Integrated Care in Seniors Housing that Meets the Triple Aim

Juniper Communities’ Connect4Life Model March 22, 2017

Executive Summary

• New research on Juniper Communities’ Connect4Life model, completed by Anne Tumlinson Innovations, promises better outcomes for frail seniors and the potential for Medicare cost savings

• The data demonstrate the promise of integrating health and senior housing to manage population health.

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About Connect4Life

• A pioneering model of integrated care for seniors housing• Integrates medical services and coordinates care for mature adults in

seniors housing communities• Is high tech, high touch, integrated via the electronic health record

(EHR) and coordinated via a “medical concierge”• Can be a model for senior living providers seeking to be part of PAC

continuum• Can differentiate senior living from home care as a triple aim solution

for HNHC individuals

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Drilling Down: Three Key Components

1. Co-located services must include onsite primary care, therapy-driven wellness programming, and pharmacy and lab services.

2. High tech includes connected services through electronic transfer of clinical information and communication

3. Human navigators ensure seamless access to and coordination with other services provided through strategic partnerships and alliances.

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Four Key Research Findings Demonstrating Value

1. Juniper residents’ hospitalization rate was 50% lower than a similarly frail Medicare population.

2. Juniper’s re-hospitalization rate was over 80% lower than a similarly frail Medicare population.

3. Juniper residents’ emergency department use was 15% lower than a similarly frail Medicare population.

4. Juniper residents use fewer services than a similarly frail Medicare population in seniors’ housing.

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1. Juniper Hospitalization Rate 50% Lower Than Similarly Frail Medicare Population

All Medicare _x000d_Beneficiaries

Similarly Frail Medicare Population

Juniper Residents0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.25

0.62

0.30

Ave

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Num

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f Eve

nts

per P

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2. Juniper Re-hospitalizations Over 80% Lower than Similarly Frail Medicare Population

All Medicare _x000d_Beneficiaries

Similarly Frail Medicare Population_x000d_

Juniper Residents0

5

10

15

20

25

30

35

18

30

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taliz

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All Medicare _x000d_Beneficiaries

Similarly Frail Medicare Population

Juniper Residents0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.38

0.62

0.52A

vera

ge N

umbe

r of E

vent

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ear

3. Juniper Residents’ Emergency Department Use 15% Lower than Similarly Frail Medicare Population

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4. Juniper Residents Use Fewer Services Than Similarly Frail Medicare Population in Seniors’ Housing

Inpatient ED0

0.1

0.2

0.3

0.4

0.5

0.6

0.7 0.66

0.55

0.30

0.52

Similarly Frail in Senior Housing Juniper Residents

Average Number of Events per Person per Year

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11

Juniper Communities’ Medicare Population

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Key Research Findings

• The Juniper population is much older than the overall Medicare population.

• The Juniper population is a “hot spot” for high-need Medicare beneficiaries.

• The Juniper Population is more cognitively impaired than the overall Medicare population.

• Juniper’s population is similar to the typical assisted living population.

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The Juniper Population is Much Older than the Overall Medicare Population

All Medicare Beneficiaries Juniper Residents0%

20%

40%

60%

80%

100%

17% 2%

46%

6%

26%

18%

11%

73% 85+75-8465-74<65

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All Medicare Benefi-ciaries

Similarly Frail Medicare Population*

Juniper Residents0%

20%

40%

60%

80%

100%

83%

14% 18%

8%

41% 27%

4%

18%

18%

3%15%

14%

2% 12%22%

4 ADLs3 ADLs2 ADLs1 ADL0 ADLs

*The Medicare population that is “similarly frail” as Juniper residents receives help with at least one activity of daily living (ADL) or has cognitive impairment.

Percentage of Population with Need for Supports and Services

The Juniper Population is a “Hot Spot” for High-Need Medicare Beneficiaries

3%

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All Medicare _x000d_Beneficiaries

Similarly Frail Medicare Population

Juniper0%

5%

10%

15%

20%

25%

30%

35%

40%

4%

30%34%

Percentage of Population with Cognitive Impairment

The Juniper Population is More Cognitively Impaired Than Overall Medicare Population

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16

Connect4Life Model Positioned to Generate Medicare Savings

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Non-Health Factors Contribute to Healthcare Spending

Succeeding in population health management will require identification and support of high- cost populations as defined by a full range of bio-psycho-social characteristics.

