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Life Health > Long-Term Care Planning

Data-Driven Wellness Programs and Long-Term Care Insurance

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What You Need to Know

  • One way to reduce the number of long-term care insurance claims is to prevent falls.
  • Another way is to connect people with LTC insurance with personal health coaches.
  • Successful LTC insurance claim control efforts might help hold the premiums down.

If there is one thing that the pandemic has taught us in the long-term care (LTC) insurance space, it’s that aging individuals want to access care at home.

They not only appreciate the convenience of in-home care and support, they also want to maintain independence in order to stay in their homes as long as possible.

While achieving this goal ultimately benefits both the LTC insurance policyholders and insurers — who are facing rising claims costs — helping people age in place isn’t always easy. That’s because carriers have historically had very little insight into the health history and risk factors of these policyholders.

This lack of data is largely due to the unique product lifecycle of LTC insurance. Policies are usually sold years or even decades before individuals actually need to use them, and during this time period, insurers have a very incomplete picture of a policyholder’s pre-claim health history, needs and challenges.

Not a New Idea

Of course, the concept of trying to predict and impact claims in LTC insurance is not a new idea. What is new is that our industry now has the data, tools and technology needed to make it a reality, and insurers are now highly motivated to bring these solutions to market, given recent increases in claims costs. In fact, I predict that pre-claim interventions, like wellness programs and caregiver training and support, will become one of the most transformative forces in our industry over the next several years.

This is also something of a personal passion for me. Three years ago, my dad experienced a bad fall and quickly went from being a healthy, active senior to someone plagued by health issues. After my company acquired LifePlans, which had a proprietary fall prevention program called LIFT, I learned more about the significant risks associated with falls, which are a leading cause of LTC claims. In fact, one out of four people over age 65 will fall every year in the United States.

I also discovered that once someone experiences a fall, the fear of falling again impacts almost everything they do, which makes it difficult for them to fully recover. Unfortunately, it was too late for me to apply this knowledge to my father’s own situation, but it’s now both my personal and professional mission to help other families avoid this outcome.

The LIFT program was designed to reduce falls by going into the policyholder’s home to assess each policyholder’s risk factors. Yet falls are only one of a number of different afflictions that put people into claim. Two important questions occurred to me through our experience with this program. If we already are going into the house to assess fall risk, why not leverage that visit to do a more holistic review of risk factors for LTC claims? And since this outreach can be costly, can we do a better job targeting the right people who are most at risk?

To do just that, my company began working closely with Assured Allies, a leader in independent aging and consumer engagement, and our customers, which include all of the top 10 LTC insurers.

From Insight to Action

Our industry has an opportunity to bring a more holistic and targeted solution to policyholders through programs built around data and engagement. If we can collect important information about policyholder health and risk factors, then stratify populations according to this risk, we can then begin engaging these policyholders with interventions proven to help them age independently.

This data collection can be done initially via health surveys that cover a broad range of topics, from caregiver support needs to safety measures in the home. By applying data analytics to this information, we can also better understand what types of evidence-based interventions are most appropriate for each policyholder.

The program then connects policyholders with personal health coaches. These skilled coaches work closely with each individual and their family members to guide them and identify resources that help them achieve their goals, whether that’s installing grab bars in the bathroom to prevent a fall or working on strength training and nutrition.

Driving Down Claims

Not only does this approach support these individuals in staying in their home, it will also help us address the larger issue of unsustainability in the LTC insurance industry. This sector is now experiencing upwards of 320,000 claims, which result in $11 billion in payments every year and rising.

There are some mechanisms in place to address this growth in claims, but carriers can only raise rates so much. As claims reach record highs, this forces LTC insurers to bolster reserves, which ultimately impacts their shareholders. These challenges have led to greater willingness by insurers to invest in pre-claim efforts like wellness programs.

Based on the data we’ve analyzed, I believe that many LTC insurance claims could be preventable, or at least delayed, but only with early intervention. The type of timely, evidence-based approach I’ve detailed here may help aging policyholders avoid devastating but preventable issues that threaten their health and independence. As an added benefit, it can also help ensure that LTC insurance policies stay affordable and accessible for younger people who will eventually need them as well.


Peter Goldstein Peter M. Goldstein is the president of LTCG, a provider of administrative, wellness and clinical solutions for the LTC insurance industry.

(Image: iStock)