Risk adjustment: what is it and how does it impact Healthcare for 2022
Risk adjustment is one tool that helps determine insurance eligibility and premiums, as well as reimbursements for providers. It allows insurance providers to compare members and determine which ones have higher risks of developing certain conditions or require more care than others. This information can then be used by regulators for setting appropriate reimbursement rates for different providers.
So, beyond that what exactly is risk adjustment? Why does it matter? And why will it continue impacting the way we approach health costs over the next several years?
What is the purpose of risk adjustment?
The official definition of risk adjustment, according to HealthCare.gov, is “a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs.”
To understand risk adjustment, you first need to know how it is calculated. The calculation of an enrollee's risk score begins with their demographics and HCCs; a.k.a. the medical codes for their conditions.
To make sure that insurance providers are reimbursed fairly and accurately for services rendered, every member ends up with a unique risk score based on various demographic factors (such as age) combined together from predefined categories called Hierarchical Condition Categories or "HCC".
The demographic factors used to calculate risk scores include:
- Age
- Sex
- Socioeconomic data
- Disability status or eligibility
- Medicaid eligibility
- Institutional status (nursing homes, inpatient care, etc.)
The demographics are paired with an enrollee's list of diagnoses. These codes have all been assigned a specific value for risk adjustment. They're part of the standard ICD-10 coding system used in healthcare -- which assigns codes to every diagnosis based on many factors like severity, location, and condition.
HCCs with lower numbers are higher in severity on the scale and thus would raise someone's risk score. For example, diabetes that is well-managed with no complications would have an HCC of 19, while diabetes in full ketoacidosis would be an HCC 17, which is more severe than the 19. These numbers, paired with the demographic information, would determine how much risk adjustment is necessary for this enrollee.
HCCs and demographics are the two factors that might most affect someone's premium and eligibility in some medicare plans. In addition, people without chronic conditions might have more fluctuation in their risk scores due to diagnosis changing year over year. Still, those who require consistent treatment will likely remain in a high-risk adjustment program.
What are risk adjustment factor scores (RAF)?
Risk Adjustment Factors -- known as RAFs -- are the average risk scores for specific HCCs. They're used in combination with demographics to determine an individual's final risk score. The higher a person's RAF, the more likely it is that they'll end up in high-risk adjustment programs or see increased premiums due to their diagnosis and demographic information.
Health plans use special algorithms paired with patient RAF scores to predict costs. Patients with multiple chronic conditions would have a higher RAF score, thus likely having more healthcare needs with higher costs.
Why does this matter? Since risk adjustment is a calculation that takes into account both demographics and the severity of an enrollee's diagnosis, HCCs will have more of an impact on premiums than ever before.
There's no doubt that risk adjustment will continue to be a complex topic for healthcare professionals and insurance providers alike as we enter 2022. There are still many questions as to how this will play out in the future of healthcare, but there's one thing that seems clear: risk adjustment is going to have a very real impact on every aspect of care and coverage moving forward.
Patients with high RAF scores can always apply for a Medigap or Medicare Supplemental Insurance plan to offset added costs not covered by their Medicare plan. In 2021, there are ten different types of Medicare supplemental plans (Medigap) available in most states. Each is indicated with a different letter: A, B, C, D, F, G, K, L, M, or N. A Medigap policy would help people pay remaining healthcare costs like deductibles, coinsurance, or copayments—in other words, fill the gaps that aren't covered by Medicare plans.
What are the three risk adjustment models?
Depending on the situation, there are three different ways to adjust for risk. Each model has a different purpose and goal in mind.
CDPS — Chronic Illness and Disability Payment Systems
The first model is called CDPS and is used by state Medicaid programs for making capitated (fixed) payments to Medicaid HMOs for disabled enrollees. It may also be used for TANF (Temporary Assistance to Needy Families) for short-term assistance.
There are some precise characteristics of the CDPS model that make it stand out from the others. These are:
- There are 20 hierarchical categories of diagnoses that group them by body system or diagnosis type.
- A focus on those who need the most care.
- Each category has subcategories that showcase their degree of expenditure, affected by the severity of the diagnosis.
