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

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

3. 6 More Questions for your Actuary & 1 recommendation
What is the ideal size for 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?

4. 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

5. 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.

6. 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

7. 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

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

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

10. 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

11. Cost of Care
Source: Genworth Financial

12. 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

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

14. Should I integrate my members with a LPC?

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

16. 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