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Active seniors decrease health costs

SilverSneakers study shows significant benefits in year two

Being physically fit improves a person’s well-being and reduces mortality, and a recent study shows that a fitness program for senior citizens can control healthcare costs.

The study, “Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults,” was funded by the Centers for Disease Control and Prevention (CDC) and conducted by Group Health and the University of Washington, both in Seattle.

Researchers studied nearly 5,000 SilverSneakers participants, who are Medicare Advantage beneficiaries, over a two-year period. The retrospective cohort study discovered that total healthcare costs and inpatient admission costs increased at a smaller rate among SilverSneakers members than the control group. (For a breakdown of healthcare costs, office visits, and inpatient admissions, see the chart on p. 8 of the PDF of this issue.)

Steve Lindstrom, vice president of the Arizona Business Unit at Healthways in Tempe, AZ, says the study is important because health plans and Medicare are demanding positive ROI for wellness programs. The SilverSneakers study, which was published in Preventing Chronic Disease, a peer-reviewed electronic journal published by the National Center for Chronic Disease Prevention and Health Promotion, one of CDC’s eight centers, shows the benefits of fitness.

“We know that it improves people’s lives and their quality of life. That’s not enough in the world we are operating in now. We have to have these positive ROIs to prove these kinds of things work,” says Lindstrom.

The study’s lead author, Huong A. Nguyen, PhD, assistant professor of biobehavioral nursing systems at the University of Washington, says the researchers analyzed total healthcare costs, including primary care, specialty care, inpatient, and pharmacy.

A total of 4,766 participants were enrolled in the health plan for at least one year before participating in the SilverSneakers study. The control group consisted of 9,035 people who mirrored SilverSneakers’ enrollee demographics. However, the study participants were slightly older, used more preventive services, made more PCP office visits, and had higher total healthcare costs at the baseline. By using more preventive services, SilverSneakers participants were already taking control of their health, which affects costs in the long run, says Lindstrom. “When people are taking charge of their health, they are more aware of things and they will seek primary care more often and earlier, rather than not go and then have an event later where they have not done any prevention,” he says.

The study did not use self-reports to measure the participants’ fitness level and wellness, but Lindstrom says SilverSneakers asks its members quality-of-life questions annually so the program can track a person’s progress and benchmark the results. Because the study focused on the Medicare population, researchers did not take into account productivity, absenteeism, and presenteeism factors.

Researchers found cost savings—in the form of inpatient admissions—in both years of the study, although the first year was not statistically significant. Nguyen speculates that the delayed reduction in costs is due to the length of time the fitness program takes to improve participants’ health, but the study did not analyze the matter.

“We need additional confirmation from other studies. Hopefully, other health plans having seen our publication will be motivated to do their own internal evaluation and will publish their findings so we can see if they are seeing similar benefits across health plans that offer similar programs to their older adults,” says Nguyen.

Lindstrom says the finding mirrors other studies done on the program. The second year is when the benefits of consistent exercise and participation are evident.

Nguyen says she is pleased with the results but suggests health plans, DM, and wellness programs not jump to conclusions. She adds that the study’s findings are not definitive but hopes that it will stimulate further study.

The study’s authors also noted that managed care companies should be careful when creating these kinds of wellness programs. “Notably, the cost of the health club benefit was included in the overall cost allocations in this study. Therefore, in constructing such benefits, payers will need to ensure that the benefit cost does not exceed savings and potential resources required to build incentives for regular participation,” according to the study.

This study was the most recent to show cost savings for the SilverSneakers program. In a 2004 study, Highmark Blue Cross Blue Shield found that healthcare costs for SilverSneakers members were 30% lower than nonparticipants with similar demographics. In another 2004 study, researchers found that healthcare costs among Medica’s Medicare plan members enrolled in SilverSneakers were 11% lower than among the control group. The researchers estimated that the 3,000 SilverSneakers members in that study saved the health system $1.3 million in the program’s first year. The study also found that those who frequented the center reported better health.

Program keys

Lindstrom says there are three key elements to the SilverSneakers program, which was founded 15 years ago by Mary Swanson:

  • Evidence-based classes
  • A fun atmosphere
  • Social networking for seniors

Lindstrom says socialization and making older adults feel welcome in the fitness center are critical in reducing barriers to exercise. According to the recent study, 61% of SilverSneakers members remained active in the program for the second year. Healthways’ SilverSneakers contracts with 40 health plans with 4 million Medicare beneficiaries. SilverSneakers has about 3,000 participating locations, including fitness centers, YMCAs, and other health/wellness partners. SilverSneakers members can use the participating locations’ equipment and services, as well as special classes for older adults. There are 490,000 SilverSneakers classes annually, and 68,000 members participate each day, according to Healthways.

The program offers four types of classes. The basic class builds muscular strength and increases range of motion. Participants use handheld weights, elastic tubing, and a ball for resistance; they may perform the exercises seated, standing, or standing with support. Cardio, water training, and yoga make up the other three classes.

Any time a managed care company contracts with a fitness center, there is the question as to whether members are actually using the services. SilverSneakers’ business model, which makes the fitness clubs and health plans active participants, removes that doubt.

SilverSneakers pays the participating locations (and bills the health plan) each time a member visits. This means that when beneficiaries visit the fitness centers more often, the gym gets more money, and better fitness should mean a better ROI for the health plan.

SilverSneakers also uses 160 account managers, who are Healthways employees. They collaborate with the SilverSneakers fitness centers to ensure that they are complying with program requirements, training fitness center staff members, and driving enrollment and participation through senior events and marketing.

Each fitness center also employs a senior advisor, who works during the peak workout times for SilverSneakers members—morning and early afternoon hours. Instructors for SilverSneakers programs enroll in ongoing training and must receive program certification.

Lindstrom says SilverSneakers programs are expanding. Looking to retain more members, Healthways has created an intervention program that will reach all SilverSneakers members by the end of the year. Healthways will work with health plans so that regular SilverSneakers members who suddenly stop visiting their gyms are flagged and contacted by their health plan’s medical management team.

Lindstrom says the gym absences could be a result of depression, a caregiver issue, death of a spouse, or other issues. By intervening, health plans will be able to reach out to their members and potentially triage them to the proper programs. Such issues usually don’t come up in typical DM or other interventions “because it really hasn’t happened yet,” Lindstrom says, adding that Healthways is speaking with health plans in order to fund a study that would further confirm the positive ROI.

What does the SilverSneakers program entail?

Healthways’ SilverSneakers program offers Medicare Advantage beneficiaries the following services:

A free fitness center membership with 3,000 participating fitness centers

Customized SilverSneakers classes

Health education seminars and wellness events

A specially trained senior advisor employed by the fitness center who introduces members to the SilverSneakers program and the fitness center