Policy & Providers
CCRC Without Borders(Continuing Care at Home)(Continuing Care at Home)
1
Presenters
Carol A. BarbourPresident – Friends Life CarePresident Friends Life Care
Ralph DonatoRalph DonatoConsultant – Towers Watson
Bob Yee (Moderator)Senior Consultant – Towers Watson
2Session 41: CCRC Without Borders
Agenda
• Overview of CCRC Business Model• Overview of Continuing Care At• Overview of Continuing Care At
Home (CCAH) Business Model• Marketing Considerations• Delivering the ServicesDelivering the Services• Financial Issues & Considerations• Questions
3Session 41: CCRC Without Borders
CCRC Business Model
• Brought to US from Europe over 100 years agoyears ago
• Provides housing, support services d h lth i land healthcare on a single campus
• Extensive, modified and fee-for-,service contract types
• Approximately 1 900 CCRCs in US• Approximately 1,900 CCRCs in US
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2009 CCRC Entrance and Monthly Fees by Contract Type
E i F FExtensive(Life Care) Modified
Fee ForService
E t F $160 000 $80 000 $100 000 Entry Fee $160,000 -600,000
$80,000 –750,000
$100,000 –500,000
I d d t $2 500 5 400 $1 500 2 500 $1 300 Independent Living
Monthly Fee
$2,500 – 5,400 $1,500 – 2,500 $1,300 –4,300
Monthly FeeAssisted
Living$2,500 – 5,400 $1,500 – 2,500 $3,700 –
5 800LivingMonthly Fee
5,800
Nursing Care $2,500 – 5,400 $1,500 – 2,500 $8,100 –
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Nursing CareMonthly Fee
$2,500 5,400 $1,500 2,500 $8,100 10,000
CCAH Business ModelHistoryHistory• Concern: no lower cost alternatives to CCRC• 1982: research begins to create CCRC
without walls• Organizational leaders:
– Foulkeways at Gwynedd– Brandeis University
• Funding: u d g– Commonwealth Fund– The Robert Wood Johnson Foundation
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The Robert Wood Johnson Foundation– Pew Charitable Trusts
1980s
• Develop business model• Search for relevant data; actuarial ;
projections• National & site-specific market researchp• Business plan/joint venture• October 1987: Certificate of Authority fromOctober 1987: Certificate of Authority from
PA Department of Insurance• November 1987-June 1990: presalesNovember 1987 June 1990: presales• July 1990: begin operations
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Fee Schedule – 1990 (Type A)
• Entry fee: $10 000 $44 000• Entry fee: $10,000 - $44,000• Monthly fee: $ 400 - $ 1,400• Life Care (no maximum lifetime limit)• No maximum age limitg
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Services
• Care Coordination• Home care (assistance with activities of
d il li i )daily living)• Coordination of Medicare home care
benefitsbenefits• Emergency response system• Home delivered meals• Home delivered meals• Adult day care• Assisted living facility (optional)• Assisted living facility (optional)• Nursing home (optional)• Referral Service
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• Referral Service
New Member Enrollment
282 276278300
202229
199
276
211
251232240 240254
278
214200
250
107
165
118
153178
148150
200
w Me
mbe
rs
107
48
8971
88
50
100New
0
50
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
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Years
Consider the Odds
• 85% of seniors prefer to remain in their own homes
• 70% of people over age 65 will require some form of long-term caresome form of long term care
• Probability of using that care for more than one year: highone year: high– Women – 85% with average of 4.2 years in
carecare– Men – 77% with average of 2.9 years in care
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The Friends Life Care Plan Today
• Daily benefits and benefit periodsy p– $75–$250 per day (in $25 increments)– 2, 3, 4, 5 and 7 year , , , y
• Elimination period0-365 days– 0-365 days
• Inflation protection
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Fee Schedule (Type B)
ANNUAL FEE (20% considered entry fee)$100 per day; 5% simple inflation$ p y; p
Age 3 year benefit($109 500 i fl ti )
7 year benefit$255 500 i fl ti )($109,500 + inflation) $255,500 + inflation)
50 $1,275 $1,529, ,60 $2,108 $2,58170 $4 332 $5 36070 $4,332 $5,36080 $7,295 $8,909
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Impact of Pricing Changes
• Increased consumer choiceIncreased consumer choice• Eliminated up front entry fee
Reduced overall fees• Reduced overall fees• Reduced risk to Friends Life Care• Increased market appeal
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Emergence of CCAH
1990: PA (licensed 1987)1998 NJ & VA1998: NJ & VA2003: TN, MD/DC, PA2004 OH2004: OH2009: CT2010 KS MI2010: KS, MI2011: NH, FL, NJ, CT2012 MI2012: MI4-5 under development
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CCAH Contract Types
Type A: • Large upfront entry fee (typicallyLarge upfront entry fee (typically
refundable or refundable on declining balance)balance).
