Daughters of Israel facility partners with health insurer’s nursing program

NJJN Staff

The Daughters of Israel skilled nursing facility in West Orange is embarking on a new insurance program designed to cover the physical therapy, medical transport, and preventive care needs for most of its residents on Medicare.

The Medicare Advantage Plan administered by Evercare, a for-profit Medicare HMO, has been in place since the start of June. It provides recipients with two in-house nurse practitioners, on call from 8 a.m. to 6 p.m. every day, who arrange to bring diagnostic and therapeutic services to residents.

Evercare represents “a great advantage for our residents and a win-win situation for both the residents and the facility,” said Lawrence Gelfand, executive director of Daughters. “One of the goals is to avoid hospitalization if at all possible by preventive care.”

Not only does that spare the residents the trauma of a hospital visit, but it represents a cost saving to the institution, which is reimbursed under Medicaid according to the number of beds that are filled.

To Dr. Joshua Schor, director of medicine at the Daughters, each nurse practitioner provides “another pair of eyes and ears to focus on preventive care. It is a way that you can have someone in place and prevent a lot of unnecessary hospitalizations.”

Schor said recipients pay no more than they would to Medicare, and receive all Medicare benefits, as well as no caps on physical therapy.

He praised the plan’s “Part D” drug benefit and said the plan covers transportation for offsite medical appointments.

Daughters of Israel is the first nursing facility in New Jersey to offer Evercare, a program conceived 19 years ago by two nurse practitioners in Minneapolis and operated by UnitedHealth Group, a Minneapolis-based insurer. It is now operational in New York, New England, and Maryland.

In its first month, 55 Daughters residents enrolled in the program. But Schor said it is not appropriate for all residents.

“There is an occasional person who might have a supplemental health insurance plan that might not make it advantageous to sign up with Evercare,” he said. “Evercare would not cover some specific needs of a person on dialysis or sub-acute post-hospital care. When you come down to people who are eligible, most nursing homes enroll about 80-90 percent.”

“Evercare is pleased for the opportunity to offer our services to the residents of Daughters of Israel,” said Diane Bednar-Flynn, executive director of Evercare New York and New Jersey. “We are honored to work with Daughters of Israel and look forward to building upon their experience and well-developed care system to expand services for their residents.”