PRESENTED BY CO-PRESENTED BY · Care for Individuals Dually Eligible for Medicare and Medicaid...
Transcript of PRESENTED BY CO-PRESENTED BY · Care for Individuals Dually Eligible for Medicare and Medicaid...
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Lindsay Parsons
PRESENTED BY CO-PRESENTED BY
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WELCOME
Christine Vogel
PRESENTED BY CO-PRESENTED BY
All proceeds support the Aging Services Foundation of Boulder County, a local 501c3
nonprofit that helps build and sustain programs, services, and events for older
adults, family caregivers, and professionals.
KEYNOTE
Kathy Greenlee
PRESENTED BY CO-PRESENTED BY
All proceeds support the Aging Services Foundation of Boulder County, a local 501c3
nonprofit that helps build and sustain programs, services, and events for older
adults, family caregivers, and professionals.
SPEAKER
Susan Tucker
PRESENTED BY CO-PRESENTED BY
1
The LTSS Landscape andState Trends Shaping theFuture for LTSS
Susan Tucker, Principal November 7, 2019
Copyright © 2019 Health Management Associates, Inc. All rights reserved. The content of this presentation is PROPRIETARY and CONFIDENTIAL to Health Management Associates, Inc. and only for the information of the intended recipient. Do not use, publish or redistribute without written permission from Health Management Associates, Inc.
2
THIS SESSION WILL COVER: State Trends for Medicaid LTSS
❑ LTSS Landscape and
Populations with Special
Challenges
❑ Integrating Care between
Medicare and Medicaid
❑ Value-based Payment for LTSS
❑ SDOH and LTSS
❑ LTSS Workforce
Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
LTSS LANDSCAPE ANDPOPULATIONS
WITH SPECIAL CHALLENGES
LTSS EXPENDITURE PRESSURE ON MEDICAID BUDGET
WHAT DOES THE MAP SHOW?The map shows LTSS expenditures as a % of total Medicaid expenditures in FY 2015.
What is the % for the US?LTSS expenditures accounted for 30% ofMedicaid expenditures in FY 2015.
What is the range for the US?Range: 15.9% in AZ to 53% in ND.
Top 5 states, highest %: Wisconsin, Iowa, NewHampshire, Wyoming, and North Dakota.
Key issues to note: States with more of their budget devoted to LTSS may feel the pressure from the demographic changes sooner. Data is purely illustrative of the variation; CMS data itself is not perfect.
Source: HMA, based on CMS data.
Medicaid is the largest payer of long-term services and supports (LTSS), which is defined as “a broad range of supportive services needed by people who have limitations in their capacity for self-care because of a physical, cognitive, or mental disability or condition.”
19
Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
TRENDS IN TOTAL LTSS EXPENDITURES
Medicaid LTSS Expenditure Growth, FY 2011-2016 Medicaid HCBS Expenditure Growth, FY 2011-2016
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Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
Source: Medicaid Expenditures for Long-Term Services and Supports in FY 2016 IAP Medicaid Innovation Accelerator Program IBM Watson Health May 2018
STATE ACTIONS TO SERVE MORE INDIVIDUALS IN COMMUNITY SETTINGS
21
Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
LTSS POPULATIONS WITH UNIQUE CHALLENGES
People with
both Medicare
and Medicaid
(dual eligibles)
People
with I/DDThe LGBTQ
community
22
Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
MEDICARE – MEDICAID DUALLY ELIGIBLE BENEFICIARIES – NUMBERS AND BENEFITS
Over12 million people nationwide
Historically, dually eligible
beneficiaries account for a
disproportionate share of
spending for both
programs. They represent:
+ 20 percent of the Medicare population and 34 percent of Medicare spending
+ 15 percent of Medicaid beneficiaries and 33 percent of Medicaid spending
Medicare is the
primary payer for their
care, mainly covering
medical services
Medicaid wraps around Medicare
benefits covering any Medicare
premiums and cost-sharing, and for
many dual eligibles, services not
covered by Medicare
Source: CMS State Medicaid Director Letter #18-012, Ten Opportunities to Better Serve Individuals Dually Eligible
23
Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
for Medicaid and Medicare, December 2018.
INTEGRATING CARE BETWEENMEDICARE AND MEDICAID
DUAL ELIGIBLE PLANS & INTEGRATED PLAN PRODUCTS
Health plans are increasingly offering multiple products.
+ Some plans offer an MMP and an MLTSS + D-SNP or a companion plan
+ FAIs/MMPs. Some states are extending their FAIs. MLTSS + MA D-SNPs. Some states are requiring that MLTSS plans operate companion plans. Examples include New Mexico, and Tennessee.