• Ongoing monthly fee (sometimes waived if member requires SNF/ALF)member requires SNF/ALF).
• Unlimited lifetime benefit.
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CCAH Contract Types
Type B:• Modest entry fee paid upfront or overModest entry fee paid upfront or over
designated period of time (typically not refundable)refundable).
• Ongoing monthly fee (typically waived if member requires SNF/ALF)member requires SNF/ALF).
• Daily and lifetime limits on amount of care.
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Marketing Considerations
• What is the target market?• What is the target market?• What is the competition?• Marketing challenges
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Target Market - Age
Age• Minimum Age: 40Minimum Age: 40• Maximum Age: 81
Income• Age 40+: $55k• Age 65+: $25kAge 65+: $25k
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Why do people enroll?
• I don’t want to be a burden on my childrenI don t want to be a burden on my children• I want to protect my assets
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Competition
“I’m not going to grow old”
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Competition?
• Long term care insuranceLong term care insurance• CCRC
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“I’m not ready yet!”
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Delivering the Services
M di l d iti• Medical underwriting• Service eligibility determinations• Prevention and healthy aging initiatives• Monitoring and maintaining qualityMonitoring and maintaining quality
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The Care Coordination Department
Director of Care Coordination
BSW
Clinical Supervisors 1 OT, 1 BSW
Wellness Coordinators
1 MSN, 1 MS/OTR/L, 1 MSW, 1 BA (Gerontology), 1 DPT
At-Risk Coordinators 1 OTR/L, 1 MSW,
Care Coordinators 2 RN, 1 MSW
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Member Distribution June 2012
Well members 61.7%
Members at risk 26.2%
Members – home care 9.8%
ALF residents 1.4%
NH residents 0.9%
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Member Eligibility for Care
Risk and Functional Assessment Tool• Social risk factorsSocial risk factors• Medical risk factors
F ti l i k f t• Functional risk factors• Mental health risk factors
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CareSync Database
• Medical history• MedicationsMedications• Environmental factors
Lif t l f t• Lifestyle factors• Care plans• Assessment tools
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Four Evidence Based Prevention Programs
• Fall Risk Reduction Program• Cognitive Assessment/MemoryCognitive Assessment/Memory
Enhancement Program• Medication Management Program• Medication Management Program• Stroke Prevention Program
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Falls Risk Reduction Program
• Annually assess members beginning at the age of 70, using a specially designed toolg g y g
• Coordinate physical and occupational therapy for in-home strength and balance trainingtraining
• Perform Home Safety Evaluations and arrange for environmental adaptations asarrange for environmental adaptations as necessary
• Screen and refer for assistance withScreen and refer for assistance with Medication Management
• Install wireless sensor-based emergency
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response and activity monitoring system
VigRTM
Vitality • Independence • Growth • Resilience
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VigRTM
• VigR Enrichment WorkshopsM ti h• eMeetinghouse
• VigR Assessment Tools• VigR Mastery Experience
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Monitoring and Maintaining Quality
• Service Provider Network Quality C d ti liCredentialing
• Member Satisfaction Surveys • Concern/complaint log and tracking• Direct feedback from membersDirect feedback from members• Member Advisory Committee
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• Insert video here
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Policy & Providers
Management Responsibilitiesg
35
CCAH Compared to LTCI and CCRC
CCBenefits
CCAH
Premiums (Type B)
LT
CC
Regulations
TCI
CRC
Management Structure
Care Management IC Care Management
Funding Discipline
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Expected Income & Outgo($000 O itt d) C h t f 100 N M b
$300
($000 Omitted) Cohort of 100 New Members
$200
$250Income
O
$100
$150Outgo
$50
$100
$0
0 5 10 15 20 25 30 35 40 45 50
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Year
Program Design Considerations
Standard features• Issue age limitsIssue age limits• Benefit limits
O ti• OptionsDistinctive issues• Moderate Underwriting• Extensive care managementExtensive care management• Credibility of experience due to small size
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Risk Mitigation for Start-Up
• SWOT analysis (Strength, Weakness, Opportunity, Threat)pp y, )
• Market Research• Find reliable sources of utilization• Find reliable sources of utilization• Meet minimum size requirement• Care delivery system setup
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Start-Up
Financial DisciplineManagement
• Market research• Organizational
• Initial funding• Care contracting• Organizational
structure• Care network
• Care contracting• Product pricing
• Care network
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On-Going
Financial DisciplineManagement
• Sales & Marketing• Administrative staff
• Periodic financial review• Administrative staff
• Experience monitoring
review• Allocated fund for
future liabilitiesmonitoring future liabilities
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Critical for Success
• Passion for the program• Financial discipline: set up funds for futureFinancial discipline: set up funds for future
liabilities that are sufficient at any time• Clear communication between Board of• Clear communication between Board of
Directors and management
42Session 41: CCRC Without Borders