Supporting people who are aging in place often requires basic home modifications like removing trip hazards and installing grab bars, handrails and other assistive devices. These changes can help people reduce the risk of falls and stay home safely.
“Aging in place should mean enabling independence, not just living out your final days at home,” said Dan Weinrieb, head of strategic partnerships at Jukebox Health, a home modifications and accessibility company that helps people stay safely in their homes as they age.
“Today, it’s complex care, palliative care in the home. People are seen after an event or only at the highest level of risk and cost,” he said. “But aging in place is more preventative.”
For example, if homes aren’t equipped with modifications to support independence, people may be afraid or unable to leave their homes. They may then become isolated and lonely, and not go to the doctor, and need personal home care. “The point is to increase independence and create an environment for safe, accessible and equitable care,” Weinrieb said.
Benefits Should Be Part of Prevention Toolbox
Progressive health plans look at supplemental benefits as they would a multidisciplinary care team–multiple providers and services are brought together to understand the needs of a family or member, and provide clinical and social support across the board, especially when it relates to health equity.
“Strategically looking at benefit design and program design as another tool in the prevention and management toolbox should be part of the strategy,” said Weinrieb. “Benefits should be utilized proactively too, not just after an event, like an avoidable fall in the home. If you look at the portion of the population that is right on the cusp of the high-need, high-cost disease state continuum, building benefits that are focused on that membership–home modification, meal delivery, transportation to appointments–is important and will make an immediate impact on people’s lives.”
Health Plans Need ROI
Health plans are making decisions based on the value and impact a benefit is going to have on membership from a cost, quality, retention, and acquisition perspective. Data that validates those things resonates with health plans. For example, home modifications have been shown to lead to a 55% reduction in falls and a 15% reduction in readmissions.
If you look at the portion of the population that is right on the cusp of the high-need, high-cost disease state continuum, building benefits that are focused on that membership is important.
Some plans are cutting back because of a lack of ROI and low utilization in previous supplemental benefit investments. “Many spent money on benefits as a way to attract and retain members, and perhaps did not fully figure out how those investments would show a return on the quality and medical-cost side,” said Weinrieb. “It’s no surprise that there’s competing priorities–that will never go away. But plans need to determine what they’re going to make their investment in so we can create benefits and programs that are coordinated, integrated and bring real value.”
Supplemental Benefits Support Chronically Ill
In other Medicare Advantage trends, in response to changes to the risk adjustment model and a spotlight on social determinants and health equity, many MA plans are refocusing their supplemental benefit offerings on members with the greatest need, such as the chronically ill.
Older adults are disproportionately affected by chronic conditions, such as diabetes, arthritis, and heart disease. Nearly 95% have at least one chronic condition, and nearly 80% have two or more, according to the National Council on Aging.
When it comes to supporting members in their homes, sweeping benefits across an entire population are typically not the best use of funds, especially as plans are feeling financial pressure due to rate changes and risk adjustment audits. Instead, Weinrieb said we’re seeing health plans make investments in coordinated, tailored benefits so that they can get support out to people who need it the most.
“About 75% of the population in a traditional MA plan doesn’t need these supplemental benefits, so why spend so much money when you’re sure to see low utilization and little return?” he asked.
“The focus will be on vulnerable populations with significant social needs–Dual Special Needs Plans (D-SNP) and regional managed care organizations that shouldn’t be as impacted as the large, national plans by the changes outlined in the final notice. We’re already seeing a shift in focus. They have a great opportunity to make their benefits and programs more applicable to what their members need and then coordinate care and support from there. With individual MA, I think a lot of it is now table stakes. But with dual-eligible plans, it’s a real opportunity to move the needle from a cost and a quality perspective.”
Aging in Place Remodeling & Other Changes Matter
Falls are common and costly, especially among Americans age 65 and older. About 36 million falls are reported among older adults each year—resulting in more than 32,000 deaths. Each year, about 3 million older adults are treated in emergency departments for a fall injury.
Fear of falling could keep older adults at risk of social isolation. Nearly one-fourth of adults aged 65 and older are considered to be socially isolated which can lead to a variety of health concerns including depression, increased hospital visits, cognitive decline, and onset of illnesses such as Alzheimer’s disease. This touches on health equity and the importance of access to care for all.
It’s been shown that older adults who are afraid of falling may limit their travel outside of the home and especially avoid new environments, which can limit their access to social activities and necessary services to living a vibrant life. Services like companion care or ride services can also help minimize social isolation.
As more people try to age in place, simple home modifications can help people reduce the risk of falls and stay home safely. Health plans have a role, too, to make sure they are focused on keeping people healthy at home, and that often means being proactive and focusing on prevention.