A gray wave is poised to wash over this country thanks to the aging of the baby boomers, and it is a wave whose effects will be felt from coast to coast. Today, seniors are 15 percent of the American population, but in less than 20 years, adults 65 and older will comprise 22 percent of our citizens (see Figure 1). In fact, it is predicted that the number of Medicare-age adults will outnumber children under the age of 18 by 2035, according to the U.S. Census Bureau's 2017 National Population Projections.
Of course, there is a huge difference in the health status of those just turning 65 and people 30 years into retirement. That is why CHI St. Joseph Health in Texas is segmenting its senior population in order to serve it more strategically and efficiently.
"In 2013, we were already caring for over 50 percent of the seniors in our market," said Donovan French, division vice president of strategy and business development. "In our service area, the over 65 population was growing five times faster than the other demographic segments combined." Unfortunately, the health system's largest primary care medical group was finding it increasingly difficult to provide the more complex care seniors need because of time constraints. It was becoming obvious that seniors could benefit from a more comprehensive care model. As a Catholic health care system dedicated to serving all, including the sick and poor, CHI felt a responsibility to create one for its aging community.
Segmentation and Strategy
CHI worked with its strategic partner Health System Advisors to help grow its penetration in the senior population through segmentation, and create a multi-faceted strategy for caring for older adults of any age (see Figure 2). Together, they identified four different cohorts within the over 65 market, all with varying health care needs:
- Healthy seniors with one chronic condition or less—The goal for this population is to help older adults remain healthy and active.
- Seniors with two or more chronic conditions—For this cohort, disease management is the priority. CHI began developing a multidisciplinary primary care model linked to chronic disease clinics, and aimed at increasing market share within this segment.
- Nursing homes residents—Typically, seniors in this cohort also have two or more chronic conditions, but their care is delivered in the residential setting.
- Super users—Although this is the smallest population in CHI's market, the group consumes far more health care services than any other. On average, these patients are hospitalized eight or more times a year and have the greatest number of emergency room visits. It is critical to closely manage their conditions.
Building the Infrastructure
As part of its senior segmentation strategy targeting both healthy seniors and those with two or more chronic conditions, CHI developed the MatureWell Lifestyle Center. A multi-purpose facility, the center combines aspects of a traditional medical clinic with a health and wellness facility. The 23,000-square-foot complex houses an integrated, multidisciplinary care team that offers geriatric and specialty care, physical therapy and the services of clinical pharmacists, dieticians, social workers and an on-site patient navigator. Lab and imaging services are also available, making the center a one-stop shop for geriatric primary care.
In addition, the facility offers a health and wellness club that features cardio equipment, fitness classes, an exercise pool and a demonstration kitchen for healthy cooking classes.
"The goal is to attract healthy older adults and create durable relationships as they start needing more care within the health system," said Kate Lovrien, principal with Health System Advisors.
To reach nursing home patients, CHI began engaging more directly with these facilities to take on their medical directorships. It used geriatrician-led teams with local nursing homes and a nurse practitioner that supervises care delivered onsite. CHI currently holds medical directorships at a majority of the nursing homes in its market.
To manage the care of super users, CHI set up an infrastructure through its clinically integrated network and accountable care organization to identify, coordinate and track care for high-risk seniors that have frequently presented in its emergency room.
The Lifestyle Center opened in March of 2017 and current volumes are exceeding budget in every area, including two geriatric practices and the physical and occupational therapy clinic. The health club has reached 80 percent of its goal of 500 members, and there has been significant crossover utilization of geriatric medical services. "Some seniors began seeing our care teams after they started using the club," said French. "And it's also worked the other way, with patients in our clinics becoming club members."
The chronic disease specialty clinic is showing impressive results as well. After the first year, readmission rates of patients enrolled in CHI's congestive heart failure clinic fell 50 percent by linking them with a nurse practitioner upon discharge.
"Our market is still rooted in the fee-for-service model, so population health is not a big focus in our area," French noted. "We engaged in this strategy because we feel it is the right thing to do in caring for our seniors."
French and Lovrien advise fellow strategists and marketers to remember:
- Organizations should begin customizing care as soon as seniors enter their health system in order to build ongoing loyalty.
- Customization is not just about the environment. It also involves the protocols, processes, services and experiences that are offered.
- Coordination with a core group of primary care providers aligned with your strategy is critical.
Learn more about senior strategies by downloading "Customizing the Health Care Experience for Seniors: What, Why and How" from SHSMD's Virtual Conference at shsmd.org/virtualconference.
This online resource provides you with access to recordings and slides from the society's 2018 annual conference.
This article features interviews with:
Vice President, Strategy & Business Development
CHI St. Joseph Health
Health System Advisors