Nursing facilities and managed care

Area of Science:

• Healthcare management
• Geriatric care
• Health services research

Background:

• Nursing facilities are increasingly interacting with external healthcare providers.
• Managed care organizations (MCOs) play a significant role in coordinating patient care and managing costs.
• Understanding the factors influencing nursing facility relationships with MCOs is vital for strategic planning.

Purpose of the Study:

• To investigate the extent of relationship development between Illinois nursing facilities and other healthcare providers.
• To specifically examine the nature and predictors of relationships with managed care organizations (MCOs).

Main Methods:

• A cross-sectional survey was administered to 867 nursing facilities in Illinois.
• Data collected included relationship objectives, obstacles, services offered, staffing, and networking strategies.
• Descriptive and multivariate logistic regression analyses were used to identify predictors of formal/risk-sharing relationships.

Main Results:

• Urban location, nonprofit status, and a higher proportion of private pay/Medicare clients predicted formal/risk-sharing relationships with MCOs.
• Provision of home care and subacute services also significantly predicted these formal relationships.
• Facilities with higher strategic goals demonstrated a greater likelihood of formal MCO engagement.

Conclusions:

• Nursing facilities with more developed networks and ambitious goals tend to establish formal/risk-sharing relationships with MCOs.
• Urban facilities have more MCO relationships than rural ones, reflecting market differences and fewer options.
• The increasing control of Medicare patients by MCOs, particularly in urban areas, highlights the importance of these facility-MCO collaborations.