Policy & Providers - ILTCIiltciconf.org/2013/PDF/41-CCRCWithoutBorders.pdf · Policy & Providers CCRC Without Borders (Continuing Care at Home)(Continuing Care at Home) 1. Presenters

Policy & Providers

CCRC Without Borders(Continuing Care at Home)(Continuing Care at Home)

1

Presenters

Carol A. BarbourPresident – Friends Life CarePresident Friends Life Care

Ralph DonatoRalph DonatoConsultant – Towers Watson

Bob Yee (Moderator)Senior Consultant – Towers Watson

2Session 41: CCRC Without Borders

Agenda

• Overview of CCRC Business Model• Overview of Continuing Care At• Overview of Continuing Care At

Home (CCAH) Business Model• Marketing Considerations• Delivering the ServicesDelivering the Services• Financial Issues & Considerations• Questions


CCRC Business Model

• Brought to US from Europe over 100 years agoyears ago

• Provides housing, support services d h lth i land healthcare on a single campus

• Extensive, modified and fee-for-,service contract types

• Approximately 1 900 CCRCs in US• Approximately 1,900 CCRCs in US


2009 CCRC Entrance and Monthly Fees by Contract Type

E i F FExtensive(Life Care) Modified

Fee ForService

E t F $160 000 $80 000 $100 000 Entry Fee $160,000 -600,000

$80,000 –750,000

$100,000 –500,000

I d d t $2 500 5 400 $1 500 2 500 $1 300 Independent Living

Monthly Fee

$2,500 – 5,400 $1,500 – 2,500 $1,300 –4,300

Monthly FeeAssisted

Living$2,500 – 5,400 $1,500 – 2,500 $3,700 –

5 800LivingMonthly Fee

5,800

Nursing Care $2,500 – 5,400 $1,500 – 2,500 $8,100 –


Nursing CareMonthly Fee

$2,500 5,400 $1,500 2,500 $8,100 10,000

CCAH Business ModelHistoryHistory• Concern: no lower cost alternatives to CCRC• 1982: research begins to create CCRC

without walls• Organizational leaders:

– Foulkeways at Gwynedd– Brandeis University

• Funding: u d g– Commonwealth Fund– The Robert Wood Johnson Foundation


The Robert Wood Johnson Foundation– Pew Charitable Trusts

1980s

• Develop business model• Search for relevant data; actuarial ;

projections• National & site-specific market researchp• Business plan/joint venture• October 1987: Certificate of Authority fromOctober 1987: Certificate of Authority from

PA Department of Insurance• November 1987-June 1990: presalesNovember 1987 June 1990: presales• July 1990: begin operations


Fee Schedule – 1990 (Type A)

• Entry fee: $10 000 $44 000• Entry fee: $10,000 - $44,000• Monthly fee: $ 400 - $ 1,400• Life Care (no maximum lifetime limit)• No maximum age limitg


Services

• Care Coordination• Home care (assistance with activities of

d il li i )daily living)• Coordination of Medicare home care

benefitsbenefits• Emergency response system• Home delivered meals• Home delivered meals• Adult day care• Assisted living facility (optional)• Assisted living facility (optional)• Nursing home (optional)• Referral Service


• Referral Service

New Member Enrollment

282 276278300

202229

199

276

211

251232240 240254

278

214200

250

107

165

118

153178

148150

200

w Me

mbe

rs

107

48

8971

88

50

100New

0

50

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012


Years

Consider the Odds

• 85% of seniors prefer to remain in their own homes

• 70% of people over age 65 will require some form of long-term caresome form of long term care

• Probability of using that care for more than one year: highone year: high– Women – 85% with average of 4.2 years in

carecare– Men – 77% with average of 2.9 years in care


The Friends Life Care Plan Today

• Daily benefits and benefit periodsy p– $75–$250 per day (in $25 increments)– 2, 3, 4, 5 and 7 year , , , y

• Elimination period0-365 days– 0-365 days

• Inflation protection


Fee Schedule (Type B)

ANNUAL FEE (20% considered entry fee)$100 per day; 5% simple inflation$ p y; p

Age 3 year benefit($109 500 i fl ti )

7 year benefit$255 500 i fl ti )($109,500 + inflation) $255,500 + inflation)

50 $1,275 $1,529, ,60 $2,108 $2,58170 $4 332 $5 36070 $4,332 $5,36080 $7,295 $8,909


Impact of Pricing Changes

• Increased consumer choiceIncreased consumer choice• Eliminated up front entry fee

Reduced overall fees• Reduced overall fees• Reduced risk to Friends Life Care• Increased market appeal


Emergence of CCAH

1990: PA (licensed 1987)1998 NJ & VA1998: NJ & VA2003: TN, MD/DC, PA2004 OH2004: OH2009: CT2010 KS MI2010: KS, MI2011: NH, FL, NJ, CT2012 MI2012: MI4-5 under development


CCAH Contract Types

Type A: • Large upfront entry fee (typicallyLarge upfront entry fee (typically

refundable or refundable on declining balance)balance).

