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Executives from Saber Healthcare Group, Majestic Care and Creative Solutions in Healthcare said they have walked away from some Medicare Advantage contracts when payments failed to cover care costs. They described using cost and outcome data to negotiate higher rates, while calling for policy changes around reimbursement and care decisions.
Executives from Saber Healthcare Group, Majestic Care and Creative Solutions in Healthcare said they have challenged Medicare Advantage (MA) plans over reimbursement, with Saber reporting it ended five to seven contracts in the past 24 months. Speaking at Skilled Nursing News’ RETHINK conference in Philadelphia, the operators said they sometimes leave plans that do not cover care costs and use performance data to seek better rates.
Saber President and founder Bill Weisberg said the company ended one contract about two weeks before the conference because the plan’s payment did not cover the cost of care. He said providers can be offered lower rates in exchange for the prospect of more referrals, but argued that plans cannot guarantee where hospital discharge planners, patients or families choose to send residents.
Weisberg said Saber tracks cost of care, length of stay, hospital readmissions and outcomes when negotiating. In some cases, he said, the company returned to the table with comparative data and made a case for an additional $25 to $35 per day, which plans agreed to pay. The report did not specify how many contracts received those increases or over what period.
Creative Solutions CEO Gary Blake said his company is also willing to leave contracts and talks with residents and families about coverage options. Majestic Care CEO Paul Pruitt described a gap between quality and cost targets that providers are expected to meet and the financial gains he said often fail to follow. The executives also raised concerns about plan rules affecting clinical decisions, including payment reductions or pressure to discharge patients whom clinicians may consider unready to return home.
Payment Disputes Shape Care Choices
Medicare Advantage plans are a source of coverage for nursing home residents, while facilities must manage the costs of staffing and treatment. When an operator ends a plan contract, residents and families may need to consider other coverage or placement options. Blake said his company explains alternatives to beneficiaries, including other MA plans and traditional Medicare.
The executives’ accounts also point to a negotiating trade-off: leaving a contract may put pressure on a facility to replace its residents with others whose coverage reimburses more adequately, while staying may preserve access to a plan’s members. The report provides the operators’ perspective and does not include responses from MA insurers or data measuring how contract exits affect resident access or provider finances across the sector.
How Operators Negotiate MA Rates
Medicare Advantage is the privately administered Medicare coverage option at issue in the executives’ remarks. Providers and plans negotiate payment terms, and the conference discussion focused on whether reimbursement reflects the costs and care demands of skilled nursing residents.
Weisberg said Saber uses operating and outcome measures to support requests for higher payment. Blake said supplemental benefits, including grocery cards, can draw attention from the adequacy and quality of health care, and that providers should explain coverage trade-offs to residents. Pruitt said managed care was intended to control costs, but he questioned whether providers see better economics after meeting plan quality and cost expectations.
““So it’s kind of like you’re playing a game of chicken.””
— Bill Weisberg, Saber Healthcare Group president and founder
Contract Effects Remain Unmeasured
The conference report does not identify the MA plans involved in Saber’s contract exits or give a facility-by-facility breakdown. It also does not include insurer responses, independent reimbursement data, or figures showing whether residents experienced disruptions or found other coverage after contracts ended.
Weisberg’s account of rate increases describes some negotiations, but the report does not say how often plans accepted such requests. The broader effects of contract withdrawals on referral volume, patient access and facility finances are also not quantified.
Providers Continue Policy Talks
Blake said Creative Solutions is in ongoing discussions with lawmakers in Washington and argued that providers should continue raising concerns with policymakers. Pruitt described meeting with members of the House Ways and Means Committee to advocate for changes. The executives did not identify a specific bill, rulemaking date or policy decision expected next.
For now, the operators said they will keep negotiating with MA plans, using data to support requests for higher rates and, when they judge a contract inadequate, considering whether to leave it. Any broader policy changes remain uncertain.
Key Questions
Why did Saber Healthcare end some Medicare Advantage contracts?
Bill Weisberg said Saber ended contracts when reimbursement did not cover the cost of care. He said the company ended five to seven contracts over the prior 24 months, including one about two weeks before the conference.
How does Saber seek higher reimbursement?
Weisberg said Saber presents data on care costs, length of stay, readmissions and outcomes. He said some negotiations resulted in an additional $25 to $35 per day, though the report did not state how many contracts received increases.
What does leaving a plan contract mean for residents?
Blake said Creative Solutions educates residents and families about their coverage options, which he said can include another MA plan or traditional Medicare. The report does not detail the effects of specific contract exits on residents’ coverage or placement.
What changes are the executives seeking?
Blake and Pruitt called for policy changes related to reimbursement and plan practices they said can affect clinical decisions. They described discussions with lawmakers, but no specific legislation or upcoming decision was identified.
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