- Hierarchies are applied to every major category and count only the highest cost diagnosis. For example, if someone had two conditions under the cardiovascular category, the higher cost condition would be counted.
- Patients can have multiple diagnoses across different categories.
- This model has been adjusted multiple times to account for changes in medical coding.
HCC — Hierarchical Condition Category
HCC — Hierarchical Condition CategoryThere are actually two forms of HCC: CMS and HHS. The CMS-HCC was developed after a mandate via the Balanced Budget Act of 1997 to adjust capitation payments based on its enrollees’ health status and demographics. Meanwhile, HHS-HCC came as a result of the Affordable Care Act. It intended to stabilize premiums for health plans offered on and off the Health and Humans Services health plan exchange. In addition, this model allowed for states who didn't want to operate their own risk adjustment program to use the HHS risk adjustment program.
CMS-HCC
- Hierarchies are applied so that only the most severe or highest cost diagnosis is counted in each category—similar to the CDPS model.
- All diagnosis codes are organized into 805 diagnostics groups, which are then organized into 189 conditional categories for a broad picture view.
- The variables that most impact one's risk adjustment are: disability status, low-income status, Medicaid, the reason for entitlement, age, and sex.
- They utilize prospective modeling, meaning they use previous year data to predict cost in the current year vs. concurrent modeling, which uses current year data.
- They use an additive model where multiple categories can be added together to determine risk.
- This model uses separate calculations for long-term care vs. new enrollees.
- There is an entirely separate risk model for enrolled with ESRD (end-stage renal disease).
HHS-HCC
- HHS-HCC is the newest model, implemented in 2014.
- They work on a risk pool model, meaning its budget-neutral by transferring funds from low-risk plans to high-risk enrollee plans.
- Again, only the most severe or highest-cost diagnoses are counted.
- Age and sex are the demographics that most affect risk scores.
- This model uses a concurrent model, using current year data to predict this year's costs, unlike the CMS-HCC that uses prospective modeling.
- This model includes 127 out of the 189 conditional categories that best predict expenses, focusing more on chronic diseases.
- Depending on the plan level (platinum, gold, silver, bronze, catastrophic), there may be separate calculations due to plans' varying actuarial value. Actuarial value is the total average of costs for covered benefits. For example, if a plan has an actuarial value of 80%, it means the enrollee is responsible for the remaining 20% of costs on all covered benefits.
ACG — Ambulatory Care Groups
Lastly, the ACG model was developed with a completely different approach than the other two. This model assigns diagnosis codes using 32 ambulatory diagnostics groups based on how the condition might affect an enrollee's health and resource needs. For example, the likelihood of disability, reduced life expectancy, or needs for specialists, therapy, or hospice care is all highly considered under this model. This model is often referred to as the Case Mix model because it is used for both risk adjustment and research.
Risk Adjustment and Healthcare
Risk Adjustment and HealthcareRisk adjustment allows for proper cost adjustments as well as setting a standard of premiums for high-risk enrollees. This is because people who are sick or have chronic conditions will be more expensive to treat than someone with few or no health issues. Overall this risk adjustment aims to provide the appropriate funding based on the severity of an enrollee's health condition.
It's a complex system that plans and providers need to have a plan for in order to create budgets properly, adjust plan coverage, and give enrollees the best possible care options. The Ōmcare Home Health Hub allows plans and providers to manage their risk by capturing RAFs (risk adjustment factors) over telehealth visits and ensures medication assistance, leading to healthier outcomes.
We are trying to make chronic care easier and more effective by allowing flexible, at-home care. If you have any questions regarding risk adjustment or bettering care for high-risk patients, reach out to us today!
Senior health: 11 tips for aging well
There are many ways that you can strive towards staying healthy and active as you age. A combination of diet, exercise, and mental wellness can help us age gracefully and maintain our independence for longer. These health tips can help you or your aging loved ones to feel better, longer.
Tips for aging well in 2021.
As you get older, your minds and bodies change, and it becomes more critical than ever to take care of yourself. Here are some tips for successful senior health management and ensuring a long, happy, healthy life.
