I have been having this conversation several times over the past few weeks with several organizations about the different types of models or programs in the industry. I think this is something that operators of programs also struggle to articulate. One of the first things we as operators of CCaH programs should be doing if we want to research outcomes is to define what this is and what makes a CCaH program fit into that category. Especially with more “membership” programs being established by Life Plan Communities, are these technically CCaH programs?
The simple elevator pitch for CCaH can sound something like a proactive membership-based program that helps older adults age in place with supportive initial services, care/wellness coordination, and coverage for future long-term care costs. These usually involve a one-time entrance fee or membership fee along with an ongoing monthly/service fee.
However, programs are evolving to meet what the consumer demands. I would argue that CCaH at its core is a proactive care management model designed to help older adults maintain control, preserve independence, and enhance quality of life wherever they choose to call home.
With this definition in mind, I have identified 4 different models of CCaH. I compare them with the way we categorize CCRC/LPC contracts in this framework.
Type A: Traditional CCaH
Also known to many in the business as a Life Care Contract. These contracts in the community setting mean the consumer pays more upfront and more per month so that as they move through the continuum their monthly payments will always remain the same.
It is similar in the CCaH industry, but traditionally provides more coverage than that of a community Type A.
I would consider this a Traditional CCaH model where members pay an entrance fee usually anywhere from $40,000 to $100,000+ and a monthly fee around $400-$800+ per member. These fees cover a package of initial services that usually include a personal emergency response system, a vetted vendor service (Dorvie), access to campus amenities if applicable, medically necessary transportation, and some meal delivery options. They also provide the core service of the care/wellness coordination. Then these programs will provide coverage for future long-term care services for the life of the individual. Coverage limits usually have a daily benefit limit that maxes out around the communities daily skilled nursing rate for a 100% coverage option. Then most programs offer 2 other options at a 70%-80% coverage for care at that rate and then a 50% option. For example, the 100% plan would cover $450 per day for care whether the person needs home care (non-medical or medical), assisted living, memory care, or skilled nursing with no lifetime maximum benefit. Then they would offer a plan covering $315 per day and then one covering $225 per day. The idea here is comprehensive coverage for complete peace of mind. Members also get priority or some preferred access to higher levels of care at the sponsoring community.
Type B: Hybrid Model
In communities these contracts typically cover some care but are not meant for full coverage. These can range drastically from a small discount to just a few days of facility coverage per person.
This is where CCaH programs get creative and can open the pricing models to be more attainable for the middle market. Programs do not have to offer lifetime coverage but instead limit the coverage to years or dollar amounts very similar to long-term care insurance. I have seen programs offer $250,000 or $500,000 lifetime maximums along with the daily benefit limits. You can have established plan options or make it a menu of options for consumers to pick from for their coverage amounts. These programs still offer the initial service packages and care/wellness coordination in the same way as the traditional model.
These benefit limits allow the cost to decrease for the consumer so maybe they can purchase a program for $25,000 and $400 per month or not have an entrance fee at all and just have a monthly fee based on age and coverage.
This model also provides protection to the organization in the way of actuarial liability. The possibilities of plan options are vast, which could be more attractive to the Baby Boomer market.
Type C: Care Coordination Only
Also known as the fee for service contract. For CCaH, I would consider this comparable to our Care/Wellness Coordination Only plan options or programs.
The program will provide some initial services plus the core service of care/wellness coordination, but when it comes to paying for services the consumer/member is responsible for that payment. The program really is just coordinating care and supporting the members. Most traditional and hybrid programs have added this plan to their offerings to accommodate individuals who may not medically qualify for another option. This has also been popular with those who have great long-term care insurance policies and do not need an additional financial protection benefit. However, we are seeing less and less of those policies.
These programs also provide access to amenities on campus of a community along with preferred access for higher levels of care. The access to services is a growing concern among consumers, so that alone can create value in membership.
Advanced Waitlist: Early Advantage
I am still on the fence on whether these programs can be considered CCaH models; however, if they do include the proactive care/wellness coordination in services I would be inclined to consider them one. I have been doing research on the make-up of these types of programs to truly understand how they would or would not fit. I am less familiar with the Early Advantage programs, so my first call was to Perry Aycock who has developed a number of these and is surrounded by them in North Carolina.
From that conversation, my takeaway was if your Life Plan Community already offers a Type A contract and has assisted living/healthcare beds to fill this is an excellent way to bring in additional revenue and help fill those vacancies. The community is really just opening their Type A contract to the broader community. Members would pay an entrance fee usually around $25,000-$35,000+ and a monthly fee for access to community amenities and then access to assisted living and skilled nursing. If they need care they would come into the community to receive that care and pay the discounted rates that are provided to Type A residents instead of the market rate.
The main differences are that no home care is covered and most do not provide the proactive care/wellness coordination portion that would be included in the CCaH models above. However, if there are programs that do include the care/wellness coordination I believe they should be considered a CCaH. Especially as we want to examine the outcomes and care utilization of those receiving that type of service. Should we then distinguish the programs that do that from those that do not and call them something different?
I am hearing more communities develop a “membership” program to their community which I think would fall under this category.
Conclusion
I don’t have all the answers, but my hope is that we can work towards this greater understanding and enhance the research surrounding it.
If we concur that the definition of CCaH should be one that includes the core service of care/wellness coordination, I think the next step is examining whether the prepayment of future services impacts outcomes differently from those programs that do not include that benefit. Then we should look at the components of the proactive care/wellness coordination to see how that intervention impacts outcomes for members.
Amanda Young, PhD, CMC, is the founder of MAL Consulting and a national expert in CCaH program development and operations. If you want to learn more or have questions, go to www.malconsulting.co or email Amanda at Amanda@malconsulting.co