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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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Independent long term care creating consumer choice and cost savings

Independent Long Term Care:

Creating Consumer Choice and Cost Savings


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

  • 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


Independent long term care creating consumer choice and cost savings

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


Independent long term care creating consumer choice and cost savings

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


Independent long term care creating consumer choice and cost savings

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


Independent long term care creating consumer choice and cost savings

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


Independent long term care creating consumer choice and cost savings

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


Independent long term care creating consumer choice and cost savings

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