Maintain a healthy diet
While it may be harder to maintain a good diet for older adults, senior health experts agree that a good diet is one of the most important factors in health outcomes. Everyone needs food A high in vitamins and protein for strong bones and muscles, which means eating plenty of lean protein sources (chicken, turkey, and fish especially), fresh produce, whole grains like brown rice or quinoa, beans, or other legumes. Studies show a healthier diet for older adults can improve cognitive function and disease control.
Taking supplements
As you age, there are critical nutrients the body becomes depleted of. Be especially cognizant of your levels of each nutrient below and talk to your doctor about supplementing if necessary.
- Vitamin D is essential for boosting the immune system.
- Vitamin C is an antioxidant that helps improve the overall function of our bodies by boosting vitamin absorption, wound healing, and aids in vision and organ function.
- Calcium is essential for bone and teeth health.
- Vitamin A is good for heart, lung, and liver health.
- B Vitamins must be replaced as you age because our bodies become less efficient at absorbing B vitamins from the foods we eat. B12 deficiency can negatively affect brain function and only increases our chances of memory loss, high blood pressure, and nerve pain.
Get regular exercise
Specific exercises and specialized training may be better than others, depending on your health or any chronic pain. For example:
For those who experience joint pain, walking or swimming at low-impact levels can still help strengthen muscles without putting too much pressure on the joints. Even just daily walks around the block can make a big difference in senior wellness. Aerobic activities like dancing or yoga have been shown to improve mood, which also helps fight chronic illness symptoms like depression and anxiety. If mobility is an issue, tai chi classes where movements are done slowly with concentration can be easier on the body while being both meditative and strengthening.
Focus on mental wellness
Mental health in the elderly can be a big issue that often gets left behind. Mental health is severely affected by the loss of loved ones, feelings of isolation, and the physical and mental changes that come with aging. Talking about it in therapy, or with loved ones, or even acknowledging feelings of anxiety and depression can be the right step towards mental wellness.
Hobbies for keeping busy
Staying busy can help alleviate feelings of loneliness and boredom, especially for older patients living in a senior healthcare facility. Some hobbies good for seniors include arts and crafts, painting, playing card games, or even gardening on the property. Doing things they once enjoyed may not always be an option for them, so finding fun hobbies to pass the time can be a crucial component to maintaining overall wellness in seniors.
Caring for skin and teeth
Dermatologists always say the best skincare in your 50s is proper skincare in your 20s. Unfortunately, we can't turn back the clock on our skin but can always do things to maintain it and keep it healthy. The number one thing seniors should do to protect their skin is to wear sunscreen every day. Skin cancer is prevalent in older adults, especially those who did not wear sunscreen consistently throughout their lives.
And as you age, you lose a lot of collagen, making the skin thinner and more susceptible to wounds and sun exposure. Teeth can also decline in health, and many seniors end up opting for dentures for ease. However, eating healthy, brushing regularly, and taking the proper vitamins can slow down the deterioration of skin, nails, and teeth.
Getting better sleep
Older adults often experience sleeping problems. This could be because of medications affecting sleep quality or health conditions like arthritis pain or acid reflux that can keep them up at night. If you're having trouble falling asleep at night, talk to your doctor about calming methods and supplements that may work for you.
Hydration!
Drinking enough water is essential for human life. Drinking water helps hydrate your skin, organs and improve bladder and digestive health. The elderly are very prone to dehydration, so ensuring they get at least 64 ounces of water every day (the eight glasses of 8 oz. water rule) can help prevent ailments and boost overall health.
Staying social
The psychosocial changes of growing old can be detrimental to someone's health. Many older adults may find it hard to maintain friendships or go to the social events they once did before they dealt with chronic illness or pain. However, socializing is a normal part of life, and without it, one can feel more lonely and depressed, which can actually lead to more medical problems. Therefore, caregivers and elderly care facilities need to make sure they keep a full calendar of social events that everyone can enjoy together each week—from bingo to dances to playing cards.
Routine medical care and tests
Regular health maintenance and prevention are vital to better health outcomes. There are some routine tests and treatments that can significantly improve the health of older individuals by ensuring their care plan is appropriate and catching any issues early before they become worse.
