market headwinds. But added that property performance always comes back to the operator. A rapid fire round of questions produced an outlook of rising property and non-real estate asset prices and continued shortages on the labor front.
• “What Seniors Housing and Care Investors Need to Know about Healthcare and Why It’s Important” Moderator Anne Tumlinson provided a backdrop of the intersection of healthcare and senior living. In short: all senior living residents are covered by Medicare and many are in the Medicaid program. These seniors account for a large amount of healthcare spending. Two senior living providers described their programs to offer care coordination and how the programs have increased census and made for happier residents.
• “The Path to Healthcare Risk: Do You Have a Decent Map and Proper Footwear?” Panelists discussed taking on risk for healthcare. Several provided insights into how they insure their own residents. The insurance route isn’t for everyone, though, they agreed.

The session, “The Secrets to Winning Managed Care Business,” provided insights from a panel of experts on how skilled nursing providers can work with managed care plans, such as Medicare Advantage. “We do not have an option of whether to play in the managed care market, if we want to stay in business,” said panelist Susie Mix, president and CEO, Mix Solutions. Suggestions on how to become a managed care preferred provider included: designate a managed care point person at the facility; provide concise patient report information; and offer outcome data. Most importantly, learn how the managed care plans approach the market. “Speak their language,” said Sheila Strand, vice president at managed care company OptumCare.

NIC Chief Economist Beth Mace presented an overview of the economy and the latest seniors housing market conditions at a session titled, “Current Market Conditions Impacting Senior Care.” The audience was polled with the Forum app during the session. They thought a recession was not likely for the next two years. But Mace made a case that growing budget deficits will negatively impact the economy and cause interest rates to rise which could trigger economic stress.  Mace also covered labor shortages and demographic trends which, in the long run, bode well for the industry. Discussing seniors housing, Mace noted the wide disparity in performance among various markets with some showing signs of oversupply, while others still have high occupancies. In fact, a large percentage of inventory growth of seniors housing has taken place in just 11 markets.  On the plus side, absorption of seniors housing units has remained strong, an indication that the product has gained wider acceptance among consumers. Looking ahead, Mace said one of NIC’s initiatives is to boost awareness of the looming problem of aging baby boomers who have not saved enough to pay for housing with supportive services. “NIC wants to raise the profile of the issue of affordability,” she said. “We are trying to build a case to the private sector that this represents an opportunity for them.”