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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

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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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