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7 things you should know about that big fall prevention study

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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.

See also: 4 steps toward keeping clients from stepping into a world of hurt

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.

Falls experience

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.

See also: Anthem boosts elder fall proofing

Severity change

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.

See also: When does home care slash total LTC costs?

Effect on claims

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.

Perhaps because the program covered a broad range of health and wellness issues, and encouraged participants to follow up with their physicians, much of the reduction in costs involved health care concerns unrelated to falls.

See also: In Japan, the rise of the machines solves labor and productivity

Risk-mitigation

4. Intervention can lead people to make their homes safer.

Participants in the treatment group were nearly 20 percent more likely to make fall-prevention modifications to their home than the participants in the control group were. 

See also: Testing sensors as safety net for seniors at home

Cohen

 5. Intervention can increase people’s sense of control over their safety.

LIFT program participants said that they were less afraid of falling, and that they believed the program would help them avoid falls. This is important because a concern about falls is actually a risk factor for a fall. 

See also: 4 ways to help LTC planning clients believe in themselves 

Satisfaction

6. People seem to like participating in fall-prevention programs.

LIFT treatment group participants were asked how they felt about the program. The vast majority of participants said that it was valuable and that they would recommend it to others. The combination of a nurse visiting the home, detailed recommendations, and continued follow-up gave participants a sense that they were part of an ongoing program. Of course, the fact that their insurance company was providing the program free of cost also went a long way toward generating positive feelings.

See also: Alzheimer’s Disease: 800,000 with Condition Live Alone

Clasped hands

7. It’s time to act.

Our study shows that the LIFT falls prevention program reduces the rate of reported falls and risk factors for people ages 75 and older, leads to lower all-cause LTCI claims costs, and has a positive return on investment.

Like the effectiveness of other multi-factorial interventions that depend in part on behavioral change, the effectiveness of LIFT weakens over time. The waning effect of the intervention suggests that a “booster” intervention may be beneficial.

This could include additional follow-up calls to monitor action plan implementation, and to provide more ideas about ways to mitigate risk. The team could also promote more intensive follow-up with the participant’s physician, to ensure that the implications of the assessment findings are understood, discussed, and acted upon.

According to America’s Health Insurance Plans (AHIP), there are now about 7 million U.S. residents who have private LTCI policies. Many of these people bought their policies so that they can get the services necessary to help them age in place, even if they require long-term services and supports (LTSS) to compensate for functional or cognitive disabilities.

The LIFT program or similar programs could be offered on a voluntary basis to current in-force policyholders as a way to help preserve independence and reduce the need for LTSS on a cost-effective basis. Experience in marketing of this program suggests that between 30 percent and 40 percent of policyholders agree to voluntarily enroll in the program.

Over the past few years, a growing number of LTCI issuers have been increasing premiums for in-force policyholders. A wellness program that — among other things — reduces falls, could help companies to hold down rate increases for policyholders who voluntarily participate in such programs. This would could help both consumers and issuers alike.

Health insurers have made prevention of obesity and diabetes a priority, and they have stepped up efforts to encourage use of mammograms to reduce the incidence of invasive breast cancer. It’s unclear what concrete steps health insurers have taken to go beyond promoting fall risk assessments and actually reduce the number of falls.

There are a number of well-designed fall-prevention programs that health insurers can consider implementing, from LifePlan’s LIFT program to the Center for Disease Control and Prevention’s STEADI program, among others. It’s time for health plans to go beyond simply assessing the risk of falls.

Plans should adopt the kinds of fall prevention programs that have been shown to deliver measurable benefits for older individuals.