Contributor: Using Real-world Data to Study and Improve Health Outcomes in Aging Populations

The growth of Medicare Advantage and delivery of supplemental non-medical benefits

CMS projects Medicare Advantage (MA) will continue its steep growth in enrollment, reaching 31.8 million people in 2023—about half of all Medicare enrollees. Recent studies leveraging real-world health care data are adding to the evidence regarding the value of MA, particularly related to new flexibilities enabling the delivery of supplemental nonmedical benefits to MA beneficiaries.

In 2022, 34% of MA plans offered at least 1 nonmedical benefit, with services that included meal delivery, transportation, strategies to reduce isolation/loneliness, and more. Studies indicate that social determinants of health (SDOH) factors like low income, lack of transportation, and social isolation have a significant impact on an individual’s health and health outcomes. The National Academy of Medicine first reported in 2017 that medical care accounts for only 10% to 20% of an individual’s health outcomes, with 80% to 90% attributed to health-related behaviors, socioeconomic factors, and environmental factors.

Nonmedical benefits can address social risks resulting in better outcomes for patients and lower health care costs for payers like Medicare. However, evidence is limited around the true value of MA plans’ ability to address SDOH through supplemental benefits.

New study leveraging real-world data examines value of healthy aging programs

Inovalon recently partnered with Tivity Health to analyze the impact of its SilverSneakers healthy aging program. Headquartered in Tennessee, Tivity Health offers health improvement, fitness, and social engagement solutions to 75 million MA members nationwide. Although healthy aging programs track valuable data on member participation, these programs and the MA plans that offer them have limited or no access to health care outcomes data for participating members, which is essential to understanding the value of the program.

Tivity enlisted Inovalon as an independent third party to use real-world data and advanced analytics to assess the impact of its SilverSneakers program on members’ health care utilization, costs, and quality outcomes. SilverSneakers is a community fitness program offered to over 18 million seniors that promotes greater health engagement and accountability by providing exercise and social opportunities at 22,000 locations nationwide. In operation since the early 1990’s, SilverSneakers is offered as a supplemental nonmedical benefit to more than half of all MA plan enrollees through partnerships with over 70 MA plans. This study provides new evidence related to the value of the SilverSneakers healthy aging program.

The study compared (1) pre- and postprogram results among MA members participating in the program and (2) participating members to a matched sample of nonparticipating MA beneficiaries. Medical and pharmacy claims from Inovalon’s MORE Registry, a warehouse of data sourced from more than 160 health plans across the nation that utilize Inovalon’s analytic services, were linked to members with 12 months of participation in the fitness program and enrolled in their MA plan during the same period.

Study findings demonstrate improvements in utilization, cost, and quality performance

A total of 8555 program participants were included in the study. The propensity score-matched sample included 42,775 nonparticipants. The participants’ mean age was 67.5 years, there were 63.6% female participants, 10.8% were dual eligible for Medicaid, and 21% were enrolled in Medicare due to disability/end-stage renal disease. Nonparticipants had similar baseline characteristics as participants after matching, including similar prevalence of chronic conditions (ie, 1 group was not healthier or more chronically ill).

Study findings show that MA beneficiaries who participated in the program had lower health care utilization, incurred lower medical costs, and had better performance on key quality measures after joining the program and compared to similar nonparticipants:

• Lower health care utilization: Fitness program participants experienced lower health care utilization after joining the program compared with similar nonparticipants, including fewer inpatient hospitalizations and emergency department visits. The mean number of hospital stays declined significantly before and after SilverSneakers: from nearly 13 to 10 stays per 100 patient-years.
• Lower costs: Participation in the fitness program was associated with significantly lower costs. Total medical and pharmacy costs were reduced by 16% after joining the program. Considering medical spending only, costs were more than 25% lower, driven primarily by fewer inpatient stays. The largest cost savings were among fitness program members aged 80 years and older, who had 3 or more chronic conditions, and who were nrolled in Medicare due to disability. Thus, the largest savings were found among older Medicare beneficiaries, those with multiple chronic conditions, and members enrolled in Medicare due to disability.
• Improved quality measure performance: Program participants had better performance on key measures of quality for MA plans, including greater adherence to hypertension and cholesterol medications after joining the program compared with nonparticipants, lower rates of 30-day all-cause hospital readmissions compared with nonparticipants, and hgher rates of vaccination and disease screening

These results were associated with higher ratings on measures in the CMS MA 5-Star Rating system. For instance, participants demonstrated significantly better performance on 30-day all-cause readmissions, a triple-weighted Star measure, compared with nonparticipants (9.1% vs 4.7%), a difference between a 4-Star vs 5-Star rating.

Study results increase evidence base around value of healthy aging programs

Results from the pre/post and matched sample analyses were largely consistent, suggesting the findings reflect real-word improvement associated with healthy aging programs like SilverSneakers. Findings were also consistent with previous analyses of senior fitness programs.

Importantly, the study expands the evidence base by using a large national sample of program participants linked to complete medical and pharmacy claims for 12 months and increases external validity by including a diverse set of MA plans. It also adds new evidence related to important measures of quality and differences based on age, disease burden, and disability status.

Real-world evidence can inform MA plans about the value of specific nonmedical benefits. The return-on-investment data for these new benefits are largely lacking but are essential to support expanded access to services and resources that can address health disparities. From improved member outcomes to improved health equity and greater health care system efficiency, the implication of these study results is clear: Supplemental nonmedical benefits like senior healthy aging programs can provide significant value for members, providers, and health plans.