Focused on transformational change and increased collaboration, the annual event brought together more than 1,700 seniors housing and care executives – and a growing number of healthcare players – in San Diego, February 20-22.

The conference theme, “Investing in Seniors Housing & Healthcare Collaboration,” addressed the reality that the sector faces a period of change in which partnerships with a variety of service and healthcare providers will be key to business success.

Educational sessions explored the availability of capital, current market conditions, local market variations and how operators of skilled nursing properties can succeed under the new PDPM payment model. Sessions also explored innovation, taking on risk, and forging new partnerships in a value-based world.

NIC president and CEO Brian Jurutka outlined three forces driving the push for collaboration, saying, “These drivers will lead to transformational change,” in his opening general session remarks. He pointed out that baby boomers have different needs and preferences, and that the industry plays an important role as home to millions of high-need, high-cost seniors amidst significant healthcare delivery and payment reform. The third driver he pointed to is technological advancement, which he said will change operations for the better.

In his first public address since leaving Capitol Hill, Former Speaker of the U.S. House of Representatives, Paul Ryan, gave an encouraging perspective on the state of the U.S. economy. He reminded the packed general session audience of the enduring strength of the American system of government and the American dream.  In a follow-up fireside chat, Ryan and John J. Kelliher, a consultant and policy expert, discussed the growing role of Medicare Advantage programs, Medicare and Medicaid payment reform, and immigration issues amid a labor shortage. “Immigration reform will get done,” predicted Ryan. “But not in the next two years.”

Luncheon keynote speaker Ian Morrison, a healthcare futurist, identified the problems with the American healthcare system (too expensive) and then suggested some fixes. He pointed to technological advances, data analysis, and the importance of social determinants of health, and said that payors will increasingly cover non-traditional services, such as housing, to keep seniors out of the hospital. He answered questions in follow-up interactive session.

Highlights of the program of educational sessions:

Day 1

“Underwriting Healthcare in Private Pay Seniors Housing” showed investors how changes in the broader healthcare system impact the NOI of their properties. Using two scenarios, one from today and one from 2025, the panel illustrated how coordination of care will make a difference for fictional 86-year-old Mary and her eldest daughter, Sue, and also drive new revenue streams and improve NOI.

In a NIC first, video highlights were replayed on Day 2 along with a discussion, and live number-crunching, facilitated by moderator Joel Mendes of JLL, and NIC founder and strategic advisor Bob Kramer.

“Equity in Senior Care: Understanding the Players” was presented in a lively “Dating Game” format, complete with theme music and dating references. In two different games, two very different capital seekers asked tough questions of three potential financial partners to find the perfect match.

“I-SNPs: Why Providers are Becoming Payors in a Value-Based World” addressed the strategy of creating a Medicare Advantage plan. A panel of experts, already involved in the process, discussed Institutional Special Needs Plans, and keys to success.

Day 2

“Medicaid Managed Care in Seniors Housing and Skilled Nursing: Opportunity or Threat?” Panelists provided a roadmap of Medicaid managed care. How it works and the opportunities it represents.

“Valuation Methodology Revisited: The Impact of Change” covered current factors impacting property values: inventory, labor pressures, investor interest in the sector, and the availability of capital. The biggest risk going forward according to a poll of the audience is competition—for labor and from other providers.

“Beyond the I-SNP: Future Opportunities for Participation in Value-Based Care” explored how seniors housing providers can profit by assuming some of the healthcare risk for their residents. Panelists noted the need to prove value through data and outcomes.

“Recruit, Retain and Profit with a Top of License Workforce.” The panelists discussed scheduling flexibility, rewards, recognition, and a career path as retention tools. Referrals are the best source of qualified new workers. Attendees broke into small groups to share best practices.

“Real Estate Secured and Cash Flow Lending: Navigating Financing Options to Meet Your Business Needs” mapped out financing options. Debt financing is readily available from traditional sources such as Fannie Mae and Freddie Mac. Panelist Adam Sherman of Live Oak Bank highlighted loan programs that get overlooked from the SBA and USDA.

In “The Boomer Hackathon: Creating Models That Work for Boomers and Investors,” three teams – and those in attendance – brainstormed innovations in seniors housing appropriate for incoming Baby Boomers. A standing-room-only crowd participated in the highly engaging event, which featured a panel of boomer judges, two minute project pitches, and projected financials to consider.

“It’s Not Room Service, It’s Healthcare… Or Is It? Forging Partnerships in a Value-Based World.”  New technology and new building designs are morphing hospitality and healthcare into a new seniors housing model. Panelists discussed how their properties blend hospitality and healthcare into a “perfect marriage.”

“Path to Healthcare Risk: Do You Have a Decent Roadmap and Proper Footwear?” Owner and operator Lynne Katzmann and consultant Anne Tumlinson gave a brief presentation about the core issues facing operators considering the formation of an I-SNP. Attendees broke into small groups to address key questions, sharing their observations on how an I-SNP may be an opportunity for a property to differentiate itself from the competition.

Day 3

“Implications of PDPM for Skilled Nursing.”  Steven Littlehale of PointRight addressed an engaged audience of investors and operators eager to understand the ramifications of the new Medicare reimbursement system. Bottom line: Lenders and capital partners should be meeting with operators to determine their readiness for the changes which will require improved patient assessments, coding accuracy and better data capture. “Skilled nursing will be seen as the best place for quality outcomes,” said Littlehale. “Make sure you are a winner.”

“A Post-Acute Survival Guide: Real Strategies and Real Results for Increased Occupancy.” Strategic up- and down-stream networks are critical for survival for post-acute providers. Payors and hospital systems use data to select those they invite into their network. Panelists noted that operators must “lean in” and engage with them for continuous improvement.

“Location Matters: Winners and Losers in Local Markets.” NIC chief economist Beth Mace highlighted the latest NIC MAP® data and key findings, including which markets performed well and which ones did not meet expectations. NIC senior principal Lana Peck introduced the new rate tier report and walkability score data, now on NIC MAP, along with a deep dive on local markets.

“Current Market Conditions Impacting Seniors Housing & Care.” NIC chief economist Beth Mace presented an analysis of macroeconomic conditions. Concerns about the economy have recently been tempered by a halt in the rise of interest rates. Seniors housing new supply is still outpacing demand, but she noted a significant uptick in demand. Occupancy rates are expected to increase with a slowdown in construction. Referring to an apparent pull back by developers, she said, “The message got out there.”

 

Mark Your Calendar

2019 NIC Seniors Housing Bootcamp, Wednesday April 10, Charlotte, N.C.

2019 NIC Fall Conference. September 11-13, Chicago