- Get vaccinated for influenza, pneumonia, and shingles (if applicable)
- Regular cancer screenings (breast, colon, prostate)
- Bone density scans for osteoporosis
- Blood pressure readings
- Check blood sugar levels to check for diabetes
- Lipid screening
- Check for high cholesterol and other blood tests
- Annual physicals
Additional safety measures
Elderly patients may face balance problems that require advance care planning to ensure they don't fall and injure themselves. Using a walker, wheelchair, and installing handrails in rooms or hallways can ensure they always stay safe while moving about.
By following these tips, you can go on to live a long, healthy life and address health concerns before they become chronic health conditions. Here at Omcare, we believe a healthy lifestyle is possible no matter what age, and you can enjoy living longer by focusing on better health outcomes and wellness early on.
Medicare star ratings: how they work + how to compare plans
Medicare star system
If you become eligible for Medicare this year or are considering switching plans when open enrollment season starts, our guide will help you decide which plan is best for you. Before you do, it’s important to know that Medicare uses a 5-star rating system to measure the quality of health insurance plans.
Plans with higher Medicare star ratings have proven higher quality (which may mean more doctors in-network, better care, or more care options), while lower ratings have not. Knowing what these Medicare star ratings mean and how to utilize them in your search for the best health insurance can be a massive help in deciding which plan is best for you.
What are the Medicare star ratings?
Medicare uses a system that assigns each plan a star rating from one to five stars. Plans with higher ratings offer higher quality, meaning they offer better care at lower costs through well-known providers and hospitals in their network.
They also offer more favorable customer service hours and higher satisfaction ratings from beneficiaries who have used them in the past year. Although 5-star plans are ideal, this rating is extremely difficult to achieve.
The star rating breakdown:
Five stars
The highest possible rating given by Medicare and means that beneficiaries will have access to a wide range of doctors, hospitals, and other providers in their network without cost-sharing or restrictions. This includes specialists such as cardiologists and cancer surgeons—even if they're outside your plan's local area.
You'll also be able to see all pricing information before you sign up for coverage, so you'll know how much each doctor visit costs ahead of time. And when it comes time to go into the hospital or need nursing home care, there won't likely be any surprises about what bills might come due since everything should already be spelled out in your plan.
Four stars
The next highest rating and means that beneficiaries will continue to have access to a broad range of doctors, hospitals, and providers in their network. This plan is considered above average and the highest number of Medicare plans fall into this rating.
Three stars
Three stars indicate that beneficiaries can choose from more than one provider within their plan's healthcare providers network. This includes specialists such as cardiologists and cancer surgeons—even if they're outside your plan's local area. You'll also be able to see pricing information before you sign up for coverage, so you'll know how much each doctor visit costs ahead of time.
Two stars
Two stars indicate that beneficiaries can choose from one provider within their plan's network without cost-sharing or restrictions.
One star
One star means the beneficiary will have access to only a single, non-network physician in their region who is contracted with Medicare.
What Medicare Advantage Plans have a 5-star rating?
Like we said, 5-star ratings are very hard to achieve for insurance companies and the Medicare advantage plan they offer. This is done intentionally to keep competition among plans. Sometimes it's something as medial as not offering transportation coverage that can drag down their 5-star to a 4.5. Plus, a lot of their fate lies in the hands of their members, who leave reviews each year indicating how well they met all levels of care.
Medicare Advantage plans have more stringent criteria to meet their star rating than other Medicare Plans, such as prescription drug coverage. In general, you can change your plan or enroll in a new one only during a Special Enrollment Period. Their star rating is based on how well they do in each of the following categories:
- Staying healthy (member access to screenings, tests, vaccines, etc.)
- Chronic condition management
- Overall satisfaction with care and health plan responsiveness
- Member complaints and members leaving the health plan
- Customer service rating
Despite these regulations and categories, there are plenty of Medicare Advantage plans with near five-star ratings to their beneficiaries. Therefore, including Medicare Advantage plans in your search for the best health insurance can be a wise decision.
Get Help From The Pros
As you search for the right Medicare plan, and Medicaid services, you can compare plans based on your specific needs, plus filter by drug coverage, special coverages, and star rating at Medicare.gov. Our Ōmcare customer care team is available 24/7 to answer any questions and provide the expert support you and your loved ones need.
