How can Actuarial Science Help Providers Create a Sustainable Life Plan at Home (CCaH) Program?

PART II Considerations for Existing Life Plan at Home (CCaH) Organizations by Brad Paulis, MAAA, ASA, FCA Partner Continuing Care Actuaries

6 More Questions for your Actuary & 1 recommendation What is the ideal size for an @Home Program? How do I meet changing consumer demands? How do I help members with LTC Insurance? Do you really know the long-term cost? Should I integrate my members with a LPC? How do I evaluate my results?

What is the ideal size for an @Home Program? Median costs of nursing home in 2016 $82,125 – Semi-private $92,378 – Private 50% of Americans underestimate the cost of in-home long-term care Source: Genworth Life Plan at Home programs: not tied to bricks and mortar can serve a larger mission can meet the needs of seniors

Marketing an @Home Program Serve (and expand) the mission Meet the needs of future generations AND Diversify market risk High consumer appeal with low capital cost. Improve financial ratios, with relatively low expansion costs and virtually no capital costs.

How do I meet changing consumer demands? Package of services Plan options Benefit caps (financial risk) Access to services (make or purchase) Portability Access to CCRC Campus Margin/Pricing Use of Membership Fees

How do I help members who have Long-Term Care Insurance How many prospective members already have long-term care insurance? What is the difference? What options are available to the at Home Program

Long-Term Care Insurance LPAH Program vs. LTC Insurance Similarities Long Term Care Benefit Differences Community feel Care Management Pricing Assumptions

Do you really know the long-term cost? Do we really know… what the lifetime costs are? how large the tail expenses are?

Do you really know the long-term cost? Percentage of Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility

Cost of Care Source: Genworth Financial

Cost of Care Our experience is that at Home Programs successfully manage down care so that utilization of facility based care is significantly less than seen in Life Plan Communities Health Care Ratio = (Perm AL Residents + Perm SN Residents) (At Home Members + Perm AL + Perm SN) At Home Programs: 5-7% CCRCs: 18-22% Average age for need of permanent healthcare At Home Programs: 88.1 CCRCs: 86.7

Should I integrate my members with a LPC? Marketing Operations Delivery of Services Transfers

Should I integrate my members with a LPC?

How do I evaluate my results? Keys to a successful program Marketing Quality care manager Effective medical underwriting

How do I evaluate my results? Marketing Tracking Claim and Utilization Data Importance of Underwriting Analyze data by year of entry Constant monitoring of data Evaluating experience on an annual basis Collaboration of providers