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Independent Long Term Care: Creating Consumer Choice and Cost Savings

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Independent Long Term Care: Creating Consumer Choice and Cost Savings. Problem: Small percent of “high cost” individuals drive nation’s health care costs. High-cost Medicaid enrollees (over $25,000 annual spending) are 4% of all enrollees, 49% of all spending

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Presentation Transcript
slide1

Independent Long Term Care:

Creating Consumer Choice and Cost Savings

slide2

Problem:

Small percent of “high cost” individuals

drive nation’s health care costs

  • High-cost Medicaid enrollees (over $25,000 annual spending)
  • are 4% of all enrollees, 49% of all spending
  • 49% are elderly and 43% are disabled.
  • nursing homes or other long-term care represent 77% of cost attributable to elderly “high-cost enrollees” of Medicaid
slide3

Cost-Savings from Health Care

Can Create the Revenue for a New Model

  • Reduced hospitalizations (average price per hospitalization is $18,000)
  • Helping seniors avoid unnecessary nursing home stays ($66k-$95k/year costs)
  • 3. More efficient delivery of community-based services
    • a) IHSS
    • b) Adult Day Health
    • c) Wellness/health promotion services
slide4

Case Study:

Mission Creek

Senior Community

San Francisco

  • Service-enriched independent living alternative to nursing home beds
  • SF DPH pays $700/month subsidy for exclusive access to units
  • $29,000 per capita annual savings to Medicaid and Medicare
slide5

Case Study:

Mission Creek

Senior Community

San Francisco

  • Mercy’s on-site team provides a holistic “blended” approach to services and property management
  • Service Coordination Health Interview
  • Health Education Food banks
  • Physical Activity Well-being Checks
  • Transition Plans Benefits Acquisition
  • SF DPH also provides access to a roving team that can meet
  • the “medical” needs of residents
slide6

Market Inefficiencies

  • Medicaid will pay for skilled nursing or residential care facilities at three to four times the monthly cost of Mission Creek
  • Medicare will pay 20X the daily cost of Mission Creek for hospital beds for patients that lack a home to be discharged to.
  • Once the patient’s medical needs have been met, hospitals pay the cost of “housing” in their $1,000/night beds
slide7

Value Proposition:

Estimated Total Costs & Savings

Health

care cost

$85k-100k

per year

Net Savings

Impact of Independent Long Term Care

LTC Fee

Ongoing health cost

Pre-Intervention

With Independent

Long-Term Care

slide8

Factors that influence revenue potential

Alignment:

Degree to which the residents are members, enrollees, patients of the health partner.

This is based in part on how access to the building is controlled.

Annual Medicaid Expense

Alignment / Access Control

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