The Demographics & Economics of Our Aging Society: THE CASE FOR A NATIONAL MOVEMENT MAY 2016
ANNE TUMLINSON INNOVATIONS
The country is
unprepared To meet the needs and desires of an aging population and their families.
I.
FRAILTY-ASSOCIATED NEED IS EXPENSIVE
II.
OUR ABILITY TO FINANCE THIS NEED IS LIMITED
III. SERVICE DELIVERY SYSTEM & COMMUNITIES ARE ILL-PREPARED
ANNE TUMLINSON INNOVATIONS
But there are unprecedented opportunities for aging services organizations and providers
Risk of Frailty-Associated Need is 50 Percent Half of Older Americans Will Experience High Need
14 % > 5 years
12 % 4 7%
2-5 years 1-2 years
8%
< 1 year 0 years
ANNE TUMLINSON INNOVATIONS
Favreault, Melissa and Judith Dey. Long-Term Services and Supports for Older Americans: Risks and Financing Research Brief. Office Of the Assistant Secretary of Planning and Evaluation, U.S. DHHS, Revised February 2015
A Quarter Face Costs of At Least $100,000
48%
15% 10%
10%
$10,000-$49,999
$50,000-$99,999
12%
6%
None
ANNE TUMLINSON INNOVATIONS
$1-$9,999
$100,000-$249,999
$250,000 or more
Favreault, Melissa, Gleckman, Howard and Richard W. Johnson How Much Could Financing Reforms for Long-Term Services and Supports Reduce Medicaid Costs? The Urban Institute. February 2016.
Personal Savings Finances Over Half of Spending Individuals Turning 65 in the Next 5 Years Will Pay Over ½ of the Average Lifetime Cost Out of Savings
ANNE TUMLINSON INNOVATIONS
Favreault, Melissa and Judith Dey. Long-Term Services and Supports for Older Americans: Risks and Financing Research Brief. Office Of the Assistant Secretary of Planning and Evaluation, U.S. DHHS, Revised February 2015
Medicare Gap-Fills - Pays More for High Need Annual Per Capita Medicare Spending in 2006, by Number of Chronic Conditions & Presence of Frailty
Source: Data from Avalere Health, LLC analysis of 2006 Medicare Current Beneficiary Survey (MCBS) Cost and Use file. Prepared for: The SCAN Foundation. DataBrief No.22: Medicare spending by functional impairment and chronic conditions.
ANNE TUMLINSON INNOVATIONS
Medicaid Moving to Constrain Per Capita LTSS LTSS as a % of Total Medicaid Expenditures, FFY 1995-2012
Taken From: Medicaid Expenditures for Long-Term Supports and Services in FFY 2012, by Steve Eiken et al., CMS and Truven Health Analytics, April 28, 2014
ANNE TUMLINSON INNOVATIONS
Very Little $$ in System to Reward Rapid Deployment of Capital In the Delivery System Innovation We Need to Meet Demand â&#x20AC;&#x153;We are fighting over crumbsâ&#x20AC;?
Home is Where We Want to Be â&#x20AC;&#x201C; Even When Frail
70 Percent of Individuals with High Need Live at Home Total: 7.7 million
14% 1.1 m 13% .97 m 73% 5.63 m
Living in a Nursing Home
Living in Residential Care
Living in the Community
Source: Data from the 2011 National Health and Aging Trends Study, Accessed Through Freedman, Vicki A and Spillman, Brenda C. Disability and Care Needs Among Older Americans, The Milbank Q u a r t e r l y , V o l . 9 2 , N o . 3 , 2 0 1 4 ( p p . 5 0 9 - 5 4 1 )
ANNE TUMLINSON INNOVATIONS
But, It’s Dangerous to Live at Home if You’re Frail Adverse Consequence Rate Among Older Adults Who Pay for Some Help
Living in Residential Care
36% 0.35 million
Living in the Community
60% 3.38 million
Source: Data from the 2011 National Health and Aging Trends Study, Accessed Through Freedman, Vicki A and Spillman, Brenda C. Disability and Care Needs Among Older Americans, The Milbank Quarterly, Vol. 92, No. 3, 2014 (pp. 509-541)
ANNE TUMLINSON INNOVATIONS
And, More Expensive Community
Medicare Per Capita Spending
$21,000 $18,308 2 $18,000 $14,001 2
$15,000
$14,594 2
$12,000 $9,000 $6,000 $3,000 $0 Community Residential Care Residents with Residents with Moderate or Severe Moderate or Severe Disability Disability
ANNE TUMLINSON INNOVATIONS
Nursing Home Residents
“I Can’t Believe I am Managing This!” And Needs Go Unmet Doctors
FAMILY: Management Frail Older Adult
PostAcute Care Hospital
Complex Medical Need
Coordination Unpaid Caregiving Legal
Long-Term Services & Support Need
Financial Home Care
ANNE TUMLINSON INNOVATIONS
Senior Housing
Nursing Home
“I Can’t Find What I Need” Information is too disperse and/or hard to trust Most “finders” produce long lists Many “Free” referral sources are biased sources of information •
A Place for Mom
ANNE TUMLINSON INNOVATIONS
“Home Care Is Challenging” Commodity Service •
Delivered by “private duty agencies”
Business model design is around scheduling service, not delivering service Low paid workers Service is too bundled Highly variable quality Too expensive
ANNE TUMLINSON INNOVATIONS
Seize the Opportunity
Connect to Customers Up and Downstream
FINANCING Service Coordination and Management Medical Management
In-home Technology
ANNE TUMLINSON INNOVATIONS
Livable, Connected Communities
Trusted Hands-on InHome Care Providers Supplemented With Tech
Home Modifications/Renova tions
Create Products that Revolve Around Client and Family Needs
Manage Complex Medical Needs
INNOVATIVE Individual Consumer and Family
Life Management
HOUSING MODELS
Support Safety AND Independent Living through Assistance with Daily Tasks
ANNE TUMLINSON INNOVATIONS
Leverage Innovation and Technology Aging 2.0 Supporting Innovation-Oriented Incubators Attempts at New Home Care Business Models (Honor, Hometeam) •
Take out overhead of massive scheduling operations in traditional home care business model
Senior Housing with Lower Price Point, More Individual Design Elements and Integration of Medical Providers Operating Risk-Based Fully Integrated Models of HealthCare Delivery for the Long-Term Care Population
ANNE TUMLINSON INNOVATIONS
Advocate for Financing Combined Out of Pocket and Insurance LTC Spending Increases 15 â&#x20AC;&#x201C; 30 Percent When Everyone is Insured $70 0
$ 624
Dollars in Billions
$60 0
$ 4 68
$50 0 $4 0 0 $30 0
$ 256
$ 220
St at us Quo Insurance
$20 0 $10 0 $0 20 30 ANNE TUMLINSON INNOVATIONS
20 4 0
Favreault, Melissa, and Richard W. Johnson Microsimulation Analysis of Financing Options for Long-Term Services and Supports The Urban Institute Research Report November 2015