Lynne Katzmann, founder and chief


executive officer of Juniper Communities, says human contact is essential for the ser- vice-enriched housing model. “We had the high-tech but knew we need-


ed the high-touch,” she says. Care is coor- dinated in-person, connecting the residents, caregivers, and providers through medical concierges. They also provide patient edu- cation to encourage engagement and help the resident be an active partner in their own care. “These navigators are the touch


Figure 1 Frail older adults consumer a


disroportionate share of hospital spending Everyone Else


Benchmark Population


34.6 3.4 Population (millions)


$78.7 $23.1


Inpatient Hospital Spending ($billions)


Benchmark Population


34.6 3.4 Population (millions)


point for the resident, their family, and the provider,” Katzmann says. For the model to work, Katzmann says


there were a few non-negotiables. “Providers must enter their data into the electronic health record and have a regular and consistent pres- ence on-site. They also participate in resident engagement and ongoing education, and are a part of the common communication meet- ing where all providers serving the individual are part of the discussion,” she says. It’s also important to note that the doctors and nurse


Figure 2


Integrated housing could substantially decrease this population's spending


Everyone Else


practitioners are paid for by Medicare and do not come out of the operating budget. They knew the model was a success,


Katzmann says, but they were still sur- prised when the analysis revealed just how much. “Our results suggest the benefits of integrating clinical care in a seniors housing environment for those with chronic condi- tions and functional limitations,” she says. “There’s also real value in managing the health of this population and being able to target possible interventions.” “What’s powerful is that everybody is work-


$78.7 $10.7


Projected Inpatient Hospital Spending with Connect4Life ($billions)


ESTIMATED HOSPITAL INPATIENT SAVINGS TO MEDICARE OF CONNECT4LIFE Medicare


Juniper


Per Capita Savings


Low-End Estimate (0.28 avoided hospitations per person)


Mid-Range Estimate (0.35 avoided hospitations)


High-End Estimate (0.43 avoided hospitations)


$2,912 $3,640 $4,472


Population Aggregate Savings*


Population Aggregate Savings


$3.93 million $10.0 billion $4.93 million $12.4 billion $6.04 million $15.3 billion *Applies per capita savings derived from study population of 471 full year residents.


Savings per person receiving Connect4Life: $3,640 0.35 (hospitalizations avoided per resident, per year) x $10,399* (average spending per hospitalization) = $3,640 (mid-range estimate of savings per person receiving Connect4Life) *A 2012 Medicare Current Beneficiary Survey (MCBS) estimate of spending per hospitalization for this population was $9,972 in 2012; it was inflated to a 2016 value by applying a spending inflation factor.


Savings projected to full Medicare population meeting the criteria: $12.4 billion $3,640 (savings per person receiving Connect4Life) x 3.42 million* (eligible Medicare fee-for-service popula- tion) = $12.4 billion (mid-range estimate of savings projected to full Medicare population meeting the criteria) *A 2012 MCBS estimate of population was 3.36 million; it was inflated to a 2016 value using same growth rate as in overall Medicare fee-for-service population between 2012 and 2016.


ing for the resident,” says Anne Tumlinson, founder and chief executive officer of ATI. “They’re all connected, sharing the informa- tion as a team. And it really does takes a team to care for a 90-year-old. That’s why it’s so hard for a family caregiver at home,” she says. “At Juniper, their program wraps a person with the team approach, resolving the issues so hopefully they won’t have to go to a hospital.” The benefits of the Connect4Life model go


beyond financial savings and improved health monitoring; they found it also increased their residents’ length of stay on average by one month. Benefits also include the possibility of increased referrals and relieving families from the added stress of coordinating health care.


Recommendations for Going Forward “We all need to be at the table for policy conversations,” Katzmann says. “The savings are in keeping residents out of the hospitals and keeping them healthier. Ser- vice-enriched housing is a big part of the solution to the health care crisis.” Tumlinson recommends that the Cen-


ters for Medicare and Medicaid Services and others continue research on the impact of care integration in senior housing and encourage and reward those who integrate care on behalf of their residents. Both Katzmann and Tumlinson say more


investment from seniors housing providers is needed to support health care integration. Residents and their families are going to


start to demand this, Tumlinson says. “This model is a way communities can differen- tiate themselves, which will enter into the decision-making process of consumers.”


ISSUE 5 2017 / ARGENTUM.ORG 29


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