• Ongoing monthly fee (sometimes waived if member requires SNF/ALF)member requires SNF/ALF).

• Unlimited lifetime benefit.


CCAH Contract Types

Type B:• Modest entry fee paid upfront or overModest entry fee paid upfront or over

designated period of time (typically not refundable)refundable).

• Ongoing monthly fee (typically waived if member requires SNF/ALF)member requires SNF/ALF).

• Daily and lifetime limits on amount of care.


Marketing Considerations

• What is the target market?• What is the target market?• What is the competition?• Marketing challenges


Target Market - Age

Age• Minimum Age: 40Minimum Age: 40• Maximum Age: 81

Income• Age 40+: $55k• Age 65+: $25kAge 65+: $25k


Why do people enroll?

• I don’t want to be a burden on my childrenI don t want to be a burden on my children• I want to protect my assets


Competition

“I’m not going to grow old”


Competition?

• Long term care insuranceLong term care insurance• CCRC


“I’m not ready yet!”


Delivering the Services

M di l d iti• Medical underwriting• Service eligibility determinations• Prevention and healthy aging initiatives• Monitoring and maintaining qualityMonitoring and maintaining quality


The Care Coordination Department

Director of Care Coordination

BSW

Clinical Supervisors 1 OT, 1 BSW

Wellness Coordinators

1 MSN, 1 MS/OTR/L, 1 MSW, 1 BA (Gerontology), 1 DPT

At-Risk Coordinators 1 OTR/L, 1 MSW,

Care Coordinators 2 RN, 1 MSW


Member Distribution June 2012

Well members 61.7%

Members at risk 26.2%

Members – home care 9.8%

ALF residents 1.4%

NH residents 0.9%


Member Eligibility for Care

Risk and Functional Assessment Tool• Social risk factorsSocial risk factors• Medical risk factors

F ti l i k f t• Functional risk factors• Mental health risk factors


CareSync Database

• Medical history• MedicationsMedications• Environmental factors

Lif t l f t• Lifestyle factors• Care plans• Assessment tools


Four Evidence Based Prevention Programs

• Fall Risk Reduction Program• Cognitive Assessment/MemoryCognitive Assessment/Memory

Enhancement Program• Medication Management Program• Medication Management Program• Stroke Prevention Program


Falls Risk Reduction Program

• Annually assess members beginning at the age of 70, using a specially designed toolg g y g

• Coordinate physical and occupational therapy for in-home strength and balance trainingtraining

• Perform Home Safety Evaluations and arrange for environmental adaptations asarrange for environmental adaptations as necessary

• Screen and refer for assistance withScreen and refer for assistance with Medication Management

• Install wireless sensor-based emergency


response and activity monitoring system

VigRTM

Vitality • Independence • Growth • Resilience


VigRTM

• VigR Enrichment WorkshopsM ti h• eMeetinghouse

• VigR Assessment Tools• VigR Mastery Experience


Monitoring and Maintaining Quality

• Service Provider Network Quality C d ti liCredentialing

• Member Satisfaction Surveys • Concern/complaint log and tracking• Direct feedback from membersDirect feedback from members• Member Advisory Committee


• Insert video here


Policy & Providers

Management Responsibilitiesg

35

CCAH Compared to LTCI and CCRC

CCBenefits

CCAH

Premiums (Type B)

LT

CC

Regulations

TCI

CRC

Management Structure

Care Management IC Care Management

Funding Discipline


Expected Income & Outgo($000 O itt d) C h t f 100 N M b

$300

($000 Omitted) Cohort of 100 New Members

$200

$250Income

O

$100

$150Outgo

$50

$100

$0

0 5 10 15 20 25 30 35 40 45 50


Year

Program Design Considerations

Standard features• Issue age limitsIssue age limits• Benefit limits

O ti• OptionsDistinctive issues• Moderate Underwriting• Extensive care managementExtensive care management• Credibility of experience due to small size


Risk Mitigation for Start-Up

• SWOT analysis (Strength, Weakness, Opportunity, Threat)pp y, )

• Market Research• Find reliable sources of utilization• Find reliable sources of utilization• Meet minimum size requirement• Care delivery system setup


Start-Up

Financial DisciplineManagement

• Market research• Organizational

• Initial funding• Care contracting• Organizational

structure• Care network

• Care contracting• Product pricing

• Care network


On-Going

Financial DisciplineManagement

• Sales & Marketing• Administrative staff

• Periodic financial review• Administrative staff

• Experience monitoring

review• Allocated fund for

future liabilitiesmonitoring future liabilities


Critical for Success

• Passion for the program• Financial discipline: set up funds for futureFinancial discipline: set up funds for future

liabilities that are sufficient at any time• Clear communication between Board of• Clear communication between Board of

Directors and management


Policy & Providers - ILTCIiltciconf.org/2013/PDF/41-CCRCWithoutBorders.pdf · Policy & Providers CCRC Without Borders (Continuing Care at Home)(Continuing Care at Home) 1. Presenters

Documents