+ FIDE SNPs. Plans in 10 states.
Capitated
Financial Alignment Initiatives (FAIs):
Medicare-Medicaid Plans(MMPs)/”Dual Demo”
D-SNPs
Medicaid MLTSS Plan +
MA D-SNP
FIDE SNPs
MARKET TRENDS FOR THREE INTEGRATED PRODUCTSANTICIPATE GROWTH
25Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
NEW OPPORTUNITIES TO INTEGRATE CARE
Three New Opportunities to Test Innovative Models of Integrated Care for Individuals Dually Eligible for Medicare and Medicaid (SMDL 19-002)
+ Integrating care through two options under the current Financial Alignment Initiative - the capitated financial alignment model and the managed fee-for-service model - and state-specific models that would give states additional flexibility.
Ten Opportunities to Better Serve Individuals Dually Eligible for Medicaid and Medicare (SMDL 18-012)
+ Utilizing new developments in managed care, using Medicare data to inform care coordination and program integrity initiatives, and reducing administrative burden for dually eligible individuals and the providers who serve them
26Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
LTSS CONTRACTING MODELS VARY
TRADITIONAL
MCO CONTRACTS
UNDER WAIVERS
TRADITIONAL
MCO PLANS WITH
MLTSS + D-SNPs
TRADITIONAL
MCO CONTRACTS
+ FIDE D-SNPs
Medicaid MCO contracts with state to deliver integrated
acute and MLTSS benefits to enrollees
with and without Medicare
Medicaid MCO delivers MLTSS & wraparound
benefits and companion D-SNP
delivers acute benefits to enrollees with
Medicare and Medicaid
Medicaid MCO delivers wraparound benefits
and FIDE D-SNP delivers acute and MLTSS
benefits to enrollees with Medicare and
Medicaid
Medicaid MCO contracts with state
to deliver MLTSS-only benefits to enrollees
with and without Medicare
Medicare Advantage Plan has 3-way contract with CMS and state to deliver integrated Medicare and
Medicaid benefits including MLTSS to
enrollees with Medicare and Medicaid
MLTSS ONLY
MCO CONTRACTS
MEDICARE
MEDICAID PLANS
(MMP)
PACE ORGANIZATIONS
States may cover PACE enrollees
under expanded Medicaid eligibility
rules to offer yet another managed care benefit with
LTSS for frail elderly
27Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
DUALLY ELIGIBLE BENEFICIARIES
Dually eligible beneficiaries are increasinglyenrolling in Medicare Advantage:
28Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL
Dually Eligible Beneficiaries
Enrolled inManagedCare 2006
Enrolled inManagedCare 2017
All 11% 35%
Partial benefit
18% 44%
Full benefit 10% 32%
Movement toward Managed LTSS (MLTSS) for many state Medicaid programsAs of March 2019
Active MLTSS Program
Intends to Implement
Active capitated Duals Demo (MLTSS for duals in demo)
States to Watch for Potential MLTSS Activity
NOTE:ID began regional implementation of MLTSS for dually eligible individuals not enrolled in its FIDE SNP program - November 2018 in Twin Fall county, with a planned April 2019 expansion to Bonneville, Bingham, and Bannock counites.NE is in the process of adding LTSS to the current MCO contracts. Phase 1 populations (older individuals and individuals with physical disabilities) would begin to be carved in on January 1, 2020, with phase 2 populations (I/DD) to follow on January 1, 2021.NY FIDA demonstration (dual demo) ends December 31, 2019; FIDA/IDD ends December 31, 2020.
DCCA
OR
WA
NV
AZ
AK
NM
UT
ID
MT
WY
CO
TX
OK
KS
NE
SD
ND
MN
WI MI
IA IL
MO
AR
LA
MS AL GA
FL
HI
SC
NC
VA
TN
KY
INOH
PA
WV
NY
NJ
MD
ME
VTNH
MA CT
RI
VALUE BASED PAYMENTAND LTSS
HEIGHTENED FOCUS ON PATIENT TRANSITIONS
Hospitalto Home
Nursing Home to
Community Setting
MCO to MCO
Hospital to
Nursing Home
Nursing Home to
ER
Home toNursingHome
Home to Hospital
ER to Home
From one Community
Based Setting to Another
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MOVEMENT TO VBP FOR LTSS
+ CMS Medicaid Innovation AcceleratorProgram VBP for HCBS
+ Program for the All-Inclusive Carefor the Elderly (PACE)
+ Shifting LTSS into managed care model and paying MCOs a capitated rate
LTSS quality frameworks
+ National Quality ForumHCBS quality measurement set
+ AHRQ and Truven Health Analytics HCBS Quality Measurement Framework
+ ACO Quality Framework in CMS Shared Savings Program in Medicare
+ HCBS CAHPS Survey
+ National Core Indicators
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MOVEMENT TO VBP FOR LTSS – STATE EXAMPLE
Value Based Purchasing+ Level 1 - Fee schedule based with bonus or incentives
and/or withhold payable only when outcome/qualityscores meet agreed-upon targets.
