Wednesday, March 17, 2010

Reducing Social Isolation Among Elders Enrolled in Medicare Advantage Plans: One Secret Sauce Behind the Cost Savings of Silver Sneakers?

When the Disease Management Care Blog isn't looking for its meclizine to help it deal with the vertigo-inducing travails of health reform, it's been looking at the seniors at its local health club. That's because, like many fitness centers, the DMCB's gym offers Silver Sneakers (SS). If SS is in session, forget about finding a convenient parking spot, an open treadmill or any room in front of the free weights: these elders mean business. There's one buddy of the DMCB who is working on her lats. You go gurl!

Readers may recall SS offers specially tailored exercise and wellness programs for the elderly. The outfit is owned by Healthways and it's services are typically sponsored (a.k.a., paid for) by health insurers, many of which are Medicare Advantage or Retiree plans. SS and similar wellness programs are not part of the fee-for-service Medicare benefit. While the insurers seem to market SS as a value-added insurance benefit that helps retain business (and may have some underwriting advantages), there's credible research that shows SS also reduces claims expense. You can get a sense of what this is all about by looking at this short video.

In its travels to the gym, what has struck the DMCB isn't the prevalence of Grateful Dead T-shirts or the disappearance of blue rinse as a fashion statement, but the amount of socializing going on. Not only is there lots of chit chat around the work-out machines (and, by the way, they're not very happy with the President), but the once-a-month pizza night is a big favorite. For that, folks start arriving 1/2 an hour early.

Which makes the DMCB think that that may part of the secret sauce behind SS's track record in reducing claims expense in this elderly population. It's been long recognized that social isolation has significant neuroendocrine effects, has a significant association with disease outcomes, correlates with the sense of overall well being and may influence seniors' level of cognition. While the exercise itself certainly has benefits (it reduces falls for example), the comraderie typified by Tuesday night pizza may be an important ingredient in achieving the insurers' cost savings.

Lacking any evidence, however, that's only a DMCB suspicion. Short of some sort of randomized clinical trial (comparing exercise without socialization to the same exercise with socialization), the 'degree' of social interaction (asessed, perhaps with a standardized survey of the participants) of a random sample of SS clubs could be mathematically correlated with insurers' claims expense. R squared anyone?

In the meantime, the DMCB says keep it up. While Medicare Advantage plans seem destined to have their premium payments reduced (and who knows when the mandarins in Congress will see fit to offer it in FFS Medicare), it seems that continued investment in Silver Sneakers is a smart thing to do. It increases fitness, decreases the key problem of social isolation and gives the DMCB some serious inspiration, even if has to wait to complete its preferred exercises.

Now where's the meclizine......

No comments: