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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.



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.

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


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.

  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.