+ Level 2 – Fee schedule based, upside-only shared savings– available when outcome/quality scores meet agreed upon targets (may include downside risk)
+ Level 3 – Fee schedule based or capitation with risk sharing (at least 5%for upside and downside risk); and/or global or capitated payments with full risk
• New Mexico Centennial Care2.0 includes aggregate VBP targets
• By contract Period 4 (Jan. 1 –Dec. 31, 2022) 36% in VBP arrangements
Source: New Mexico Medicaid Value Based Purchasing and Nursing Facilities; available at this link
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FRAMEWORK FOR SOCIAL DETERMINANTS
OF HEALTH IN LTSS
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SOCIAL DETERMINANTS OF HEALTH AND LTSS
LTSS programs are increasingly recognizing thevalue of addressing SDOH to achieve better outcomes.
1.Social connection (loneliness)
2. Employment needsEmployment services are an optional covered benefit in MLTSS programs
3.Housing and utilities access and security
4.
5.
6.
7.
8.
Food security and nutrition
Exercise needs
Environmental safety
Medical and non-medical transportation
Education
Over one-third of states reported that SDOH data was collected as of FY 2018 or would be collected beginning in FY 2019
SOURCE: Kaiser Family Foundation Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October2018.
SOCIAL DETERMINANTS OF HEALTH AND LTSS
Thirty-seven states reported offering at least some housing-related services in FY 2019 and/or FY 2020
36
SOURCE: Kaiser Family Foundation Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October 2019.
EXAMPLES OF STATE’S ADDRESSING SDOH
ARIZONA+ Arizona Project-Based Rental Assistance
Program (PRA) developed 54 rental units for extremely low-income adults ages 18 to 61 who have at least one intellectual or developmental disability.
+ The state Medicaid agency, found that: (1) state Medicaid agency staff benefit from keeping abreast of forthcoming Housing and Urban Development grants that can support new affordable housing options for LTSS populations; and (2) local housing authorities may require education on the needs of individuals who receive LTSS benefits, including vulnerable subpopulations that cannot afford to pay for room and board
TEXAS+ Texas Medicaid’s agency collaborates
with the state housing agency, the Texas Department of Housing and Community Affairs, and Public Housing Authorities to expand affordable, accessible housing opportunities for individuals with disabilities, including those with SMI and SUD.
+ Texas Department of Housing and Community Affairs administers a Section 811 PRA grant in which private developers of Low Income Housing Tax Credit properties agree to set aside units for individuals with disabilities exiting institutions, young adults exiting foster care, and individuals with mental illness.
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DIRECT CARE WORKFORCE
INVESTMENTS
OPPORTUNITIES TO ADDRESS DIRECT CARE WORKFORCE CHALLENGES
Collaborating
with educational
institutions on
core training
Training videos
to strengthen
job skills
Scholarship
programs
Mentoring
programs
39
To address LTSS direct care workforce shortages and turnover, more states are reporting wage increases and workforcedevelopment activities
DIRECT CARE WORKFORCE CHALLENGES
SOURCE: Kaiser Family Foundation Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October 2019.
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SPEAKER
Hayley Gleason
PRESENTED BY CO-PRESENTED BY
State Perspective on Aging and
Long-Term Services and
Supports
Department of Health Care
Policy & Financing
Presented by: Hayley Gleason
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November 7, 2019
Our Mission
Improving health care access and
outcomes for the people we serve
while demonstrating sound
stewardship of financial
resources
44
Health First Colorado:
Older Adult Members
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46
Population Aging: Colorado
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
2015 2030 2050
65-74 75-84
78%
173%
282
%
128
%
47
Health First CO Older Adult Members
Long Term Services & Supports (LTSS), 25,762
Health First CO
Members, Non-LTSS,
46,459
SOURCE: Members 65+ Served by the Department as of November 2018.
Expenditures for Older Adults
48SOURCE: Members 65+ Served by the Department, FY2017-2018.
