Fall-related injury-claims are a growing problem for elders, and a growing number of both acute and long-term care insurance (LTCI) claims are for fractures related to falls.
Roughly one-third of individuals ages 65 and older living in a community, fall each year. Individuals ages 75 and over who fall are four to five times more likely than other people their age to be admitted to a long-term care (LTC) facility for a year or longer.
Some LTCI carriers are trying to reduce the frequency and cost of fall claims by adding fall-prevention programs. Health insurers are also beginning to put more focus on reducing fall risk, in part because of the influence of the Centers for Medicare & Medicaid Services (CMS) “star” rating program for health plans.
Recognizing the growing interest in fall-prevention programs, in 2004, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS) contracted with my company, LifePlans Inc., to work with a number of insurers to design and implement a multifactorial fall-prevention intervention: the LIFT Wellness Program. LIFT stands for “Living Independently and Falls-free Together.”
The participating insurers helped us conduct a national demonstration and evaluate the program’s effect on falls and LTCI costs. More than 5,700 policyholders ages 75 and older participated in the demonstration, with roughly 1,800 ending up in the treatment group.
The program consisted of an in-home assessment of individual and environmental risk factors, the development of a customized action plan with information on how to mitigate risk factors, a telephone follow-up consultation, and a fall prevention tool kit.
This tool kit included a medication minder, fall prevention tips, a National Institute on Aging (NIA) exercise DVD and booklet focused on balance and mobility exercises for elderly persons, and a pedometer to encourage walking. On a quarterly basis, individuals also received a newsletter presenting them with information about fall prevention and wellness. The recommendations were also sent to the participants’ personal care physicians, and the participants were encouraged to set up appointments to review the recommendations (action plans) with their doctors.
The results of the demonstration show that the program significantly reduced fall rates, fall risk and LTCI claims incidence, and that it also led to a mitigation of risk factors and resulted in high consumer satisfaction.
For a look at some of the major study findings, read on.
1. Intervention can reduce risk.
The participants in the LIFT program treatment group had a 13 percent lower rate of falls than the participants in the control group had. The rate of falls, or the number of falls over the observation period, also declined for the treatment group members: For every 100 falls in the control group, there were only 87 falls in the treatment group.
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2. Intervention can reduce the severity of the falls that do occur.
By the end of the first year of the program, there was an 18 percent reduction in the risk of participants in the treatment group having an injurious fall.
A greater proportion of people in the control group who had a fall reported requiring medical attention than those in the treatment group did.
3. Intervention can reduce the effects of falls on LTCI claims.
The participating insurance companies provided claims data for the three-year period following the implementation of the LIFT program.
Over that period, the claim incidence rate for treatment group participants was 33 percent lower than for those in a control group.
The program had a positive return on investment. Every $1 invested in the program led to $1.68 in savings on claims. Gross claims costs savings were $838 per program participant over the three-year period, which exceeded the cost of the program.