When examining a Medicare Advantage (MA) population, one unhealthy day was enough to increase 30-day medical costs, a new study found.
The study sought to examine the connection between self-reported physically and mentally unhealthy days and health care costs among an MA population. One of the driving forces behind the study was Papa, a company that has a number of wide-ranging partnerships with MA plans.
“As a vendor, or a supplemental benefit, we’re in this tough position where we want to prove our value,” Kelsey McNamara, senior director of research at Papa, told Home Health Care News. “Our clients are asking us, how are you reducing medical costs? It’s rare that we have direct access to health care claims data, so we work hard with our partners to do studies and do claims-based analyses.”
Founded in 2017, Miami-based Papa is an in-home companionship platform that connects Papa Pals with older adults. Aside from companionship, Papa Pals provide seniors general assistance, including transportation services, light housekeeping and similar task-based help.
McNamara is one of the study’s authors.
The study looked at a regional Ohio-based MA plan that has partnered Papa to give its members access to companion care services. The MA plan has roughly 23,000 members.
These members were asked to report on their physical and mental health using the Center for Disease Control and Prevention’s (CDC)healthy days measure.
Overall, the study found that each additional unhealthy day a member reported was associated with an increase in 30-day medical costs – $60 for physically unhealthy days, and $34 for mentally unhealthy days.
“What that means is, if we can improve health-related quality of life and reduce the number of unhealthy days that people report, we can have confidence that we’re not only providing value to the members by improving their health related quality of life, but that we’re also providing value to our clients and health plans, that this is likely translating to a reduction in medical costs for our partners as well,” McNamara said.
This finding, of course, also is of note for traditional home care providers that interact with MA plans’ members.
McNamara noted that those eligible for the Medicare Low Income Subsidy were more likely to use companionship care.
“It just goes to show that people who are low income are roughly twice as likely to engage with a service like Papa, and it’s because they need it,” she said. “That was just a nice finding that helps make that even more clear.”
McNamara also pointed out that the study emphasized the need for industry alignment around measurement tools.
“In an ideal world, we would all be using similar tools, we’d all be using the CDC healthy days measure, so we can compare across our interventions and be able to clearly see the value that we’re all providing,” she said. “Right now, everybody uses a different approach, a different tool. Getting better alignment and using something like the CDC healthy days measure would be a real win for the entire industry.”
Ultimately, McNamara believes that it’s more important than ever for companies to prove their value to their MA plan partners.
“We’re in this period where health care utilization is going up,” she said. “Health plans have less money to spend. There are higher cost trends. SDOH industry companies, we really need to provide and show value. Members rely on us. We need to evaluate our outcomes and prove that we’re helping the people who have historically been left behind. We always say, ‘We can only improve what we measure.’ And we risk limiting our collective impact if we’re not all holding ourselves accountable.”
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