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By Kevin Nolan, Global Head of Healthcare Marketing at HGS Healthcare
Did you know the direct medical cost of falls exceeds $50 billion?
That’s one of the powerful stats that was shared during HGS’ recent webinar with the Florida Association of Health Plans titled, “Aging in Place: Integrating Fall Risk Assessment and Prevention to Ward off Frailty.” The speakers were Dr. George Mayzell, President of Empowered Health Care, and Krithika Srivats, VP Clinical Practice and New Solutions, HGS AxisPoint Health.
At a glance, the webinar talked about:
- Functional ramifications of frailty
- How to help people “age in place” by addressing the physical attributes of falls prevention, physical/medical considerations, along with the psychosocial and caregiver issues
- The importance of offering a comprehensive approach in falls prevention to commit to improved health outcomes and reduce claims related to falls
The speakers first discussed what frailty is and the factors that contribute to it, as well as how to get ahead of the issues it can cause, such as falls. When empowered with data and other information that help assess a person’s risks of frailty and subsequent falls, families, caregivers and healthcare providers can best provide care in a way that proactively gets ahead of those issues.
Proactively avoiding frailty and falls
The discussion covered the key factors that increase frailty progression such as:
- Nutrition and weight
- Mobility and strength
- Sensory limitations
- Psychosocial vulnerabilities
- Cognitive issues
- Progressive risk for skin issues and ulcers
- Caregiver dependency
The discussion emphasized the need to reduce fall risk proactively. This can be done by considering the various inputs that indicate risk. In addition to comorbidities, data must also be looked at in order to provide a comprehensive assessment. Claims data, for example, can help identify frailty based on medical diagnoses. Additionally, the social issues involved with a patient, like isolation, should be factored in. By combining those factors with considerations such as history of falls, a good prediction can be made for who is at risk and who is not.
Based on that, an operational plan for the right care at the right time can be implemented.
Fall prevention programs in focus
The two speakers then outlined what a fall prevention program and subsequent outcomes look like. Fall prevention programs are offered through a health plan, and members can enroll through various channels, such as a call center or online portal.
The individual begins by completing their registration and self-assessment for fall risk. The assessment detects fall risk across several domains including:
- Sensory (think: vision or hearing)
- Physical mobility capabilities
- Evaluation of other conditions that predispose someone to fall risks, like cognitive impairment
- Home safety
Once the risk profile is determined, an active engagement program is devised. Working with care managers and physical and occupational therapists, a whole person care approach is developed. That includes things such as:
- Home safety and caregiver education
- Recommended exercises
- Local fitness groups such as Silver Sneaks
- Fall impact
- An overview of plan benefits
These personalized health plans focus on building long term resilience through behavioral changes. Overall, they aim to increase quality of life by reducing fall risk. The plans include ongoing home safety assessments and engagement with a care manager to ensure care coordination efforts are being made. Members can easily stay connected through automated and online channels.
The webinar then focused on some of the outcomes of fall prevention programs, which are measured in effectiveness based on things like:
- Engagement of members
- Sustained adoption levels
- Potential results from fall risk reduction
The panel then provided a look at the ROI of fall prevention resulting in claim reduction. For example, it’s estimated that for every 100 members with reduced claims costs due to injury reduction, $420,000.00 in savings is achieved. For every 100 members with avoided hospitalization costs, $650,000.00 is achieved.
The webinar closed with acknowledging that, by preventing the frailty cycle from starting by providing resources for individuals to have self-motivated behavioral change, a reduction in falling incidents can be achieved with measurable results. Frailty and falls are expensive and have a significant impact on an individual’s quality of life. They also have a significant resource cost to the healthcare system. Falls are a subset of frailty, and they start a cycle of frailty leading to higher medical costs, hospitalizations, industries and the need for long term care.
The solution to frailty and fall prevention is a comprehensive aging in place program. A proactive and preventive focused approach will benefit everyone, increase patient and family loyalty, and commitment to their physicians and healthcare systems.
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