A Graying America Challenges the Health Care System

Nearly one quarter of baby boomers are likely to live past age 90. Despite that longevity, aging baby boomers have high rates of chronic disease.

Although Americans are living longer, they’re not necessarily healthier. And a storm surge of older Americans looms.

The numbers add up to broad ramifications for the health care system. From those newly entering the senior age bracket to the oldest old, this growing senior population will need more treatment, spend more on health care and require more access to doctors, hospitals and other facilities.

More than 50 million people in the U.S. are now 65 and older – more than the total census of 25 states – and this segment is expected to grow much faster than the rest of the population, reaching 98 million by 2060.

And nearly one quarter of baby boomers are likely to live past age 90. Despite that longevity, aging baby boomers have high rates of chronic disease, including high blood pressure, high cholesterol, obesity and diabetes. About 80 percent of adults 65 and older have at least one condition, and almost 70 percent have two or more chronic health problems, according to the National Council on Aging.

Specialists needed

Specialized geriatric care is increasingly critical to meet the unique needs of this expanding elderly population. A shortage of health care professionals specifically trained to care for the elderly is already an issue and growing worse.

“Caregiving needs will affect us as a society – we should all care about this,” says Dr. Janice Knebl, the Dallas Southwest Osteopathic Physicians Endowed Chair in Geriatrics at the University of North Texas Health Science Center in Fort Worth, Texas. Knebl has advocated for all health professionals to be trained in geriatric care at some level.

By 2022, the American Nurses Association predicts, the U.S. may need more than 1 million new nurses alone to care for the growing number of older Americans and to replace nurses who are retiring. And physician ranks will thin as the baby boomers among them retire, as well.

Knebl helped launch one of 44 programs in the U.S. funded by federal grants to train future doctors, nurses, social workers and others to understand the complex conditions facing older adults. She recently testified before the U.S. House Energy and Commerce Subcommittee on Health about the shortage of health care professionals trained to meet the needs of the growing elderly population.

Geriatric medicine specialist Dr. Janice Knebl

Dr. Janice Knebl

“Across health professional training, there is a paucity of content focused specifically on ensuring the health care workforce of tomorrow has the skills and competence to care for us all as we age, particularly as our healthcare needs become more unique with the rise of multiple chronic conditions,” she told committee members.

Aging in place

Baby boomers are also accustomed to high standards of living, including quality health care.

They “are more educated consumers,” Knebl says. “They will demand more from our system, challenge it, push it.”

These seniors prefer to age at home with clinicians, medical equipment and products coming to them. This “aging in place” approach creates new demands for home maintenance, mobility and transportation, and access to programs and services. Even those looking at long-term care facilities expect to have a variety of care options.

They’ll need years of ongoing care, as well, and family members will do much of the daily caregiving. Many people are balancing their jobs with caring for aging relatives. Already, nearly 25 million people care for elderly friends or relatives. That often creates stress for families who lack the necessary skills and support. Businesses also feel the impact, with some workers using family medical leave to care for aging parents.

Insurers may serve as a guide for members and their families because encounters with the health care system become increasingly complex as people age, says Dr. Scott Sarran, a divisional senior vice president of health care management for government programs for the Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas.

Most medical decisions pass through the insurer for preauthorization of services, admission and discharge planning, and insurers employ nurses, social workers, medical management specialists, community health workers and health advocates who work together to support the patient and their family.

That added level of centralized coordination makes it easier for the member to get the care they need. It has been shown to lessen the chance of hospital readmissions, for example. Care coordinators can also help connect patients and their caregivers to community resources.

Caregiving needs will affect us as a society – we should all care about this.

That care coordination service is available to members of Medicare Advantage plans, which are Medicare benefits administered by a private insurer rather than the government. Seniors also covered by Medicaid (“dual-eligibles”) will often have additional services available via Medicaid, which is increasingly administered for the states by private insurers.

Exploring solutions

The surge in the elderly population presents challenges beyond caregiving, according to a Robert Wood Johnson Foundation report titled The 2030 Problem: Caring for Aging Baby Boomers. Chief among them is developing better payment and insurance systems to address the costs of medical services and long-term care.

The Centers for Medicare & Medicaid Services – tasked with leading the effort to address health care spending for the aging population – is changing the way it pays providers to get ahead of the uncontrolled and unsustainable spending it sees looming on the horizon. It is moving away from paying providers’ fees based on services they provide. That fee-for-service model is ripe for driving up costs, because more money is made when more services are provided, even if unnecessary.

Instead, CMS is adopting alternative payment models that reward doctors, hospitals and other providers of health services based on the value of the care they offer – providing high-quality care, coordinating care more effectively, and saving money for their patients with Medicare and Medicaid benefits.

Technology is also fueling new ways for the elderly to access care from their homes. Medicare provides limited coverage for telemedicine, or health care visits with a physician by phone or video chat. Congress is considering a nationwide telehealth coverage bill, named the Medicare Telehealth Parity Act of 2017, designed to introduce an incremental, though significant, expansion of coverage for telehealth services.

Medicaid waivers allow states to authorize some long-term services to disabled and elderly people through home care or community centers rather than nursing facilities, allowing seniors to stay at home while getting the care and social support services they need.

Insurers play a role in supporting these alternative approaches, including developing value-based care payment models with their provider networks and developing tools to deliver on government programs.

“Participating in both Medicare and Medicaid managed care programs offers us opportunities to help coordinate care for our members in ways that help them optimize their health as they age,” Sarran says. “It allows us to work with the state and federal agencies to take more proactive approaches in how we allocate resources, approaches that help people stay healthy as long as possible in the least restrictive environment.”


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