By: Alina Schreiber, Chief Financial Officer – Emcara Health
It’s been well-documented that the US population is rapidly aging. The number of Americans older than 65 increased by 34 percent between 2010 and 2020, with an additional 32 percent increase predicted by 2030. A growing share of these individuals are covered by health plans that take risk on their total cost of care. For example, currently about 36 percent of American seniors are covered by Medicare Advantage (MA), but the share will grow to 51 percent by 2030.
These aging Americans increasingly want to stay at home for as long as possible. Nearly 9 in 10 Americans between 50 and 80 years of age said it's important to remain in their homes as they grow older, according to the University of Michigan’s National Poll on Healthy Aging.
Unfortunately, aging at home requires careful navigation of a set of highly specific challenges, many of which are off the radar for older adults. Nearly half (47%) of older adults who want to age in place have given little or no thought to the steps they need to take to remain safely and comfortably at home as they age.
The need to better support members who are aging at home has led to a monumental shift in resources. In fact, up to $265 billion worth of care services for Medicare fee-for-service and Medicare Advantage beneficiaries could shift to the home by 2025. Part of these evolving investments should be squarely aimed at addressing the unique challenges facing older adults who are aging at home, such as:
The CDC estimates that 70 percent of Americans over the age of 55 have at least one chronic condition. Just under half are dealing with two chronic illnesses, while 20 percent of the population is juggling three or more. The average older adult takes four or more prescription drugs each day, while one out of every three seniors sees at least 5 different doctors per year.
In addition to increasing concerns related to direct care, older adults also have significant needs when it comes to social determinants of health (SDoH). For older adults, SDoH needs such as access to safe housing, food, financial resources, and transportation play a critical role in their overall health. A report from AARP found that more than half of older adults are experiencing at least one unmet SDoH need.
Social isolation and loneliness are among the specific health concerns that must be considered when discussing how older adults can successfully age at home. Nearly one-fourth of adults aged 65 and older are socially isolated, according to the National Academies of Sciences, Engineering, and Medicine. The CDC reports that social isolation is associated with a 50 percent increase in dementia, a 29 percent increased risk of heart disease and a 32 percent increase in the likelihood of stroke.
For older adults who live alone, the risk of falling is another significant challenge. About 25 percent of adults 65 and older fall every year, according to the CDC. And about one-fifth of those falls result in serious injury, including broken bones and head trauma. Many fall victims believed their homes were safe and their mobility was just fine prior to the fall.
In most countries around the globe, older people typically live with an extended circle of relatives. That’s not true in the United States. Older Americans are far more likely to live along or with only a spouse of partner. Because of this, built in support systems are less common for older adults in this country. As a result, many individuals are missing critical roles to help them age at home, including someone to help make decisions for health issues, or even someone to support daily needs. In fact, 48 percent of older Americans who live alone report not having someone in their lives who can help them with personal care such as bathing or dressing.
Given these specific challenges, how do you as a health plan ensure that you are effectively caring for older members who are aging in place? Here are three strategies to consider:
Innovations in care models, and evolving member preferences, have shifted the conversation and created interesting new possibilities for supporting members at home. Health plans should focus on finding a quality partner who can help them implement a care model that delivers high frequency contact with members to ensure tightly attuned treatment plans, closure of gaps in care, as well as higher member quality of life. This model should facilitate medical, behavioral, and social care and treatment to members where they live 24x7x365.
As part of this model, the health plan should expect their partner to leverage sophisticated analytics capabilities to identify appropriate members while tracking changes in status to match resource intensity with acuity. The right partner will also offer a compelling risk arrangement (i.e. be willing to place fees fully at risk).
While all older adults could benefit from additional support as they age in place, a specific cohort of a health plan’s population should take priority. These members typically make up from 3 to 12 percent of an MCO population. On average, they have three or more chronic conditions, and many have functional limitations. They account for 40-50 percent of all claims. Effectively supporting this subset of the population is the first order of business.
A multidisciplinary team maintains a frequent, coordinated rhythm of member contact and efficiently addresses broader member issues. Multidisciplinary teams also give providers clinical leverage, extending the influence and impact of community physicians. One of the key roles on this team is a Community Health Worker, who can effectively engage with members with an eye toward SDoH needs. A behavioral health specialist is another important resource, given the prevalence of anxiety, depression, isolation and loneliness among older adults.
Our society is aging rapidly and most older adults fully intend to age in place, in their homes. Traditional models of care will not be sufficient for responding to this cultural shift. Health plans who can fortify their capabilities for delivering care in the home and addressing the specific challenges facing older adults will be in a leadership position, both in terms of clinical outcomes as well as overall costs and the quality of the member experience.
Want to learn more about how your health plan can help members age in place? Contact Emcara Health for a personal consultation.