Brookdale CEO: We’re Positioned for ‘Where Health Care is Going’ as Medicare Advantage Expands

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If you’ve paid attention to Brookdale Senior Living (NYSE: BKD) in the last few years, you have no doubt heard of HealthPlus.

When I spoke with Brookdale CEO Cindy Baier this week, we chatted about the program and its place in the company’s growth plans.

“One of the most important things you can have in life is your health, particularly as you get older,” Baier told me. “So, we made a very conscious effort to say, ‘How do we become a better, more integrated part of the health care continuum?’”

The Brentwood, Tennessee-based operator launched HealthPlus at the start of 2020, and it has grown the program out to about 50 communities in the time since. The program, in a nutshell, tasks nurses with coordinating care for residents, with the goal being better managing their health outcomes.

This year, the operator is planning to expand the program to 130 communities in its roughly 650-community portfolio. And I can see why: Since implementing it, Brookdale has touted the program as achieving 78% fewer urgent care visits and 36% fewer hospitalizations for residents. Communities that offer the program are faster to grow “profitability” than communities not offering it, the company has noted in the past.

Other senior living operators have implemented similar models and also achieved significant gains, but Brookdale’s scale makes HealthPlus particularly noteworthy. Brookdale’s size arguably should give it more negotiating power with insurance companies and health systems, and open up interesting possibilities for leveraging the results of the HealthPlus program as it continues to be introduced across the portfolio.

In this week’s exclusive, members-only SHN+ Update, I analyze Brookdale’s HealthPlus plans and share key takeaways from my conversation with Baier, including:

• Why Brookdale is going big on HealthPlus
• How the program works in Brookdale communities
• The forces underway that might drive other operators to similar conclusions

Inside Brookdale’s HealthPlus program

At its heart, the HealthPlus program is a way for Brookdale to offer many of the services residents need and want, while offsetting some of those operational costs.

At the community level, the program is facilitated by registered nurses who act as care coordinators for residents and also serve as “extra hands and eyes and ears” to better manage resident health outcomes.

“What we’re trying to focus on is more preventive care, helping residents manage their chronic conditions,” Baier said. “We have a nurse care coordinator who will work with the residents, will work with the families, and work with their health care practitioners to make sure that they’re addressing their health care conditions as much as they possibly can.”

The program is powered by electronic health record technology that helps residents and their coordinators track and manage their conditions in real time. Should a resident need more care than the community can provide, their coordinator can arrange transitions, referrals, medication changes and follow-up visits with medical professionals.

To offset the costs, Brookdale has negotiated a per-member, per-month plan for residents in qualified health plans, under which it also receives a payment.

When a Brookdale community joins the program, Baier said the operator typically hires a registered nurse. The community also gets access to a new electronic health record system and receives new protocols based on HealthPlus parameters.

“We have to train even the salespeople in terms of how to talk about HealthPlus, and how to explain it to prospects and families,” Baier said.

Brookdale is expanding the program to a total of 150 communities in 2024, and it’s not hard to see why. The operator has a portfolio weighted in favor of assisted living and memory care, and is incentivized to help those residents manage their outcomes in a better way for the simple fact that they will live in the community longer.

“It’s a win for the residents because they have a better healthspan, and they avoid things that are incredibly stressful like ER visits and hospitalizations; it’s better for the associates, because they’re dealing with something that’s innovative, and they’re really improving and moving the business forward; and it’s better for the government and for all taxpayers, because we’re lowering costs for the health care system overall,” Baier said.

‘Virtually every senior will be on a Medicare Advantage plan’

Underpinning Baier’s and Brookdale’s thinking about HealthPlus is the fact that the senior living industry is moving steadily toward a value-based care future in which payment will be tied to resident health outcomes.

As she looks into the not-too-distant future, Baier sees a world where “virtually every senior will be on a Medicare Advantage plan.”

Indeed, the number of enrollees in such plans have ticked up steadily in recent years. The total number of MA enrollees grew by 2.2 million in 2023, representing an increase of about 7.1%, according to an analysis from ATI Advisory. Today, the national MA penetration is 50.2%, which is up from 47.9% in 2023.

Baier believes that providers are going to be increasingly focused on managed health outcomes in order to cater to that population.

“The majority of health outcomes are really driven by things that don’t happen at the doctor’s office,” she said. “It’s things like, are you eating properly? Are you exercising? Are you taking care of yourself? Are you identifying issues early so that they don’t become really big issues? That’s something that we are uniquely qualified to help with.”

Looking across the industry, I see more senior living operators coming to the same conclusion.

Preventative care is a growing trend in senior living, and Brookdale is not the only company exploring offering such services. One leader with a similar view of Baiers’ is Juniper Communities CEO Lynne Katzmann, who has been at the forefront of the care coordination and value-based care trend for years. Juniper’s Connect4Life model offers a similar blend of high-tech and high-touch as HealthPlus.

“Prevention, lifestyle management, and chronic care management are keys to wellspan — living longer, better,” Katzmann wrote in an SHN op-ed earlier this year. “As we have been reminded over and over, medical intervention contributes only 10% to overall health while lifestyle and where you live (housing) contribute 60%.”

Another company trying to achieve similar aims is the Senior Living Transformation Company, which came together last year with help from industry veterans Arnie Whitman and Chip Gabriel, along with Omega Healthcare Investors (NYSE: OHI) and a relatively new operator called Kalven Senior Living.

In addition, there are numerous health plans that have sprouted up across the country related to MA in senior living, and operators participating in institutional special needs plans tailored to senior living residents.

The writing certainly seems to be on the wall related to the growth of Medicare Advantage, and there’s no question in my mind that Baier is right about “where health care is going.” Still, the expansion of Medicare Advantage has led to serious cost pressures and administrative burdens across the health care sector, including in post-acute care. Just this week, our sister publication Skilled Nursing News reported that there is $274.9 million in lost nursing home revenue for every percentage that MA plans grow, according to new data from Zimmet Healthcare.

Medicare Advantage expansion creates an opportunity for senior living providers to tap into new revenue streams to support more robust health care models – but many providers also are concerned that they will not see appropriate financial upside for the value they deliver to Medicare Advantage payers. This is one major reason that several operators have themselves become insurers, through ownership in special needs plans.

Given that value-based care is essentially at a tipping point, I think that senior living operators increasingly will have no choice but to negotiate with the health plans in their market areas. Having the right care models in place to deliver key outcomes for such plans will be critical, but negotiating power comes not only from being able to provide data that shows the value of their models, but from having the scale to move the needle for large insurance companies.

This makes the Brookdale model of particular interest – not only to see how well the company can sustain its initial strong results as the program expands from dozens to hundreds of communities, but how Brookdale will seek to leverage those results, perhaps through closer alignment with payers. I’m sure that Baier is right about the role of senior living changing to become more integrated within the continuum – what that integration ultimately looks like, and how beneficial it will be to operators, is an open question that will be answered through efforts such as HealthPlus.