Functional

Behavioral

Social

Residential

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Functional Impairment Trumps Chronic Conditions In Relation to Healthcare Spending

Any Chronic Condition 5 or More Chronic Conditions

$7,228

$11,519

$17,961

$20,700

No Functional Impairment High Functional Impairment

Source: ATI Fact Sheet: Functional Impairment and Medical Spending, 2012 MCBS Cost and Use File, Analysis on Older Adults Receiving Help with 2+ ADLs

Annual per capita Medicare spending is twice as high for beneficiaries with high functional impairment (2+ ADLs) and chronic conditions than for beneficiaries with chronic conditions only.

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Spending 2X Higher for Similarly Frail Medicare Population

Annual per capita Medicare spending is more than twice as high for beneficiaries similar to Juniper–who receive help with 1+ ADLs or have dementia–than for overall Medicare population.

Inpatient Medicare Per Capita Total Medicare Per Capita

$2,155

$8,568

$5,975

$18,377

All Medicare Beneficiaries Similarly Frail Medicare Population

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20

Methodology and Contributing Organizations

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Methodology: Juniper Resident Acuity Data

• To analyze the acuity and healthcare utilization of the Juniper communities, Juniper staff analyzed and reported data collected through resident assessments, level of care determinations and electronic health records for a sample of 471 residents of 10 separate assisted living communities. All of the residents included in the study population had been living in the communities for over one year.

• Data collected on the Juniper study population included functional limitations, cognitive impairment, chronic conditions, ER use, hospitalizations and re-hospitalizations.

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Methodology: MCBS Benchmarks

• A team from Anne Tumlinson Innovations analyzed the Medicare Current Beneficiary Survey (MCBS) Cost and Use File from 2012 to evaluate the Medicare cost and service utilization of three comparison populations.

• The first is all community-dwelling Medicare beneficiaries which reflects the average Medicare cost and utilization experienced in the fee-for-service Medicare population not living in institutions. (n=50,038,595)

• The second group is refined to an LTSS need population living in the community– that is those who are living at home and not in residential care who reported receiving help with at least one ADL or had a diagnosis of dementia or Alzheimer’s disease. The team limited this population to those 65 years of age or older. (n= 6,254,290) .

• The third group is refined to those with LTSS need living in a residential care setting that provides personal care services who also reported receiving help with at least one ADL or had a diagnosis of dementia or Alzheimer’s disease. The team included respondents 65 and older. (n= 418,797)

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Additional Study Details and Limitations

• Utilization for all services except readmissions was defined as events per person per year, whereas readmissions were defined as all cause readmissions within a 30 period of the initial hospitalization per 100 hospitalizations per year. All-cause readmissions were calculated by identifying any hospitalization that took place within 30-days of another hospitalization. Inpatient hospitalization counts include readmissions.

• The team was unable to match MCBS comparison populations with the Juniper resident population on chronic conditions due to gaps in ICD-10 codes in the Juniper system. As with any study that attempts to measure differences in utilization across population, there may be unmeasured differences between the benchmark and Juniper populations that account for differences in utilization.

• The analysis is limited in that the healthcare utilization data in the Juniper population is not based on paid healthcare claims and therefore is not independently verified. This analysis is instructive directionally in evaluating outcomes for a senior housing population receiving an integrated care intervention.

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About Anne Tumlinson Innovations LLC

Anne Tumlinson has more than two decades of research and consulting experience in post-acute and long-term care financing and delivery. Her consulting firm, Anne Tumlinson Innovations, helps organizations respond to demographic changes and delivery systems reform, with a special emphasis on addressing gaps in financing for long-term services and supports for older adults. Her research focuses on measuring the impact on Medicare acute spending for managing long-term services of frail, older adults. Anne has testified before Congress and appeared before the Long-Term Care Commission and the Bipartisan Policy Center.

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About Juniper Communities

• Thought leader and innovator in assisted living and memory care

• More than 20 communities in NJ, FL, PA and CO

• Pioneering Connect4Life – one of seniors housing’s first truly integrated models of supportive services and clinical care

• Serves more frail seniors than the average Medicare population yet its Connect4Life program has managed to reduce:

• ED Visits • Hospitalizations• Readmissions

JUNIPER’S MISSION:To be the people, places and programs that nurture the spirit of life in each individual we touch

JUNIPER’S VALUES: To be person centered, life affirming, values driven, attentive, responsive, compassionate, competent, innovative, socially responsible and environmentally friendly, dedicated, efficient, solution oriented and celebratory

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