America is getting older, and seniors have been able to live active and fulfilled lives well into their golden years. With the Baby Boom generation benefiting from improved standards of living and the progress of modern medicine, the country’s population continues to skew older.
In spring 2023, the U.S. Census Bureau published observations drawn from 2020 census data that demonstrate just how significant this shift in age has been. In the past century, the population of people aged 65 and over grew nearly five times faster than the total population. In 1920, about 1 in 20 Americans were age 65 and over, but by 2020, that ratio increased to 1 in 6.
With Americans growing older, we’ve been forced to adapt how we pay for and deliver health care. Since Medicare became law in 1965, senior Americans have been relying on the program for most of their health care needs. But the growth in our aging population combined with new and expensive medical treatments have put us on an unsustainable path. Between the years 2000 and 2022, Medicare spending increased a whopping 272%, up from $200 billion to $744 billion, according to data compiled by KFF Health News.
The Centers for Medicare and Medicaid Services (CMS) has been working diligently for decades to test and implement new payment models aimed at controlling spending while improving care and outcomes. Medicare Advantage (MA) has been by far the most popular program for achieving these goals. The difference is that MA shifted away from fee-for-service in favor of value-based care models that enable private insurers administering these plans to focus on whole-person care.
As shown below, MA now accounts for half of all Medicare enrollees. That growth is expected to continue with MA on track to reach 69% of the Medicare population by the end of 2030.
A Growing Need for Comprehensive Behavioral Health Care
As health care for seniors continues to evolve — and the older population and adoption of value-based care grows — attention should be paid to senior behavioral health.
Mental health conditions among seniors have been steadily increasing for several reasons. One of the most notable is social isolation, which was an existing challenge that worsened with the COVID-19 pandemic. The effects of social isolation can quickly compound, leading to trauma, anxiety and depression.
Additionally, seniors have not been immune to the ongoing opioid crisis. Since seniors are more likely to suffer from chronic illnesses, they are highly susceptible to the addictive properties of prescription opioids. Substance use among older adults, especially related to alcohol and prescription drugs, is a widespread problem. Substance use disorders stemming from prescription drugs affect up to 17% of older adults, and as the Association of Health Care Journalists points out, the problem is “largely underestimated, underidentified, underdiagnosed and undertreated.” It’s not uncommon for these addictions to be mistaken for other age-related conditions, like dementia, heart disease and increased frailty. Yet two-thirds of seniors with mental health problems ultimately do not get the treatment they need.
The Feedback Loop of Mental and Physical Health
The links between mental and physical health are well documented, and while mental health problems often increase the chances of physical health problems, the opposite is also true.
For example, in some cases, mental health disorders will have an adverse effect on a person’s sleep habits, placing a physical toll on their bodies that can manifest in various ways. Conversely, the onset of chronic disease could create mental health challenges that effectively cause a person’s overall health to spiral.
A study published in 2021 by the American Heart Association (AHA) pointed to a growing body of data that suggests a relationship in the ways a person’s mental health can “positively or negatively affect cardiovascular health, risk factors, events and prognosis over time,” also known as the mind-heart-body connection.
This connection extends well beyond heart disease. Mental illness also increases poor outcomes and mortality for common conditions such as cancer, hip fractures and diabetes, and the life expectancy for people with severe mental illness is shorter than it is for the general population.
As President Biden pointed out when launching an initiative last month to expand mental health benefits, “mental health care is health care.” It should be treated no differently than when a person seeks medical help for a cold, broken arm or other physical ailment. This is especially true for seniors — a group whose mental health issues have been historically underdiagnosed and undertreated.
“By recognizing the link between mental and physical health among seniors and focusing on whole-person care, we can decrease the rate of spending while providing older Americans with improved quality of life.”
Brian C. Doheny – Chief Operating Officer, Lucet
Lucet Can Help with Behavioral Health Integration
With Navigate & Connect, Lucet can facilitate behavioral health care integration for health plan members with predictive screening, improved scheduling access and better outcomes.
Lucet’s increased connections to care have proven to help save costs. Our partnership with health plans has resulted in savings of more than $90 per connected member per month (PMPM), sustained over three years.
In addition, a five-year analysis of our care management services for one prominent health plan delivered benefits including:
- 46% decrease in total emergency room visits for physical concerns for enrolled members
- 32% fewer total inpatient admissions compared with non-enrolled members
- 46% decrease in emergency room visits for enrolled members with substance use disorder, compared with a 13% increase for non-enrolled members
By working with Lucet to focus on mental health care among seniors, Medicare Advantage plans can realize similar results. Lucet can help administer a robust mental health program that delivers concierge-level care management services to seniors to close gaps in care across the acuity spectrum.
By recognizing the link between mental and physical health among seniors and focusing on whole-person care, we can decrease the rate of spending on senior care while providing older Americans with the improved quality of life they deserve.
Brian C. Doheny, FACHE is chief operating officer at Lucet.
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