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
• 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
Cost-Savings from Health Care
Can Create the Revenue for a New Model
1. Reduced hospitalizations
(average price per hospitalization is $18,000)
2. 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
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
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 Education
Physical Activity
Transition Plans
Health Interview
Food banks
Well-being Checks
Benefits Acquisition
•SF DPH also provides access to a roving team that can meet
the “medical” needs of residents
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
Value Proposition:
Estimated Total Costs & Savings
Net Savings
Health
care cost
$85k-100k
per year
Impact of
Independen
t Long
Term Care
LTC Fee
Ongoing
health cost
Pre-Intervention
With Independent
Long-Term Care
Factors that influence revenue potential
Cost Savings Potential
Alignment:
$60,000
Degree to which the
residents are
members, enrollees,
patients of the
health partner.
$50,000
Annual
Medicaid
Expense
$40,000
$30,000
Cost
$20,000
$10,000
$25%
50%
Alignment / Access Control
100%
This is based in part
on how access to
the building is
controlled.