Some Health Care Lessons from the Elderly

Imagine a health plan that covers 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of prescription drugs, includes dental, has no co-pays or deductibles, helps with issues like arranging transportation to medical appointments, and offers a personal touch that few see from the health care system.

This kind of plan already exists in Massachusetts for poor seniors — and it may offer lessons to everyone in health care as the industry seeks to stem rising costs and care for the growing elderly population.

Known as Senior Care Options, it combines all the benefits of Medicare and Medicaid into one comprehensive health services package. It was originally designed to help seniors stay at home and out of a nursing home by using local agencies that know a community and its residents.

Plan members are delighted with their care. At Senior Whole Health, we have a 99{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} retention rate. Almost 10,000 seniors are enrolled in Senior Care Options statewide, half of them with Senior Whole Health. In Brockton, 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the eligible population is participating in Senior Whole Health.

Our success is even more striking, given the target population: More than 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Senior Whole Health members do not speak English, and 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are illiterate. Most have one or more chronic diseases. The average number of prescriptions is five. This is not a case of saving money by covering a young, healthy population in need of minimal health care.

Why has this approach become such a success? Here are some lessons we have learned:

Create one-stop shopping. Navigating the health care system is difficult at best. Our members have a nurse care manager who becomes their main contact and chief advocate in arranging the right combination of services. A nurse is available for consultation 24 hours a day. While ensuring that the member receives the appropriate care in a timely way, this approach also averts future complications that can be more costly.

Use a team approach. In addition to having a primary care doctor and an assigned nurse care manager, every member receives a home visit by a geriatric social worker from a local elder services agency. Each member receives an individual care plan. Senior Whole Health has just launched a new initiative that expands and strengthens the team by creating a caregiver advocate — someone to link in and support the primary caregiver from the member’s family.

Pay for appropriate nonmedical costs. We’ve found that non-medical issues can have a significant effect on health care. If a patient can’t get to the drugstore to pick up a prescription, for example, that could lead to serious and expensive consequences down the line. Employing a multilingual staff can avert medical issues that arise from a lack of understanding. We have also expanded our definition of preventative care to cover such non-traditional programs as tai chi to help prevent falls. All of these strategies are a form of prevention, which has been demonstrated to improve health and save money.

Home care works. Supportive care in the home can help reduce the need for even more hospital visits and, in some cases, nursing home placement. By combining preventive programs with an emphasis on home care, Senior Whole Health has reduced avoidable hospital admissions by 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for members over the past two years. In particular, re-admissions for the same diagnosis within 30 days of being discharged are being reduced.

The Massachusetts Legislature created the regulatory structure for Senior Care Options, in part, because more than 6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of our elderly live in nursing homes compared with the national average of less than 4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. But everyone who cares about health care policy should consider the lessons of this successful model for all of the population.

John Baackes is the chief executive of Senior Whole Health.