7.7%
92.3
%
Provides in-home and community supports like
transportation, personal care, adult day care, and
assisted living to individuals with physical, intellectual,
and developmental disabilities of all ages
49
Home and Community-Based Services
SOURCE: FY 2016-17. Enrollment from MMIS analysis. Expenditures from FY 2017-18 HCPF Budget Request.
50
Alternative Care Facilities (ACFs)
4,450enrolled
56% are older adults
65 and older
$51,571,332spent
48% for older adults
65 and older
Provides assisted living to individuals with physical,
intellectual, and developmental disabilities of all ages
**These numbers are included in the HCBS Services data on previous slide
Individuals ages 55 and older can live in any setting and
receive all acute and long-term services and supports
through this program because it is a capitated program
including Medicare
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Program of All-Inclusive Care for the Elderly
SOURCE: FY 2016-17, FY 2017-18 HCPF Budget Request, Average Monthly Paid Enrollment and Cash Based Actuals for PACE
52
Nursing FacilitiesProvide three types of services: skilled nursing or medical care
and related services; rehabilitation needed due to injury,
disability, or illness; and long term care — health-related care
and services not available in the community, needed regularly
due to a mental or physical condition
SOURCE: FY 2016-17. Enrollment from MMIS analysis. Expenditures from FY 2017-18 HCPF Budget Request.
53
LTSS Expenditures for Older Adults
SOURCE: Members 65+ Served by the Department, FY2017-2018.
51.1%
25.7%
14.4%
4.4%
4.4%
54
Average Total Costs for
Older Adults by Setting
SOURCE: HCPF data request, FY 2017-18, Ages 65+, Total Cost per Utilizer per Year by Setting (includes “setting costs” and “other costs”)
Serving Older Coloradans:
Now & Into the Future
Department of Health Care
Policy & Financing
55
56
•Align work focused on older adults within the
Department
•Strengthen aging expertise within the
Department and through external partnerships
•Expand older adult stakeholder outreach and
engagement
•Enhance collaboration with other Departments
and state-level organizations around aging
efforts
•Launch a formal strategic planning process
focused on serving older adults
Health Care
Policy &
Financing
Support Ongoing Work
57
Align Current
Department Initiatives
• Form intra-agency Aging
Strategy Workgroup
• Identify internal initiatives
focused on the older adult
population
• Align efforts and build
collaboration internally
Strengthen Aging Expertise
• Create Older Adult Policy
Advisor Position to lead
aging strategy efforts
• Contract with outside
consultants, vendors to
support internal work
58
Enhance
Stakeholder
Engagement
Expand Older Adult
Stakeholder Network
Develop and Roll-Out
Stakeholder Engagement
Plan with the Roadmap
Enhance Collaboration
59
Align Cross-Department Efforts
around Aging and Older Adults
•Partner with key state leaders
to coordinate efforts (Aging and
Adult Services, CDHS;
Governor’s Office; CDPHE)
•Form ongoing aging work group
•Develop focused, topic-specific
work groups as needed (ex.
Workforce)
Engage with State-Level
Organizations
•Strategic Action Planning Group
on Aging
•Lifelong Colorado
•Colorado Commission on Aging
•Thought Leaders in Aging
•Catalyst for Aging
Launch Formal Strategic
Planning Process
60
Engage Stakeholders
at the State and
Local Levels
•Conducted seven
focus groups
•Conducted ten
regional listening
sessions
Access External
Expertise
•Identify evidence
based programs or
innovative strategies
•Form Expert
Advisory Committee
Create a
Five-Year
Older Adult
Strategic
Roadmap
Promising Strategies
Consider social determinants of health
Expand support for family caregivers
Ensure access to the right services at the right time
Enhancing provider capacity, including strengthening
the direct care workforce
Invest in better end of life planning
61
Strategies to support Colorado’s family caregivers
Governor Polis’ 2020-2021 Budget
• Paid family leave for state employees
• Allow employees to care for a new child, aging partner or
parent
HCPF: Informal Caregiver Supports
62
Family Caregivers
Ensuring access by enhancing provider agency, facility,
and workforce capacity & focusing on quality care
• Nursing Facility Program Capacity
• Program for All Inclusive Care for the Elderly
• Direct Care Workforce Initiative
63
Ensuring Access to High Quality Services
SPEAKER
John Emerson
PRESENTED BY CO-PRESENTED BY
Convening, Collaborating, and
Catalyzing Efforts to Improve the
Lives of Older Coloradans
“It is therefore the intent of the General Assembly to establish a multi-disciplinary private and public sector stakeholders group to develop a comprehensive Strategic Action Plan on Aging in Colorado through the year 2030. The group shall provide to the Governor and General Assembly comprehensive data on and specific recommendations regarding private and public options for addressing this demographic shift for the state to consider.”