6 (Effective) ways to remember to take your meds
How often do you struggle with remembering to take your medication? It's a common problem that can often feel difficult to overcome since it's all about solidifying that habit. Fortunately, some tools and devices are available to help you remember to take your meds on time. We're listing some of the most popular methods for how to remember to take your medications on time each day.
What happens when you miss a pill dose?
There are many reasons why people frequently miss doses: forgetfulness, changing schedules due to work or vacation plans, misplaced pills & pill boxes—the list goes on! The time of day you take your medication matters significantly, especially with those with chronic conditions with strong medications that could cause withdrawal symptoms or jeopardize their regimen.
Depending on all your medications, symptoms for missing doses can vary greatly. Going through your medication regimen as prescribed is highly important. If you're ever unsure what to do if you miss a dose, make sure you reach out to your healthcare provider.
6 Ways To Remember To Take Your Meds
You can use a few different methods to put reminders in place for when it's time to take your daily meds. Here is the list of some of the most popular methods:
Setting a daily reminder or alarm
Set an alarm on your phone or create calendar slots with reminder notifications. If it's too easy to hit snooze on your smartphone or you don't always have your calendar handy, you may need another method. For example, try setting an alarm and placing it next to your pill box so you'll remember to take your pill when you walk over to shut it off.
Use a manual pill dispenser
Choose the same day each week (many choose Sunday) and put all of your pills in their respective day slots in a pill organizer. That way, you can quickly and easily see whether or not you've taken that day's pills. It's a less automated way of doing things but can still help those who take multiple meds per day.
Pair the action with activities every day
Taking your medication on time becomes more attainable when it’s a habit. And most of us already have daily habits like brushing your teeth in the morning or washing your face before bed. By pairing your dose with a daily routine, remembering becomes easier each day.
Notification devices
Use a reminder device like a vibrating pill box or a smart wristwatch that vibrates to remind you to do things. These notification devices often come as complete kits with everything you need, so there's no need to worry about forgetting anything else.
Utilize health apps
Set reminders within health apps such as Medisafe Pill Reminder, Mango Health, MyTherapy, or MedMinder. These apps allow you to lookup drug information, set medication reminders and have the added benefit of tracking your own personal medication records.
Automatic pill dispensers
Automatic pill dispensers are devices with built-in schedules so you can be reminded and dispense your medication the minute it’s due. These devices have helped bridge the gap between patients, family members, and doctors who must ensure the prescription is taken as directed. For older adults remembering to take the meds can be quite difficult: these automatic pill dispensers make it easy.
How Omcare Can Help!
Ōmcare has invented the Ōmcare Home Health Hub, which includes a high-tech pill dispenser with additional easy-to-use features and the R ball. Using advanced technology, we've crafted a device that offers video support on top of automatic dispensing: no more blister packs, cumbersome refills, reminders, or last-minute calls to the pharmacist. Ōmcare's Home Health Hub takes care of everything and ensures you or your loved ones never forget to take their medication. Our Ōmcare customer care team is available 24/7 to answer any questions and provide the expert support you and your loved ones need.
Staying connected and caring during a health crisis
Information surfaces hourly about the newly classified pandemic COVID-19, and the headlines can be alarming.
The Centers for Disease Control and Prevention advises that people over 80 years of age with major illnesses have the greatest risk and should take extra precautions, such as staying in their place of residence and limiting the amount of exposure to other people, including family members and caregivers. Meanwhile, the Centers for Medicare and Medicaid Services has issued guidelines for restricting access to residents in skilled nursing facilities.
If you’re caring for an aging loved one who is either living independently or in nursing home, these guidelines can raise concerns about feelings of loneliness and isolation, as well as adherence with medication or other care plans for your loved one. Technology can play a significant role in keeping family members, patients, and care providers connected while decreasing the risk of exposure to COVID-19 or influenza – which is still a primary cause of illness, complications, and death for seniors.
3 ways technology can enable care, from anywhere during a health crisis
- Stay socially connected. Healthy adults can do their part to mitigate loneliness for the older population by introducing them to technology such as FaceTime or Skype. Take a few minutes to install the app on an iPad, tablet or smartphone, provide a bit of training, and encourage family members to connect with seniors online, in theevent that in-person visits are prohibited.
