Long-term care insurance—a solution?
Some older adults think that long-term care insurance is the answer to avoiding the high costs of health care. Long-term care insurance is a relatively new type of insurance designed to pay for the costs of long-term nursing care services, many of which are not paid for by Medicare or other health insurance.
But long-term care insurance can be very expensive and may only pay for a small portion of the services older adults need. In addition, many policies have coverage gaps, exclusions, and loopholes. Many older adults deplete their savings while trying to pay for uncovered services at home or extended stays in nursing homes.
How is Erickson Health care designed to reduce costs?
Erickson Health doctors are tackling rising health care costs by educating their older adult patients about how to stay out of hospitals and nursing homes—the most expensive health care settings. Studies show that each day spent in a hospital or nursing home raises someone’s chances of developing complications arising from factors like medical mistakes, infections, pressure wounds, or delirium. These complications can cost patients not only money, but additional short- and long-term illness and loss of function.
Members of Erickson Health’s Medicare Advantage insurance program have had shorter average hospital stays (3.8 days versus Medicare’s 5.9 days) as well as shorter average skilled nursing facility stays (11.89 days versus Medicare’s 25 days) as a result of Erickson Health’s integrated network of physicians, programs, services, information, and research.
- Care coordination—a better way: For older adults who may have more than one health condition, the current health care system can be inefficient, time-consuming, and costly. Arranged by care delivery setting, the system dictates how insurances pay bills, where doctors see patients, and which rules and regulations apply. In addition, care providers often work in one setting (hospitals, nursing homes, doctor’s offices), and patients are left to navigate the system on their own.
To provide quality care for people with several health conditions, services must be well-coordinated among multiple providers and settings. Erickson Health coordinates care onsite among various doctors, health providers, programs, and services as well as off-site with non-Erickson Health doctors, physician specialists, and facilities. This coordination is done person-to-person and through the use of electronic medical records. Aside from providing safely stored information that is instantly accessible, 24 hours a day, the electronic medical record allows Erickson Health doctors to read laboratory results, electronically generate prescriptions, and identify adverse medication interactions immediately. For example, within 24 hours of the 2004 Vioxx recall, Erickson Health doctors were able to alert all individuals in the electronic system who were taking the drug.
- Innovative programs with a preventive care focus: Erickson Health also helps reduce costs through its focus on wellness and preventive medical care. Preventing potential problems like falls or fractures can save substantial costs and disability.
A U.S. government study estimated the direct costs of nonfatal falls to be $19 billion in 2000. Direct costs are what insurance companies and patients pay for the treatment of fall-related injuries.
According to the CDC, more than one-third of adults age 65-plus fall each year. Of those who fall, 20% to 30% suffer moderate to severe injuries—such as hip fractures or head traumas— that reduce mobility and independence.
Erickson Health identifies older adults at high risk for falls using the VIVA! program. VIVA! is a comprehensive health screening aimed at helping older adults live healthier, not just longer. VIVA! assesses physical elements like body composition, gait and leg strength, balance, and osteoporosis as well as mental and social elements like memory, depression, and social interaction.
Participants receive recommendations for making improvements based on shortfalls. For example, a resident found to be at risk of falling due to osteoporosis and/or balance problems may be referred for FallProof™ balance classes. FallProof training has been scientifically tested and proven to improve balance and mobility and to reduce the risk of falls.
Promoting wellness: Improving the status quo
Older adults can avoid some serious illnesses and functional disabilities by receiving regular vaccinations against certain common diseases.
- Influenza vaccine: Influenza (flu) complications like pneumonia lead to increased hospitalizations and outpatient visits and thus increased health care costs. The CDC reports that older adults comprise 90% of the 36,000 deaths that occur on average each year from influenza complications.
Nationally, only about 60% of older adults receive annual flu vaccines. Since Erickson Health has started a flu vaccine initiative, up to 98% of residents at Erickson communities have been vaccinated.
- Pneumonia vaccine: The pneumonia vaccine helps prevent the most serious form of pneumonia: invasive pneumococcal disease. Nationally, thousands of people over age 65 are hospitalized each year with pneumonia—but only 50% of adults over age 65 are vaccinated each year against this debilitating lung infection.
Although the final numbers have not been tabulated, Erickson communities were on target to reach their goal of a 100% pneumonia vaccination rate in 2007.
n Shingles vaccine: Erickson launched a major shingles vaccine initiative in 2007. Shingles is a painful skin rash caused by the same virus that causes chicken pox. More than one million new cases are diagnosed each year in the U.S.
Shingles can result in a debilitating and costly complication of long-term, chronic pain that affects up to 90% of patients. The shingles vaccine may not only prevent the disease but may also reduce the persistent pain experienced by those who still get shingles even after receiving the vaccine.
Nationwide example
Are older adults’ fears valid? Yes. Health care costs are rising. But Erickson Health is working toward a solution by setting a nationwide example for older adults’ quality health care. The combination of Erickson Health physicians, sophisticated care coordination, and a strong preventive care focus enables people to live better—and more cost effectively—no matter what their state of health.