Long-term care benefits may reduce end-of-life medical care costs.

Abstract This study explores whether personal care services for functionally dependent or cognitively impaired individuals paid for by a long-term care (LTC) insurance policy can reduce health care utilization and costs at the end of life. This retrospective study uses propensity score matching methodology, hierarchical multiple regression, and Poisson regression to compare 830 decedents who utilized benefits from a voluntary LTC insurance plan ("claimants") to 6860 decedents who never purchased coverage but were similar to claimants on 17 variables, including age, sex, frailty, burden of illness markers, and propensity to have needed LTC services. Claimants using LTC benefits experienced significantly lower health care costs at end of life, including 14% lower total medical costs, 13% lower pharmacy costs, 35% lower inpatient admission costs, and 16% lower outpatient visit costs. They also experienced 8% fewer inpatient admissions and 10% fewer inpatient days. The presence of dementia at the end of life moderated these effects. This study suggests that use of insurance-based LTC services measurably reduces health care expenditures at the end of life. (Population Health Management 2014;17:332-339).

Stratifying long-term care risk by cardiovascular risk factors--an analysis of claims experience with atrial fibrillation.

OBJECTIVE: The objective of this study is to stratify all-cause disability experience by stroke risk factors in a large cohort of individuals who have been underwritten and successfully enrolled in a long- term care insurance (LTCI) program. METHOD: A large database of over 120,000 underwritten insured lives for LTCI between 1994 and 2002 allowed classification of claims risk for atrial fibrillation, hypertension, diabetes, and combinations of these cardiovascular risks. The mean duration of policy was over 5.7 years. A simple model utilizing the mean amount per covered life paid as a claim per year of coverage allowed for stratification of these risks for all-cause long-term care claims. Data analysis produced relative risks for these categories compared to individuals without any cardiovascular risks. RESULTS: There was a significantly increased relative risk of 2.5 and 2.6 for atrial fibrillation and diabetes in individuals underwritten at ages 65-74, but not in ages 75 and older. This study also shows the relative risk of hypertension and diabetes to be less than diabetes alone at ages 65-74. CONCLUSION: The current study is considered preliminary and establishes the foundation for future relative risk or "LTC morbidity ratio" studies for long-term care insurance.

Community-based health coaching, exercise, and health service utilization.

OBJECTIVE: The outcomes of the California Public Employees Retirement System's Health Matters program, a replication of a health promotion and fitness program known as the Senior Wellness Program (SWP), are reported. METHOD: A randomized controlled design (n = 504) was used. Eligibility included one or more qualifying chronic health conditions, age 65 or older, member of a participating health plan, and owner of a CalPERS long-term care insurance policy. Disability risk factors were measured via questionnaires and included health status, pain, exercise, depression, and social activity. Activity was compiled in project records. RESULTS: At 12 months, Health Matters members were engaged in significantly more stretching and aerobic exercise than the controls. Depressive symptoms decreased among those with moderate or higher symptom scores. DISCUSSION: Health Matters extends the SWP model to younger, more active, and healthier individuals with improvements in duration of exercise and stretching; use of other health promotion activities was low.

Community-based nurse health coaching and its effect on fitness participation.

This article reports on the characteristics of the individuals participating in Health Matters, a community-based health promotion and fitness program for the elderly. A total of 255 persons were recruited into the program. Eligibility criteria included having one or more qualifying chronic health conditions, being 65 or older, having membership in a participating health plan, and ownership of a CalPERS long-term care insurance policy. The intervention included nurse health coaching, training in self-management of chronic illness, referrals to community resources, and a fitness program. More than 90% of participants were in exercise programs at 12 months, and 30% had participated in one or more condition management classes. Health Matters' senior-oriented fitness program was more successful in attracting higher disability risk members than were either community-based or self-exercise programs. Health Matters demonstrated that it is possible to proactively recruit and retain individuals in a health-promotion program. The nurse coaches/case managers communicated with primary care physicians about the enrollees and their health action plans, but recruitment did not rely on physician referrals.

Preventing disability through community-based health coaching.

The California Public Employees Retirement System (CalPERS) Health Matters program is a randomized controlled trial of a community-based health coaching program operating in Sacramento, California, since January 2001. It is modeled after the Health Enhancement Program and Senior Wellness Program of Seattle, Washington. Like the Health Enhancement Program, this program incorporates a menu of disability-prevention strategies, with health coaching, patient education on the self-management of chronic illness, and fitness forming the program's core. Unlike the Health Enhancement Program, the Health Matters program focuses as much attention on linking participants to existing community, health plan, and self-directed programming as it does encouraging them to participate in programming developed especially for the project. All participants and controls continue to receive their usual medical care from their managed care providers. Eligibility criteria for the program include having one or more qualifying chronic health conditions, being aged 65 and older, being a member of a participating health plan, and being accepted into CalPERS' Long Term Care Insurance Program. Baseline exclusions include being cognitively impaired or qualifying for long-term care insurance benefits due to deficiencies in two or more activities of daily living. The project has been successful in its enrollment strategy. It has also been successful in recruiting participants into project-sponsored, community-based, and self-directed disability-prevention programming. This is particularly true for programming related to diet, exercise, and various aspects of disease management.