- Manage medications. A consistent care routine is the foundation of a successful, long-term care plan and is especially important when visits from a caregiver are limited. Use two-way video capabilities to remind loved ones of when to take their medications and to oversee that process. If needed, you can even dial in a clinical care provider for a three-way call.
- Conduct virtual visits. Nearly half of family caregivers travel to care for someone. If you’re worried about exposing your loved ones to COVID-19 or influenza, lean on systems like Google Nest and Amazon’s Alexa to ensure that all systems are “go” for seniors who live alone at home.
While the current situation is frightening and confusing for everyone, now is the time to use technology to unite health care providers and caregivers, and to foster communication and support that is essential to keeping everyone healthy. Our team at Ōmcare is committed to applying our expertise in video communications and remote care technology to change the way the world cares. We welcome the opportunity to share information with you about the Ōmcare Home Health HubTM and how it will enable caregivers of all types to provide support, care, and medication assistance from anywhere for older adults and people with chronic conditions.
In good health,
Lisa Lavin
Founder & CEO, Ōmcare
3 Strategies to help aging loved ones master their meds
Despite the widespread use of tools like lockable pill boxes and smartphone apps, it’s estimated that only half of patients take their medications as prescribed. In September of 2018, the American College of Physicians reported that medication non-adherence accounts for 30% to 50% of treatment failures and 1-in-4 hospital admissions.
Medication non-adherence directly impacts the senior population, wherein millions of seniors depend on a home care aide or family caregiver to administer medication. Managing the dosages and schedules of multiple drugs can be a complicated, confusing, and even stressful task for caregivers. As a result, part-time family caregivers often experience anxiety related to not knowing if their loved one has taken the right medication at the right time.
If you or someone you know is a caregiver, or if you’re concerned about medication management for a loved one or family friend, here are three strategies to help ensure they take the right medication at the right time.
1. Establish a routine and method of reminders.
A consistent care routine is the foundation of a successful, long-term care plan. Following a simple, memorable routine and reminder system can help aging loved ones remember to take their medications throughout the day, even if their caregiver can’t always be there to remind them.
Continue reading on The Caregiver's Voice.
Podcast: Lisa Lavin on game-changing technology for seniors
Ōmcare founder and CEO Lisa Lavin was recently interviewed for the podcast Health Innovation Matters.
In this episode, Logan Plaster, editor of StartUp Health, mixes the personal with business as he interviews Lisa about the source of her passion for changing the caregiving experience and how technology can extend the reach of caregivers and ensure the right medication is taken by the right person at the right time.
Tune in to the podcast episode: https://healthinnovationmatters.libsyn.com/mcare-with-logan-plaster-and-lisa-lavin
Top 3 reasons connected care requires telehealth
Interest in telehealth is increasing rapidly around the world, including here in the U.S. In fact, the telehealth market has grown over 250% since 2015 and is expected to exceed 15% CAGR* through 2025. This growth is attributed tech-enabled services and a regulatory environment that has started to embrace virtual connected care options.
The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. And while many consumers are just now becoming familiar with the term, it is most often understood as two-way video interactions with doctors or other medical professionals.
#1 - Telehealth is a conduit to enabling value based care
Telehealth has traditionally been considered by CMS as a stop-gap for people with access issues, either in rural area or constrained by limited mobility. A number of progressive health systems that are leading the shift to value based or outcomes based payment see telehealth as a critical component to keeping people healthy, especially seniors with multiple conditions who tend to be heavy utilizers.
#2 - The shortage of caregivers will strain an already strained system.
And for those in the Home Health business, incorporating more frequent remote touchpoints using video-enabled technology along with in-home visits aligns with a desire to create a tighter community of caregivers while offering a response to the new and growing shortage of qualified caregivers. By 2050, there will be 19 million Americans over the age of 85. At the same time, the number of available caregivers is projected to stay constant or decrease.
#3 - Cost avoidance and increased patient satisfaction is more possible.
