The high price we pay when seniors lack access to health care

Lack of access to health care is costly on many levels and creates a ripple effect for both patients and payers. From delayed diagnoses to poor management of chronic conditions, the inability to access care leads to:

• Sicker patients
• More frequent ER visits and hospitalizations
• Higher utilization of medical services

I grew up in an underserved inner-city community. Later in my own practice, I had the privilege to care for underserved patients in a rural community. Regardless of location, access challenges are part of my lived experience.

As a family physician practicing in low-income communities, many of my patients were faced with choosing between medication and food. I frequently used resources to help my patients contain costs, including the generic $3 and $4 medication lists available at some pharmacies.

I often had patients navigating housing problems that could mean living in their cars or couch surfing among friends and family. I’ll never forget one of my patients who was living on her porch because a fire made her trailer home uninhabitable.

The social determinant and behavioral health obstacles associated with poor health care access account for 60% to 80% of health outcomes and utilization,² making them an enormous concern not just for members but for payers as well. Solving the access problem for our seniors can’t wait.

Not only does delivering care in the home alleviate barriers to accessing health care, like transportation, that many of our seniors face, it also creates huge opportunities to improve health outcomes and lower costs.

Treating seniors in their homes allows us to better manage chronic conditions, helps us administer important preventive care and gives us a view of critical social determinants of health (SDOH) we may otherwise miss. For example, a care coordinator can:

• Connect a diabetic patient to resources accessing healthy meals
• Arrange assistance for a member who is homebound
• Provide additional support for someone returning home after breaking a hip

Prevention and care in the home instead of the hospital can reduce costs by over 10%, cut spending by nearly 35%, and generate savings of up to 30%. One study showed that members who were successfully connected to social services saw a 10% reduction in healthcare costs compared to those who were not. In another case, housing support for high-need members resulted in a 40% reduction in hospital stays and a 26% reduction in ER visits.³

Payers are in an ideal position to help bridge some of these gaps. When members have someone from their plan to connect them with the resources they need, the outcomes are better for everyone

It’s a disservice to all concerned to view seniors as a single group of people over age 65 with the same care needs. From comfort with telehealth to the desire for information and choice, baby boomers have very different attitudes and preferences toward health care than their parents. Physical health needs – and so much more – vary drastically among people who are 65 versus 75 versus 85.

There’s another shift that occurs within that age continuum. Too often, after contributing to their families and society for their whole lives, older people are marginalized – viewed as burdens and left out of their own care decisions.

To deliver truly equitable, patient-centric care to seniors, we need to know who our seniors are. To do that, we need to go to the source, allow them their voice and listen to what they have to say. They know better than anyone what they need to live their healthiest lives.

Here at Optum Home & Community, we’ve developed solutions to improve access to care for seniors, while aligning with their desires to age and receive care in the comfort and convenience of their homes.

We conducted over 2.7 million in-home health assessments in 2023 – screening for underdiagnosed diseases, identifying SDOH needs and making hundreds of thousands of referrals for needed assistance. In the process, we closed 87% of Star gaps.

Delivering seamlessly coordinated in-home care to members with complex chronic conditions, including 24/7 urgent support, empowers them to achieve and maintain their best health. In doing so, health plans can see savings from a 25% reduction in ER visits, hospitalizations and days in skilled nursing facilities.⁴

Safeguarding members through transitions of care and ensuring their safe return home and beyond not only improves their recovery experience but also reduces readmissions.

Change is hard, which is why it is often avoided until the pain of not changing becomes too great to ignore. We’re at the point where we can no longer afford to wait.

Among 10 countries with high-performing health care systems, the U.S. ranks first in spending – at 16% of our GDP and growing – and last in nearly all performance measures, including equitable access to care.⁵ The good news is that we rank second in care delivery.⁶

We can and do take good care of people, but that care isn’t accessible to all our seniors. We’re at a pivotal moment, with unprecedented numbers of people aging into Medicare. We can no longer afford to ignore the systemic barriers preventing seniors from having access to the care they need and deserve.

My reason for becoming a physician was to help people. When I was in private practice, I wanted not only to help my patients but also to support members of the community by providing employment opportunities. My private practice was financially successful because I learned early on to prioritize taking care of my staff and giving the best care possible to my patients.

The same is true for improving access to quality health care for our seniors. Achieving good business results is not in conflict with improving access – improving access can create good business results.

The data clearly demonstrates that improving access to care for all seniors is good for all stakeholders. Instead of reacting to health episodes, we need to foster lifelong health and well-being through home-based coordinated care for both physical and behavioral health, optimized technology innovation and a transparent, collaborative system that is available and affordable to all.

Improving access to quality health care is complex. Changing the things that are within our power to control can help our seniors now, while we continue the work of building a better senior care system – one that we’ll be using ourselves before we know it.