- Legislative Declaration from House Bill 15-1033
C O L O R A D O S T R A T E G I C A C T I O N P L A N N I N G G R O U P O N A G I N G A C T
S T R A T E G I C A C T I O N P L A N N I N G G R O U P O N A G I N G
Jane Barnes – Benefits in Action
Karen Brown – iAging and Aging 2.0
Steve Child – Pitkin County Commissioner
Jim Collins – Mayor Las Animas
Sarah Elliott – Vivage Senior Living
John Emerson – Flying Cloud Health and Aging 2.0
Mindy Gates – Department of Human Services
Hayley Gleason – Department of Health Care Policy and Financing
Christian Itin, Chair – Metropolitan State University of Denver
Gabriel Kaplan – Department of Public Health and Environment
Chris Lee – Visiting Nurse Association
Maureen McDonald, Vice Chair – National Council on Aging
Jean Nofles - AARP
Dave Norman – Northwest Colorado Area Agency on Aging, Retired
Sophie Shulman– Department of Transportation
Karin Stewart – Aging and Adult Services, Jefferson County
Tony Tapia – Latino Age Wave
Jayla Sanchez Warren – Denver Regional Council of Governments Area on Agency on Aging
John Zabawa – Seniors’ Resource Center, Retired
C O L O R A D O ’ S C H A N G I N G 6 5 + D E M O G R A P H I C S
2015 2030
+ 52%
708,200 to 1.2 million
Source: Colorado State Demography Office
C O L O R A D O ’ S C H A N G I N G 8 0 + D E M O G R A P H I C S
2015 2030
+ 63%
164,400 to 315,700
Source: Colorado State Demography Office
O L D E R C O L O R A D A N S A N D T H E L O N G E V I T Y E C O N O M Y
Source: AARP & Oxford Economics
42% of Colorado’s GDP – $135 billion
42% of state and local taxes - $11.3 billion
46% of Colorado’s labor market - 1.6 million jobs
61% of health care consumer spending
51% of entertainment consumer spending
A D U L T S 6 5 + A N D H E A L T H I M P A C T S
35% living with a disability
80% living with chronic condition
68% living with multiple chronic conditions
75% of health care expenses in US
1% of health care expenses spent on public health
Source: National Council on Aging
A C T I O N P L A N H I G H L I G H T S1. Senior Advisor on Aging in Governor’s Office
2. State funding data on top-8 aging-related programs
3. Retirement Security and Colorado Secure Savings Board
4. PERA unfunded liability
5. Financial Security Coalition / Abuse and Fraud Prevention
6. Colorado Work Force Development Council
7. Municipal and County age-friendly planning
2 0 1 9 L E G I S L A T I V E A N D C O N S T I T U T I O N A L F O C U S
• Affordable housing and renter’s Issues - eg. Property Tax/Rent/ Heat Credit
• Increased supports and protections for family caregivers
• Workplace retirement savings and financial security
• Elder abuse, abandonment, and financial fraud
• Age-friendly planning and implementation
• Senior Property Tax Exemption
• Office of Public Guardianship
S A P G A P R I O R I T I E S I N 2 0 1 9
•Health and Wellness
• Increase Outreach and Awareness
•Explore Age-Friendly Public Health Systems
•Continue the Workforce Development and Transportation Committees
•Support Lifelong Colorado
S A P G A M E E T I N G 2 0 1 9 S C H E D U L E
• Full SAPGA Meeting – 2nd Monday of the month (1st Monday in Oct and Nov) at DRCOG 1001 17th Street Denver, CO from noon-3 pm - Aspen Conference Room
• Workforce Development Meeting – 2nd Monday of the month (1st Monday in Oct and Nov) at DRCOG 1001 17th Street Denver, CO from 10:30-11:30 am -Aspen Conference Room
• Transportation Committee Meeting – 4th Monday of the month at CDOT 2829 W. Howard Place Denver, CO – TREX Conference Room
• Engagement and Education Meeting – Quarterly/As-Needed – Email for details
Call-in options are available!
www.colorado.gov/agingstrategy
Innovations DrivingBetter Aging
John Emerson
Founding Partner
November 6, 2019
Technology Marches into Aging Space
Last Century
New Millenia
Listen to me Now!
