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Primary Care Physicians and the Optum ISNP Care Model in SNFs

Close gaps in care and reduce fragmentation by participating in a cross-functional, team-based care experience.


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Optum partners with health plans to bring specialized benefits and clinical support to residents in long-term care — coordinating primary care, skilled care and specialty services for members of participating Institutional Special Needs Plans (ISNPs). 

The Optum care model places an advanced practice clinician (APC), typically a nurse practitioner or physician’s assistant, at the center of the multidisciplinary care team. 

The APC collaborates with the member, primary care physician (PCP), family and other stakeholders to develop a care plan that delivers proactive, preventive care on site.

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Collaboration to drive long-term care forward

"I have nurse practitioners within my practice group, but they can't maintain a small caseload. The money isn't there. With the Optum care model, I have the Optum nurse practitioner and that takes the pressure off my staff and me."

– Randolph Clark, MD

Momentum toward the quadruple aim


Providing the right care

in the right place at the right time

Achieving 51% fewer ED visits

and 38% fewer hospitalizations1


Reducing fragmentation

with high-touch communication and care


Providing 24/7 coverage

for members including weekends and holidays


Ensuring manageable caseloads

so Optum APCs can be patient-focused


Demonstrating 92% satisfaction

among patients and their families2

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Flexible collaboration

At Optum, partnerships are fundamental to success, so we offer flexibility in collaborative practice models depending on the PCP preferences.

Let's talk about a partnership in care.

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  1. McGarry BE, Grabowski DC. Managed care for long-stay nursing home residents: An evaluation of institutional special needs plans. American Journal of Managed Care. 2019;25(9):400–405.
  2. 2018 Member Satisfaction Survey, Optum Consumer Experience Research Program.