Health plans in search of cost savings should focus on fall prevention

Falls are the No. 1 cause of nonfatal emergency department visits for adults over 65. One in 4 older adults falls each year, with the associated medical costs totaling more than $50 billion annually. And that number is projected to increase to up to $100 billion by 2030.

Recent data also shows the average cost per hospitalization for a fall exceeds $50,000. Falls are one of the top five Medicare expenditures, costing about as much as all cancer care combined and accounting for approximately 5% to 6% of the total Medicare spend.

Despite these numbers, many health plans show low performance over time related to reducing the risk of falling. In fact, a review of CMS data shows that 80% of healthcare plans reported less than 4-star ratings for this measure.

To see the savings and truly prioritize aging members’ total health, plans should work to boost this star rating. Here are three tips for doing so.

Start to close the gap between health and life span

For many of us, there is a need to shift our thinking and approach to aging. This starts with thinking about the gap between health span and life span and how best to close it. Much of the groundwork for that approach can be found in preventive care.

Considering the sheer amount Medicare spends on falls annually and that every 11 seconds, on average, an older adult is treated in the ER for a fall, it’s clear our current approach is reactive. But there are proven, proactive ways to prevent falls – and thereby avoid incurring the associated costs. In fact, clinical research shows specific yet simple exercise regimens that include strength and balance training can prevent a significant number of falls for older Americans.

Many adults experience a loss in muscle mass between ages 50 and 70. Educating members 50 and older on the merit of science-based exercise programs and encouraging and incentivizing them to participate in these types of programs is a critical first step in reducing the risk of falling. By focusing on this age group, in addition to the younger demographics more traditionally targeted when promoting fitness benefits, the gap between health and life span will continue to decrease.

Leverage technology

Covid-19 has been incredibly hard on older adults. This population is already at high-risk of social isolation regardless of the state of the world. The pandemic further raised their risk of isolation and correlated effects including loneliness and depression.

Because of this, many were quicker to turn to technology to stay connected and ensure their basic needs, like grocery deliveries and doctor’s appointments, were met.  As a result, 44% of older adults view tech more positively as a way to stay connected than they did before Covid-19.

As we continue to navigate the pandemic, online fitness programs allow for older adults – many of whom are still wary to enter crowded spaces such as gyms – to focus on preventive care from the comfort of their own homes. Long after the pandemic, this type of programming will continue to allow for flexible schedules, privacy and personalization.

Look for solutions rooted in research

Until recently, expert trainers who specialized in fitness for older adults were spread across the country and primarily focused on private studios and expensive personal training sessions. This cut off access to wellness solutions for millions of Americans. Fortunately, this is no longer the case.

When analyzing potential opportunities, look for solutions rooted in research – using data to inform and adjust. The proof will be in the numbers.

The ability to customize and allow for accessibility are also key components to look for in a potential solution. In having this at your disposal, you can rest assured that members across the spectrum of needs and in a wide array of locations are all receiving the assistance they need to age well.

Regardless of how you approach a solution, it’s imperative that both health plans and older adults understand the benefits of addressing aging in a way that focuses on preventing certain outcomes and improving others. By doing so, both members and health plans will benefit.

Photo: Toa55, Getty Images