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......

A Role Model for Fitness. Or Rather, Thousands & Thousands of Role Models

The Disease Management Care Blog salutes Veronika Lusianoviaa* as a role model for fitness, wellness and prevention. Ms. L dotes on Nikolas (a canine of uncertain pedigree), cannot resist the lure of the make-up counters at Macy’s and dons nylons every day. She misses Richard Burton, prefers Vladimir Horowitz and has a working familiarity with Teilard de Chardin. She doesn’t use the TiVo, but only partly because of the GUI: there also little on TV that interests her. She finds email to be marvelous. She rarely queues and resists being rushed, but not because of the effort involved. She is not lazy. Rather, she has learned over her lifetime that there is little that is that important or cannot wait.

She recently decided to pay more attention to her health. At her discreet age, she has been to more than one funeral and knows that while death is fickle, it prefers the passive and the portly. She has also secretly concluded that her bottom should be of more modest proportions. She asked her nice doctor about getting exercise but the few minutes of worth of advice she received was about as helpful as her long deceased second husband’s plumbing skills.

Veronika is baffled by the modern ideals of elite athleticism, professional sport and freakish body builders. She wonders at her neighbor’s chubby son, who dreams of being a professional baseball player yet is partially immobilized by Grand Theft Auto. She has also read about silly persons older than her who jump out of planes, join karate classes, run marathons and other such nonsense. Despite widespread adoration of the famous and rich, she finds few lessons in their leisurely fitness regimes. Ignoring popular media’s cacophony, misinformation, disservice and fixation on rippled abs, Veronika has correctly concluded that more modest levels of exercise are suitable. For this alone she deserves an award.

Veronika had already joined the new Medicare plan because it was cheaper, she could see the same doctor, there is no intention of snowbirding to the strip malls and condos of Florida and the plan helps pay for some of her pills. She found out afterwards that the plan sponsored a once a week exercise program. She doesn’t care about the business model, but did care about having to forego the nylons. For this brave act also she deserves an award.

You go Veronika!

*Veronika is, of course a very fictional woman. However, a Google search on Silver Sneakers will generate hundreds of hits like this about many thousands of real persons much like Veronika who have something to teach the United States about the attainment of fitness.