The average lifespan has increased by almost three decades since the 1950s. However, "health span" has not followed the trajectory, largely due to chronic conditions affecting aging populations and their quality of life. In the U.S., for example, the demographic of those aged 65 and over is projected to reach 20% of the population by 2030, and 70% of them are estimated to require long-term care at some point.
While Medicaid, a government program, can help to cover LTC costs, eligibility often requires individuals to redeem their assets and spend down most of their cash. This creates a financial burden for the elderly and their families and limits access to basic care. On the other hand, LTC insurers are facing challenges because of the rise in the number of claims (indemnity, reimbursement etc.), increase in capital risk due to increased cost of care associated with inflation, shortage of skilled caregivers and long cycle time for state filings for rate increases. So insurers are limiting their services to in-force policies and not underwriting new business.
The gap in care needs to be looked at by society, government, providers and insurers, and early diagnostics need to be leveraged to devise interventions to address age-related multimorbidity, such as dementia, Alzheimer's, chronic kidney disease (CKD) and frailty.
See also: The Crisis in Long-Term Care
LTC Challenges - Different Perspectives
For insureds and their families, financial stress is exacerbated by long claims processes and the resulting payment delays for monthly services such as home health aide services; higher premiums; and limited or no early detection or diagnostics services for multimorbidity conditions.
On the other hand, insurers are facing fraud, waste and abuse (FWA) challenges such as claimants misrepresenting impairments to satisfy eligibility, providers billing for services not rendered, increased claim payouts and underestimated cost of care, resulting in capital risk.
From the caregiver perspective, the cognitive declines among patients increase stress, especially when detected late.
These realities underscore the complexity of the care ecosystem and the need for innovative approaches to early detection of multimorbidity conditions. Such approaches would reduce the cost of care, increase health span and promote elderly independence.
New Pathways
With recent advancements in Alzheimer’s disease pathology, researchers estimate that up to 40% of dementia risk is attributable to 12 modifiable risk factors such as hypertension, obesity and physical inactivity. These factors, along with social determinants of health (SDOH) and non-modifiable risk factors, provide a means to identify the segments at risk, through machine learning algorithms.
Primary care providers can recommend or refer this segment for digital cognitive assessments such as speech analysis to determine the high-risk class. Those in danger could then undergo brain imaging or FDG-PET scanning; digital biomarkers would help to determine the deposits of amyloid proteins, if any, allowing for early detection and appropriate intervention to delay the onset.
LTC insurers providing benefit coverage for such scenarios will help to delay the condition and, thus, potential claims and reduce the financial burden for insureds. Also, digitization would enable straight-through processing for claims for recurring monthly services.
Digital twins for the aging, plausible digital copies (base on real-time physiological, medical data) of elderly people, can help to maintain a high quality of life. Connected homes (using environment/IoT data) can help prevent trips/falls, predict the onset or worsening of illness at an early stage and enable elderly to remain in their own homes.
See also: The Future of Caregiving
Empower the Future of Aging
An interagency coordinating committee (ICC) on healthy aging, chaired by the Administration of Community Living (ACL), has set a strategic framework focused on four overarching domains: age-friendly communities, coordinated housing and supportive services, increased access to long-term care services and aligned healthcare and supportive services.
LTC insurers, along with ecosystem participants such as regulators, primary care providers, specialists, community, facilities and care givers, play a vital role in realizing the vision of person-centered care, early detection and prevention services for healthy aging and independence.
