Issue Brief: Value-Based Payment and Skilled Nursing Facilities - Supporting SNFs During COVID-19 and Beyond
Duke University's Margolis Center for Health Policy has published an issue brief, "Value-Based Payment and Skilled Nursing Facilities: Supporting SNFs During COVID-19 and Beyond."
The key themes discussed in the brief are:
- While value-based payment (VBP) models are common in many health care settings, direct skilled nursing facility (SNF) participation in VBP is limited. Evidence is mixed on how SNF-focused VBP models have affected quality, outcomes, and value.
- SNFs indirectly benefitted from VBP during the pandemic, specifically through prepandemic relationships built between VBP providers and SNFs. During COVID-19, these relationships became avenues for obtaining resources and assistance with COVID-19 prevention, testing, and treatment activities.
- While many people sought to receive care outside of a SNF facility during COVID-19, and there’s a broader trend to de-institutionalize and provide more home and community-based services, the COVID experience also highlights that a significant fraction of people will require facility-based care due to their health, functional needs, and limited caregiver resources. This highlights the continued need for VBP models that support improvement and flexibility in SNF settings.
- If VBP is to more directly benefit SNFs during future crises and facilitate effective changes in care patterns, new approaches to SNF-focused VBP models will need to account for the unique circumstances of SNFs (including their staffing, ownership structures, resident needs, financing, and other post-acute care sector challenges).
The findings are the product of a literature review on payment and care delivery challenges in SNFs prior to and during the COVID-19 pandemic and interviews with SNF staff and leadership, professional societies representing SNFs and SNF providers, VBP providers working with SNFs, and post-acute and long-term care experts. JAHF President Terry Fulmer, PhD, RN, FAAN, was a contributor to this issue brief.