Transforming long term care: provider insights on establishing first I-SNP

PURPOSE: The Center for Medicare and Medicaid Services (CMS) established Special Needs Plans (SNPs) to target high-risk, high-cost Medicare beneficiaries. One type, the Institutional Special Needs Plan (I-SNP), primarily serves nursing home residents with a focus on reducing hospitalizations, early detection of symptoms, improved quality of care, member satisfaction, and reducing costs. This study explored the perspectives of Nurse Practitioners (NPs), and Primary Care Physicians (PCPs) involved in the first I-SNP implemented in a southern U.S. state to examine how care delivery within the model influences CMS- intended outcomes compared with the traditional Fee-For-Service (FFS) model. METHODS: A qualitative descriptive design was used. Semi-structured interviews were conducted with seven primary care providers involved in I-SNP care during the initial implementation. The interview guide was designed using CMS intended benefits of the I-SNP model. RESULTS: Through qualitative thematic analysis, the findings revealed four primary themes: the current nursing home environment, challenges to I-SNP adoption, gaining acceptance, and the I-SNP model effectiveness. The I-SNP model enabled personalized care through shared decision-making, improved staff nurse assessment skills, and enhanced care coordination, addressing gaps in the traditional system. This research highlights the challenges associated with transitioning a care delivery model, including entrenched practices within nursing homes. CONCLUSION: With the growing prevalence of SNPs across the country, these findings suggest that relationship-based I-SNP care models with sustained nursing practitioner involvement may inform future policy and practice to improve outcomes for older adults in long-term care.