Does Our Healthcare System Support Healthy Aging?

Aetna’s Medicare CMO outlines the potential of Medicare Advantage “to keep people happy, healthy and at home.”

Is our healthcare system well-equipped to support healthy aging? There are many ways to answer the question, from access and affordability to disease and mortality rates to Star Ratings. Answering well would require volumes.

How does the role of supplemental benefits and Special Needs Plans in the aging-care healthcare ecosystem of the country’s fourth-largest MA plan? We interviewed Dr. Ali Khan, Chief Medical Officer of Medicare at Aetna, a CVS Health company. Khan is also a practicing physician providing primary care for older adults on Chicago’s west side at Oak Street Health, also a part of CVS Health.

The ”whole ecosystem” of aging care

HealthLeaders asked Khan about one aging care model — patient-centered medical homes for seniors, with care coordinated by geriatricians — and how Medicare was performing in this respect and what it could do better.

“This is the active talk track for a lot of my day. I wish we had enough geriatricians and gerontologists to staff that kind of work,” says Khan.

“But any great clinician is thinking about more than just a patient’s lab numbers. They’re thinking: ‘What about the whole ecosystem of care, of health, and how do we put that together?” Khan said. “Is the patient trying to get to a doctor’s appointment? Do they have security challenges?’”

Khan adds: “Our goal from a Medicare Advantage perspective is to fill in those gaps, the missing pieces in a member’s day-to-day life — the places where their clinical teams are so busy taking care of patients, that they need a secondary player like us to come in and connect those dots.”

Khan provides a few examples of how Medicare Advantage “can unlock private sector innovation beyond traditional Medicare.” These include fitness benefits and social isolation support.

“We are making sure that every Aetna member has access to Silver Sneakers across 1,500 locations” says Khan. Silver Sneakers is a fitness benefit that expands behind exercise classes to include online/digital app education and support.

“We also know that 33% of older adults feel lonely. It’s the biggest health risk factor in our time. As a result, we spend a lot of time on social care connectivity programs.”

Khan also cited Aetna’s Resources for Living® Program, which connects members and/or their caregivers with community services and resources.

“Resources for Living helps members figure out how they want to live their lives and navigate related resources with an omni-channel approach [e.g., interaction via digital apps, phone, email, traditional mail]. Being able to offer these core services through our supplemental benefits program becomes really powerful.”

How supplemental benefits support aging care

Supplemental benefits are a key differentiator of Medicare Advantage. They represent extra benefits — dental, vision, and hearing, as well as SDOH services like transportation and in-home services — that original Medicare does not offer.

Khan noted that Aetna members “are excited about supplemental benefits and what they provide.” This includes care innovation.

“Over the past 10 years, there has been great innovation across all health plans to support people with food insecurity, to give them access to healthy meals — whether that's right after hospitalization or on a more regular basis.”

In addition to Silver Sneakers and Resources for Living, Khan cited the Aetna/CVS Health Extra Benefits Card, which provides a monthly allowance toward every day expenses like food, transportation, even durable medical equipment.

“Members make those decisions, and that helps give them autonomy.”

In addition to autonomy, supplemental benefits must deliver “real clinical impact” and support healthy aging while offering “a proactive journey for members.”  Here Khan applauds the power of proven programs outside of Aetna. One example is Capable, a Johns Hopkins University School of Nursing program that launched in 2009 and sends teams of nurses and carpenters into patient homes to identify needs and make repairs in real time.

“Capable was profoundly useful in reducing medical costs and improving quality of life for patients with low incomes,” says Khan. “So today at Aetna, we’re asking: How do we do that same kind of work? We don't have any carpenters in homes yet, but how are we proactive? How do we prevent problems before they start?’”

Khan asks these questions from personal experience, specifically his grandfather who had been a professor.

“We didn't catch my grandfather’s hearing loss. Two years later when his dementia became very abruptly noticeable, we realized that my grandmother had been covering for him for a long time. The biggest thing that his team said is that if we'd caught his hearing loss earlier, it probably would have enabled him to stay more socially connected.”

How Special Needs Plans support aging care

Supplemental benefits in Medicare Advantage help address the needs of specific members, including those enrolled in Special Needs Plans (SNPs). These plans cover those who are chronically ill (C-SNPs) and those who are dually eligible for Medicare and Medicaid (D-SNPs).

Two examples at Aetna include fall prevention services, which are a standard plan benefit for D-SNP members, and in-home supports for C-SNP members with congestive heart failure. The latter includes wireless scales that do not require member WiFi but can provide remote monitoring data on weight and fluids without a hospital or office visit.

These aren't just nice-to-have benefits. They can make a real difference,” says Khan.

“The shift is toward keeping people healthy at home,” says Khan. “That’s true across the board, but it gets really interesting within different cohorts of patients across different generations, even people who are potentially in their last year of life.”

How Aetna’s CVS connections support aging care

Aetna is not the only partner in these efforts. As a CVS Health company, it collaborates with the pharmacy-clinic retailer and its other companies. They are Signify Health, a technology and services company with a network of 10,000 clinicians who support in-home care in 50 states, and Oak Street Health, a network of comprehensive primary-care centers for older adults.

Khan details how all four companies work together.

“Now, Aetna can leverage reminders from CVS pharmacists right at point of care. Or identify high fall risk based on Signify Health’s home health assessments. Or deliver high-value primary care through provider networks like Oak Street.”

“We're here to shift care from reactive to proactive,” says Khan, adding that “the potential of Medicare Advantage is to show how benefit and resource coordination come together to keep people happy, healthy and at home.”

The Aetna Medicare CMO concludes: “The more we are doing to provide common sense benefits and ensure members understand what they're eligible for, the more we're connecting the dots. That's the work we're here to do.”