Fitness and Movement trackingCognitive tracking /Tap controlLanguage translations/ Fall detection /Ear Buds
My Background
“How are you doing?” Talk to doctor w/out phone
“What’s the matter” Ask the Internet first
“Do you need an appointment?” Get the right care, faster
“Let’s stay healthy” Avoid doctors
Care Delivery Trends Impacting Aging
“Leading medical companies are combining personal devices with advanced technology for personalized care management to offer superior patient care and gain larger market share in the US market.”Telehealth Market Outlook and Forecast 2018-2023 (2019)
“It’s not about the technology…. It’s about using the solution to do a job for consumers that makers of incumbent solutions are ignoring—usually in a cheaper, simpler and more accessible way.” (Christensen Institute / HBR/ 2018)
Real Time Impact on Health and Aging
FUTURE OF TRANSPORT:CERNER+UBER=Prescribe transportation from EMR
FUTURE OF CARE DELIVERY:AMAZON: End-end integration symptom checking, telehealth, house calls
FUTURE OF DIABETES COACHING:Pharmacy, digital, coaching and social support
@johannerson
https://www.linkedin.com/in/john-emerson-79480/
mobile: 303-563-9921
Q&A
Susan Tucker
Hayley Gleason
John Emerson
PRESENTED BY CO-PRESENTED BY
All proceeds support the Aging Services Foundation of Boulder County, a local 501c3
nonprofit that helps build and sustain programs, services, and events for older
adults, family caregivers, and professionals.
SPEAKER
Chrissy Esposito
PRESENTED BY CO-PRESENTED BY
When Trends CollideHealthy Aging and the Housing Crisis for Older Coloradans
Chrissy Esposito, MPH
Data Visualization and Policy Analyst
Age Well Conference November 2019
Key Takeaways
1. Coloradans are living longer, but income for older adults is being outpaced by the cost of housing.
2. Older Coloradans increasingly find it difficult to find adequate, accessible housing.
3. New data and information is available to help Coloradans advocate for change.
We are Aging Well in Colorado
79
U.S. Life Expectancy
Today
U.S. Life Expectancy
100 Years Ago
39
Source: UN Population Division
But Then There’s the Reality of Paying for Housing in Colorado…
Two Trends Collide: Housing and Aging
Source: State Demography Office
Colorado’s Older Adult Population is Growing
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
Year
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
2023
2025
2027
2029
2031
2033
2035
2037
2039
2041
2043
2045
2047
2049
65 to 79 Population 80+
Housing Has Increasingly Become Unaffordable
Home is Also a Setting of Care
Who are Your People?
Coloradans are Living Longer, But Income for Older Adults is Being
Outpaced by the Cost of Housing.
Affordability
The Case for Affordable, Adequate Housing
Half a million plus older adults could be housing cost burdened by 2030
The Affordability Gap for Older Adults is Growing, 2010-2017
Source: American Community Survey / Zillow
Source: American Community Survey, 2017
More Than One in Four Older Coloradans is Housing Cost Burdened
What It Takes: Monthly Housing Costs
Median monthly income = $2,162
Affordable = $649 per month
$347 in the red
Source: American Community Survey
Median monthly rent = $996
Homeownership Offers Some Protections
Source: American Community Survey
Half of older adult renters are cost burdened
Two in 10 older adult homeownersare cost burdened
Cost Burden Increases as Household Income Decreases
Housing Cost Burden Across Colorado
A Workforce As Housing Burdened As Their Patients
Affordable Housing for Workers is Also Needed
Housing Costs Can Crowd Out Health
53%
70%
Healthy Baseline
Less on Food
Less on Medical Care
Low-income cost-burdened older adults spend …
Source: Joint Center for Housing Studies, Harvard University
Older Coloradans Increasingly Find it Difficult to Find
Adequate, Accessible Housing.
Accessibility
Accessible Homes are Needed as We Age
2 in 3 older adults will develop a disability and need care in their lifetime
1 in 3 older adults will develop a disability and need care today
Accessible Housing: Two Forms
Reality: Few Homes are Truly Accessible
About 1 in 3 homes in Colorado have a zero-step entry
Less than one percent of homes in Colorado are wheelchair accessible
Accessing Places is Getting Harder in Colorado
72% 66%
0%
20%
40%
60%
80%
100%
Ease of Getting to Places in the Community
Just half of rural Coloradans are within 15 minutes of a hospital …
Compared with 87% of urban Coloradans.
