The US Census Bureau predicts that by 2034—less than 15 years from now—there will be 77 million seniors age 65 and older in the US, outnumbering those age 18 or under. In terms of cost, the impact on an aging population is significant for providers, payers, and patients alike. The diseases seniors are most likely to have are those that are also the most expensive to treat, namely heart disease, type 2 diabetes, cancer and stroke. Today, 80% of those age 65 or over have at least one chronic condition and 77% have two or more.
The prevalence of Metabolic Syndrome (MetS) in the senior population has led to an increase in the rate of chronic conditions, a significant risk factor linked to poor health and increased costs. This means they have at least three of the following measurements:
- Abdominal obesity (waist circumference of greater than 40 inches for men, greater than 35 inches for women)
- Triglyceride level of 150 mg/dL or greater
- HDL cholesterol of less than 40 mg/dL for men or less than 50 mg/dL for women
- Systolic blood pressure of 130 or greater, or diastolic blood pressure of 85 or greater
- Fasting glucose of 100 mg/dL or greater
Individuals with metabolic syndrome are five times as likely to develop type 2 diabetes, two times more likely to develop heart disease, and three times more likely to have a stroke. Of all MetS measurements, obesity appears to be the most significant risk factor.
A missed opportunity
Groups that serve seniors, like Medicare Advantage (MA) plans and Accountable Care Organizations (ACOs), play a significant role in improving the health of their members. In so doing, they also lower financial risk, reduce costs, and improve quality of care. New research shows that a comprehensive lifestyle intervention program can help prevent, reverse, and slow the progression of chronic disease in seniors, saving organizations millions each year.
Newtopia, a habit change platform for disease prevention, commissioned Santa Barbara Actuaries Inc. (SBA) to develop a high-level economic model demonstrating the financial efficacy of the company’s disease prevention program on a given MA population. SBA used datasets from Newtopia’s over-65 commercial population and, because obesity plays such a significant role in MetS, focused on weight loss as the primary criteria. The results were eye-opening.
In terms of health improvements, of the 65+ population assessed, 90% of the program’s participants lost weight over the 12-month period, with an average body weight reduction of 5.5%. This is significant because research has shown that even a 5% body weight reduction can lead to multiple health improvements. Those losing the most weight experienced an average of 13% body weight reduction. Interestingly, the results for this senior population outperformed the under 65 population.
In terms of cost-savings, the results were even more impressive. SBA estimated that applying Newtopia’s program to a typical MA population could generate savings of about $1,700 per member per year for those who engage with Newtopia for at least 12 months. For an MA plan with 100,000 members, this translates to estimated potential savings of $10.8 million to the plan.
How to choose the best habit change provider and whole health experience for your members
Traditional disease prevention programs are designed with a one-size-fits-all approach where everyone is given the same basic classroom-style curriculum in hopes that some part of it will resonate and cause the participant to take action. More effective programs are designed around the individual—a one-size-fits-one approach that takes into consideration each individual’s unique health needs and goals, as well as their personality traits, habits, lifestyle, and genetics. This information is then used to design a plan just for the participant. This makes the program more meaningful, which can help seniors be more successful. It also positions MA as an advocate for its members, not just as a payer collecting membership fees.
The most effective programs are those designed around improving overall health, not just losing weight. They tap into each senior’s goals and motivations and work those elements into a more personalized program.
Another factor to look for, and one that cannot be overemphasized, involves personal engagement with a health coach on a regular basis. This can be especially important for seniors, many of whom grew up in an era when customer service was always a human interaction, not a bot or automated phone system. Many disease prevention programs today use digital tools in place of human engagement. But the best programs are those that use digital tools to enhance human interaction, not replace it. Many seniors prefer that one-on-one relationship that only a dedicated coach can provide. Meeting with health coaches via phone or video on a regular basis can help keep seniors motivated and on track. The most effective programs go even one step further by matching coaches to each senior based on personality and preferences.
The bottom line
MA organizations and ACOs face significant stressors from multiple factors, including fierce competition, unpredictable revenue, more stringent quality measures, and increasing consumer expectations. By leveraging a hyper-personalized disease prevention program like Newtopia for even a portion of members with the highest costs, organizations can address all of the above. It’s a win-win for payers and their members.
Learn more about the SBA study here.