Healthcare has many stakeholders. Not the least of which are older adults. There are more than 59 million people 65 years and older in the US today, according to the US Census Bureau. And that number continues to grow.
These older adults find their way to traditional Medicare or Medicare Advantage, while others may be dual-eligible because of their financial circumstances.
They have a common desire to live in their homes and communities as they age. For some, this is easy, thanks to good health. For others with declining health, including chronic conditions, comorbidities, and dementia, it’s much harder to accomplish.
That’s where aging-in-place programs come into play.
Getting it right is complex. Consultants can help to examine organizational data, claims, existing programs, and additional data points to increase the likelihood of your program’s success.
Payer, Member Opportunities for Aging in Place
Aging in place opens the door to lower costs while helping members accomplish what may be one of their most important lifelong goals: maintaining independence.
With the help of a consultant, payers can identify operational savings, while concurrently improving the member and provider experience. It’s not an either-or decision. It’s the ability to create the best experience for all stakeholders.
Consultants offer a new assessment of the aging-in-place solution while gathering a holistic view of data and prospective aging-in-place members.
That abundance of data can help drive an exceptional aging-in-place program. When a consultant works hand-in-hand with a payer to parse that data, the findings help payers understand what services and benefits are needed to build an effective program that can drive lower costs.
Using data analytics, the consultant helps the payer understand the chronic conditions found in the older adult population. This helps determine what preventive care services should be administered in a lower-cost setting, such as the participant’s home or an outpatient clinic, compared to services administered in a hospital. Data analytics also uncovers the need for non-emergency medical transportation, meals, and community services.
For health plans, the opportunity derives from cost takeout generated by healthier members, fewer ED and urgent care visits, and better relationships with primary care providers and community organizations.
Get There Before the Puck
Expanding access to preventive healthcare, primary care, and aging-in-place services not only drives down costs but also benefits Medicare and dual-eligible populations.
Aging-in-place programs, like Sagility Smart Step™, help health plans move from reactive medicine to initiative-based medicine. Rather than waiting to identify members through a series of claims indicating diabetes or heart failure diagnosis, payers can get ahead of the puck.
As hockey great Wayne Gretzky famously said: “I skate to where the puck is going to be, not where it has been.”
Healthcare-focused consultants have the knowledge, expertise, and insight to help payers get ahead of the puck by recommending actions to shape an aging-in-place program that benefits multiple stakeholders, including payers, providers, members, and patients.