Ultimately, weaving telehealth into the tapestry of the full healthcare continuum addresses everything from cost avoidance to better outcomes and greater patient satisfaction. And the data proves it. Organizations that embrace technology as a way to define patient needs and deliver personalized care will weather payment system transitions and demographic shifts much more successfully that those unwilling to see the shortcomings of the status quo.
At Ōmcare, we’re building the tele of telehealth right into our core of what we do. From connecting people to integrating a myriad of point solutions and remote monitoring technologies, we can help realize healthier, more affordable outcomes more quickly. Now, that’s healthy. In more ways than one.
Why in-home care is the next big healthcare opportunity
By Laurie Knutson, President
As you might imagine, having been active in the healthcare community for some 30+ years, I’ve seen some fairly significant changes and shifts in our industry. From the inception of Consumerism and High Deductible Plans, to Medicare Part D, implementation of the ACA, and a shift to retail medicine and growing need to redefine medication adherence, the industry keeps evolving.
Each change is well-intended and disruptive for stakeholders and individuals. And in every case, these changes have called for a societal shift and consideration for new ways of managing our health - financially, systematically and behaviorally.
And try as we might to design around the individual, it’s a struggle. We struggle to consider how regulations, advancing technology, payment models, and structural change impacts day-to-day lives and the care journey for each individual. The goal of putting the person at the center of the care model has been difficult to achieve.
But wait, at the intersection of technology and economic necessity there is innovation!
As the population ages, the broader healthcare ecosystem is beginning to embrace new thinking around what really matters to people. And this time, care actually IS centered around the person. It’s in-home care. Now more than ever, seniors in particular have a strong desire to remain in their homes as long as possible and the focus of the healthcare system is shifting to how best to achieve that end. Aging in place, in-home is valuable to the individual, their caregivers, and to the broader healthcare system. Here are 3 reasons why:
- In-home care saves money
The cost of healthcare isn’t just increasing, it’s becoming down right unaffordable. As the personal cost of care escalates, the vast majority of seniors will spend their entire retirement savings to keep up long before they planned. The average out of pocket medical costs for a 65 year old couple will be $218,000 over the next 20 years, excluding long-term care. And skilled nursing facility care center expense averages around $200,0001 year. Leaving the home can be financially devastating, and for many, it’s simply out of the question. Remaining in-home longer supported by care as needed, is more than the best option, it’s often the only option.
- In-home care complements an already evolving system
While retail offerings (ie., MinuteClinic, mobile care units, etc.) offer some level of convenience, seniors generally continue to receive care at their primary care clinic. Doctor visits require mobility, coordinating appointments and can be costly too. For many, getting to doctor appointments becomes the primary focus of day-to-day life. The increasing availability of telehealth and supplemental in-home services offers a new level of convenience for seniors when care can be safely administered without compromising quality. CMS is warming to the benefits of in-home care by broadening eligibility criteria and payment for appropriate telehealth and home-based care.
- In-home care addresses the impending shortage of caregiver resources
Oftentimes, remaining in-home requires active support from family caregivers. Employers are feeling the productivity pinch when employee caregiver responsibilities burden their time, wallets, and their own health. In situations where a family member isn’t a support option, individuals must retain community resources and paid staff to subsidize their care needs. The problem is that future demographics point to a looming human resource crisis nearly as alarming as the financial pressures of an aging population. Today there are 10 caregiver resources for every senior. By the year 2050, when the majority of baby boomers are over 75, that ratio will shrink to 3.2 Home Care providers and Senior Living facilities are already struggling to find workers. We need to embrace new models of remote care that align with demographics.
So where do we go from here? If in-home care saves money but the uptake in more non-traditional care models is slow, how might we get to both more quickly? And how can we better support family caregivers who fill the gaps that enable loved ones to age in place? Therein lies opportunity.
Startups, disruptors, and newcomers to in-home care have a role to play. I’m talking about the Best Buy, Alexa, Nest, Apple, Amazon, Simple Meds and Ōmcare’s of the world. New technologies are enabling a remarkable shift from an acute-case, illness-based system to a more connected system that includes care many professionals in many places. From personal care assistance, home healthcare providers, tech-enabled home security, remote monitoring and medication assistance, supporting the many needs of those aging in place is both an opportunity and a necessary change. There will certainly be disruption to existing stakeholders, however meeting the growing needs of our aging population is in everybody’s best interest. Creating a community of caregivers and using technology to align resources will help ensure better care, greater independence, financial sustainability, and well-being for the future.