2010 2018
Accessibility and Health
Walkable neighborhoods can mean:
• Lower rates of cognitive decline
• Overall better health
• Lower rates of obesity
In-Home Supports
Supportive Housing Services
Indirect Supports
Permanent Supportive Housing (PSH)
Service Coordination
Housing in Colorado
Summarizing the Impact
The Visible The Invisible?
• Displacement and doubling up• Physical and mental health
impacts• Food access• The workforce• Transportation• Access to medical appointments
and community ties
• Rent• Utilities• Property taxes• Repairs• Insurance
New Data and Information is Available to Help Coloradans
Advocate for Change.
The Vision: Make the Case for Housing
Link to Toolkit: coloradohealthinstitute.org/community-toolkit-housing
Spotlight: Boulder
Print and Share: Tell Your Story
Link to Toolkit: coloradohealthinstitute.org/community-toolkit-housing
• Built for everyone, non-experts
• Share with city council, planners, aging partnerships,developers, health systems, etc.
Where Do We Go From Here?
• Senior Residences at Three Springs
• SASH Program in Vermont
NextFifty Initiative: Phase Two
Family, Friends, Neighbors
Photo: http://www.homecareaustralia.com.au
Who Will be Caring for Older Coloradans?
Direct Care Providers
Key Takeaways
1. Coloradans are living longer, but income for older adults is being outpaced by the cost of housing.
2. Older Coloradans increasingly find it difficult to find adequate, accessible housing.
3. New data and information is available to help Coloradans advocate for change.
A Note of Thanks
Chrissy [email protected]
720.382.7098
Sponsor Visits & Beverage Break!
All proceeds support the Aging Services Foundation of Boulder County, a local 501c3
nonprofit that helps build and sustain programs, services, and events for older
adults, family caregivers, and professionals.
SPEAKER
Claire Cruse
PRESENTED BY CO-PRESENTED BY
November 2019
The future of aging:
What might aging look like in 2040?
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
The future of health will be driven by digital transformation
enabled by radically interoperable data and open,
secure platforms
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
What is Health?
Health is defined holistically asan overall state of wellbeing
encompassing mental, social, emotional, physical and
spiritual health
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
“Longevity is here to stay” – Ashton Applewhite
Silver tsunami or permanent sea change?
The middle aging of society
• While longevity has increased in the last century, the years we have gained were not added to the end of life—those “extra” years have been added to the middle of life.
• But still today, the average health span (age 63)—the amount of time that one is healthy in life—stops more than a decade short of the average life span (age 79).
What would happen if we extended health span?
We’ll follow the lives of three individuals:
Larry: Widower, type II diabetic
Chase: Using nudges and technology to manage chronic disease
Dana: Few financial resources, not prioritizing health
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
A future of health focused on preventing disease can change people’s experiences for the better and create opportunities for today’s life sciences and health care stakeholders
The future of aging could look radically different than experiences people have today
We explored this deeper by discussing four questions with experts in aging services, policy, innovation, and technology:
What will health care “treat” in the
future?
How will the future of health change how people work, retire, and pay for their later years?
How will the future of health change where and how people will live?
How will the future of health change death and dying?
“Social isolation and loneliness are not the same thing. There is overlap, but they are not the same thing. We need a much more thoughtful approach to social isolation and loneliness than what is in place today. You can be lonely in a crowded room.”
—Nonprofit foundation leader
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Health care could shift to a greater focus on mental and behavioral health, suicide, loneliness and social isolation
What will health care “treat in the future?”
Vision for 2040:
Data and the consumer will be at the center of the health model; the focus will be on holistic health
Chase
Age in 2040: 40
Health: Living with indolent non-Hodgkin Lymphoma for five years.
Support:
• Embedded sensors in body and environment
• Predictive analytics
• Health advocate assisting with disease monitoring, medication adjustments, and wellness routines to complement disease status
Change is emerging:
Suicide, social isolation, and loneliness epidemics on the rise
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Some innovators today are shifting to focus beyond physical health
Early movers to watch
Element3 Health
Socially Determined
Neolth
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Attaining this future will likely require action
Bridging the gap: Getting to 2040
Source: Deloitte Analysis
Adopt emerging technology
Forge partnerships
Build new business models
Shift in mindset
“I don’t think people will use the word retirement in 20 years. The fundamental narrative of how we think of our lives—school, work, retirement periods—will be gone. We will have new narratives that will allow older people to work.”
— Longevity market digital publisher
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
How will the future of health change how people work, retire, and pay for their later years?
