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Independent Long Term Care: Creating Consumer Choice and Cost Savings

Addressing the issue of high-cost individuals in healthcare, this proposal explores cost-efficient models like independent long-term care. Highlighting case studies from Mission Creek Senior Community, it showcases the benefits of holistic service coordination and market efficiencies. By focusing on creating revenue through reduced hospitalizations and efficient community-based services, this innovative approach aims to save costs and provide better care for seniors.

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Independent Long Term Care: Creating Consumer Choice and Cost Savings

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  1. Independent Long Term Care: Creating Consumer Choice and Cost Savings

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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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