There’s no silver bullet here. Instead, a more connected ecosystem of solutions will support our senior population segment and better serve their needs. And those who build into the fabric of existing systems will do this best, leveraging the power and creativity of many to keep the consumer at the center of their care.
At Ōmcare, we are passionate about connecting people with the resources they need to maximize their independence. As a video conduit into the home that enables remote medication dispensing, we address the most basic reason people are forced to leave their home; they can no longer manage their medications. We offer peace of mind to family caregivers, and more frequent monitoring and face-to-face conversations gives clinicians what they need to keep seniors healthy and well at home. And it’s easy to use, eliminating the need for multiple devices and logins.
Ōmcare makes the extension of care at home possible - for a longer period of time. We know that’s what matters most to seniors and their caregivers and we invite others to connect, work with and join us to achieve the goal of independence through better remote care, at home.
1 Source-Fool: https://www.fool.com/retirement/general/2016/01/26/20-retirement-stats-that-will-blow-you-away.aspx
2 Source- AARP: https://www.aarp.org/home-family/caregiving/info-08-2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html
What is medication non-adherence? Health and financial risks
Medication non-adherence. It’s a big problem. People are not taking the right pill at the right time. The health and financial risks associated with medication non-adherence impacts individuals, families and caregivers. Today, millions of people depend on others for their medications and, for those who manage multiple medications, it can be complicated and confusing. For many people, loved ones can’t always be there to keep track.
The Financial and Health Risks
Nearly 37% of seniors take 5 or more medications and one out of every ten seniors hospitalized are the result of the consumption of ill-timed, mistaken, or missed medication. The cost of medication non-adherence exceeds $300B and more than 125,000* deaths annually in the United States. That’s a high price to pay for both individuals and the healthcare system more broadly.
In addition to all of this information, it’s important to call attention to the cost of non-adherence at a more personal level, as oftentimes the expense of not taking medications shows up indirectly. The National Council Medical Director Institute published a report in September, 2018 stating that “medication non-adherence accounts for 30-50 percent of treatment failures and 10-25 percent of all hospital and nursing home admissions.” A host of other expenses from the ambulance to the Emergency Room are triggered by non-adherence. These unplanned expenses can be devastating for individuals living on a fixed income, and put additional financial pressure on Medicare and other public programs.
As it relates to better health, the cost of ill-planned or timed drug interactions means risking outcomes that could be debilitating to the patient in more ways than one. For many chronic conditions, improved health outcomes are difficult without proper adherence. A Network for Excellent in Health Innovation (NEHI) study showed that non-adherence could be tied back to an increased risk of hospitalization, while also providing evidence that mortality rate for heart disease and diabetes was 12.1 percent for non-adherence patients compared to 6.7 for adherent patients.** This is just one example of the implications of non-adherence reported in a specific population.
Reducing the Risks
So what can we do to reduce these risks? Several options are: increase access to or engaging the services of a paid caregiver, add more frequent communication with your provider to monitor your adherence activity, or find a technology-enabled medication assistance solution that your loved one can manage on their own. Since most people are reluctant to admit their shortcomings in taking their meds, it’s often unclear when non-adherence has become a liability.
Trust in Ōmcare
That’s why Ōmcare was created: to address medication non-adherence and offer remote care solutions through simple, face-to-face interactions and monitored remote pill dispensing that reduces the risk to financial and personal health outcomes. With Ōmcare you have remote, visual confirmation of adherence and a complete medication history that gives caregivers peace of mind, and provides better information for physicians and nurses to treat and diagnose.
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Sources:
*https://www.nacds.org/news/the-cost-of-medication-non-adherence/
**Network for Excellence in Health Innovation. (2016, September). Better Uses of Medicines for Diabetes Patients. Retrieved from https://www.nehi.net/writable/publication_files/file/better_use_of_medicine_for_patients_wieth_diabetes_nehi_9.8.2016.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/