Larry
Age in 2040: 70
Health: Type II diabetic, at risk for depression due to recent loss of wife
Support:
• Virtual assistant that detects mood changes
• Health advocate assisting with recommendations to keep him socially engaged (e.g., local clubs, virtual affinity network)
• Paid for mentoring but enjoys intergenerational aspects of work too
Vision for 2040:
Longer health spans could give people the physical and mental stamina to work later in life.
Change is emerging:
Working longer, but out of desire rather than need
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Encore.org
emPower
Changes in the concept of work and retirement will likely require new tools to prepare people—and they should focus on the beginning of their careers as much as the end.
Early movers to watch
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Attaining this future will likely require action
Bridging the gap: Getting to 2040
Source: Deloitte Analysis
Go beyond care
Forge partnerships
Build new business models
Shift in mindset
“If you installed 100 grab bars at $300 apiece and avoided one fall, you would break even because the average fall costs nearly $30,000.”
—Aging in place expert
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
How will the future of health change where and how people live?
Age in 2050: 80
Health: Type II diabetic, at risk for depression due to recent loss of wife
Support:
• Engagement with social club has led to deep interpersonal relationships
• Move in together to share cleaning and cooking service
LarryVision for 2040:
Pairing smart homes with smart health communities could transform the way older people live.
Change is emerging:
Maintaining choice in aging
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Minka
Best Buy
The future of health will shift away from brick-and-mortar locations to meet people in their homes and communities
Early movers to watch
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Attaining this future will likely require action
Bridging the gap: Getting to 2040
Source: Deloitte Analysis
Close technology gaps
Forge partnerships
Move into the community
Go beyond care
“I’m hopeful that 20 years from now as a culture we are not afraid to talk about death and dying as part of the human experience –that there will be less of a fear of aging.”
—Nonprofit foundation leader
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
How will the future of health change death and dying?
Vision for 2040:
Concrete plans for end of life supported by data and care teams
Change is emerging:
Open conversations around death and dying
Chase
Age in 2060: 60
Health: His cancer has an accelerated progression at the end stage of the disease that is resistant to treatment
Support:
• End of life planning done years before, now it’s carrying out his wishes
• Enrolling daughter in grief support system
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Fabric
Embodied Labs
The future of health may make death more predictable
Early movers to watch
Death Cafes
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Attaining this future will likely require action
Bridging the gap: Getting to 2040
Source: Deloitte Analysis
Arm health care professionals with new tools
Forge partnerships
Go beyond care
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Two critical considerations (questions) for the future
How critical is analogue in the
digital age?
What roles will caregivers play
in the future?
Age in 2040: 60
Health: Declining mobility, at risk for depression
Support:
• Sensors in the grocery section of her local community health hub store detect unhealthy purchases and alert network
• Virtual assistant provides regular check-ins, sends coupons for healthy food options, and alerts established in-person support system to changes in her behavior
Dana
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
Contacts
Leslie ReadPrincipalDeloitte Consulting LLP+1 617 437 [email protected]
Sarah Thomas, MSManaging directorDeloitte Center for Health SolutionsDeloitte Services LP+1 202 220 [email protected]
Claire CruseHealth policy managerDeloitte Center for Health SolutionsDeloitte Services LP+1 303 305 [email protected]
The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.
The source for health care insights: The Deloitte Center for Health Solutions (DCHS) is the research division of Deloitte LLP’s Life Sciences and Health Care practice. The goal of DCHS is to inform stakeholders across the health care system about emerging trends, challenges, and opportunities. Using primary research and rigorous analysis, and providing unique perspectives, DCHS seeks to be a trusted source for relevant, timely, and reliable insights.
To learn more, please visit: www.deloitte.com/us/centerforhealthsolutions
About the Center for Health Solutions
About Deloitte
Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities. DTTL (also referred to as “Deloitte Global”) does not provide services to clients. In the United States, Deloitte refers to one or more of the US member firms of DTTL, their related entities that operate using the “Deloitte” name in the United States and their respective affiliates. Certain services may not be available to attest clients under the rules and regulations of public accounting. Please see www.deloitte.com/about to learn more about our global network of member firms.
Copyright © 2019 Deloitte Development LLC. All rights reserved.
This presentation contains general information only and Deloitte is not, by means of this presentation, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This presentation is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.
Deloitte shall not be responsible for any loss sustained by any person who relies on this presentation.
MODERATED PANEL
Moving the Needle
PRESENTED BY CO-PRESENTED BY
All proceeds support the Aging Services Foundation of Boulder County, a local 501c3
nonprofit that helps build and sustain programs, services, and events for older
adults, family caregivers, and professionals.