What was the Purpose of the Study?
A study by Avalere was conducted to examine the differences in healthcare outcomes among Medicare beneficiaries enrolled in Medicare Advantage and those participating in the SilverSneakers healthy aging program to assess the potential value and/or benefits to participants and providers designed to promote physical and social engagement in seniors. It has been well studied and well known that physical and social engagement in seniors has improved the quality of life but there has been limited, or no, access to the healthcare outcomes of the participating members. The previous studies that were done were restricted to a single health plan in a specific geographic region and did not address areas of quality care. Understanding prior study limitations Avalere developed a two-pronged approach:
- compare pre- and post-program results among participating MA members; and
- compare participating members to non-participating MA beneficiaries using a large propensity score matched sample.
with the following, specific aims to the study:
- Integrate program participant data from a large senior fitness program with MA plan claims data and create longitudinal and matched participant and non-participant study cohorts.
- Describe the demographic, enrollment, and clinical characteristics of the two cohorts.
- Use the longitudinal cohort to conduct pre/post program participation comparisons on measures of healthcare utilization, cost, and quality outcomes.
- Use the matched study cohort to compare program participants with similar non-participants on measures of healthcare utilization, cost, and quality outcomes.
- Convey insights from the two sets of analyses concerning the value of the program to Medicare beneficiaries and to MA plans that offer a fitness benefit.
Who were the Participants?
Of the over 168,000 members who had enrollment with Medicare Advantage and claims data in MORE, 8,555 met the criteria for the specific aims of the Avalere study and were included in the final study sample. The 8,555 individuals their average age was 67.5 years old with 63.6% being female and 36.4% being male. These statistics were similar to the control group who had an average age of 68.1 years old with 63.9% female and 36.1% male. Both the study participants and the control group also had similar rates of chronic conditions such as: hypertension, hyperlipidemia, rheumatoid arthritis, osteoarthritis, cataract, diabetes, hypothyroidism, and depression.
What were the Results of the Avalere Study?
When the study was completed results were released in the following categories:
Healthcare Resource Utilization:
Program participants experienced significantly lower healthcare utilization after joining the program by 21.3%, but rates of Emergency Department visits and observation stays remained comparable. Compared to the control group, program participants had 7.3 fewer hospitalizations, 7.6 fewer Emergency Department visits, and shorter inpatient stays by 1.4 days.
Healthcare Expenditures:
The total cost of health expenditures per patient per year significantly declined by 16.3% and medical cost declined by 18.4% of program participants after starting the program. While pharmacy costs did decline, the decline was not statistically significant. The total medical cost for program participants was $841 less than non-participants. The greatest cost savings were found in those over the age of 80 with a drop of costs by 49% after joining the program and 58% lower than non-participating members. This drastic difference was primarily from the drop in inpatient costs.
Number of Chronic Conditions:
Program participants with 3 or more chronic conditions had a medical cost decrease of 33.6% while program participants with less than 3 chronic conditions remained stable. No matter the number of chronic conditions, program participants' medical costs decreased by $777 compared to non-participants. The $777 decrease is largely attributed to less inpatient costs.
Disability Status:
Those members of Medicare that have a disability status have the highest cost of medical care not dependent on program participation. The total medical costs of disabled program participants dropped by $1,457 compared to non-participants.
Dual Eligible Status:
Dual eligible status was defined as participants who were eligible for Medicare and Medicaid. Medicaid is an indication of individuals with lower income. Dual eligible participants incurred a higher medical cost than non-dual members due to them taking advantage of medical care not previously affordable for them. Dual eligible program participants total medical costs were 23.8% less than non-program participants due to lower inpatient, emergency department, and post-acute care costs.
Medication Adherence:
Taking prescribed medications as directed has shown to improve health outcomes and lower healthcare costs. Program participants with hypertension increased their adhere from a 4 star rating to a 5 star rating and and those taking cholesterol medications increased their adherence from a 3 star to 4 star rating. Program participants taking diabetes medication lowered their adherence by stayed within the 4 star rating.
Preventive Screenings and Vaccinations:
Preventive screenings and vaccinations lead to better outcomes, more efficient healthcare utilization, and lost costs of care. Program participants were more likely to receive a breast cancer screening (from 71.5% to 77.7%) after joining the program. The increase in program participants receiving a colonoscopy also from 16% to 21.1%. Overall, 5% more program participants received their preventive screenings and vaccinations than non-program participants.
Conclusions
Medicare beneficiaries who participated in the SilverSneakers senior fitness program had lower healthcare utilization, particularly inpatient hospitalizations and emergency department visits, after joining the program and compared to a propensity matched group of non-participants. Program participants also incurred lower total medical costs, driven mainly by lower spending on inpatient hospitalizations, but also lower use of post-acute care such as skilled nursing facility stays, home health, and inpatient rehabilitation. Program participation was also associated with higher expenditures on outpatient visits and physician services and tests, but the higher spending in these areas did not offset the overall lower costs. There is a value and benefit of the fitness program approach to increasing physical and socialization activity among Medicare Advantage members.
