LIMRA LOMA DI

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(No Transcript)
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LIMRA LOMA DILTC Insurers Forum September 6-8,
2006
ARE THERE ANY SILVER BULLETS OUT THERE?
Deborah Kahler CHCS Mary Ann Wilkinson Gen Re
LifeHealth Carole Wright CHCS
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Silver bullet

• A Program
• Driven By A Plan
• Based On Function
• Focused On Where Claimant
• Could Be Tomorrow

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A Successful Study

• Community based study using occupational therapy,
  assistive devices, and home modifications vs.
  Standard Homecare
• 37 reduction in home care cost
• 74 savings NH hospitalization combined
• After 18 months program participants scored
  better in function, mental status, pain vs.
  standard homecare participants.

ARCH Fam Med/Vol. 8 May-June 1999 William Mann
OTR, PhD., et. al.
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Key Drivers

• Vision and Value

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Vision and Value through

• Fulfilling our fiduciary responsibility to
  protect the policyholders investment
• Supporting the financial stability of the policy
• Improved quality of life for our policyholders
• Disciplined objective decision making

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Evolution of the Program

• Conducted in depth claims analysis
• Reviewed cost of claims data that included
• Intensity of services ( hrs per day / days per
  week)
• Duration of claim ( length of time on claim)
• Analyzed clinical information included
• Age
• Diagnosis
• ADL deficits
• Reviewed national stats to confirm our findings

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Chronic Conditions Statistics
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Statistics on Assistive Devices
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Disabilities by Age

• National Center for Health Statistics

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Modalities

• Identified the modalities to be used in the
  Restorative Management Program (RMP)
• Considered the availability of resources
• Physical Therapy
• Occupational Therapy
• Social Worker
• Speech Therapy
• Skilled Nursing
• Durable Medical Equipment

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RMP Project Scope

• Incorporate a therapeutic rehabilitation model
  that focuses on a multidisciplinary collaboration
  by utilizing therapist (physical, occupational
  and speech), social workers and registered nurses
  nationally.

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Goals of the RMP Program

• To maximize the functional abilities of all the
  claimants / clients and encourage as much
  independence as possible with their ADLs/IADLs.

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Case Study

• 75-yr-old retired male policyholder residing in a
  single story home with his spouse. He suffered
  from a recent stroke and was hospitalized for 15
  days. He received some inpatient therapy prior to
  discharge. Discharged home with orders for
  physical, occupational speech therapy 2-3
  times/week.

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Assessment Clinical Findings

• Right Sided paralysis with facial droop (arm and
  leg)
• Difficulty swallowing - speech impairment
• Functional status post stroke-
• Requires hands on assistance with bathing,
  dressing, transferring, toileting, eating,
  walking
• Dependent for transportation, telephone use,
  finances, shopping, laundry, housekeeping and
  food preparation
• Generalized weakness and poor endurance

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Plan of Care

• Goals for this case study
• Knowledgeable about disease and any co-morbidity
• Participating in daily Home Exercise Program
  exercise developed by the PT
• Demonstrates safe swallowing
• Communicates need/wants and initiates
  communications
• Optimum independence and functional abilities
  with ADLs/ IADLs

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Rehabilitation Focus
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LTC Policy- Home Health Care

• Plan of service with support system in place
• Week 1 2 10 hours/day x 7 days week
• Week 3 4 8 hours/day x 7 days/week
• Week 5 6 6 hours/day x 7 days/week
• Week 7, 8 9 4 hours/day x 7 days/week
• Week 10, 11 12 2 hours/day x 7 days/week

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Discharge Outcome

• Completed therapies with an increase in overall
  functional mobility
• Utilizing assistive devices in the home to help
  with ADL independence
• Autonomous and in-charge of most of his
  healthcare
• Policyholder, spouse, family satisfaction with
  care and living arrangements achieved

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Measurement of Program Benefits

• Intensity of Services
• Duration of Claim
• Direct Cost of Care
• Total Claims Cost
• Satisfaction Survey

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Summary Results of the RMP
53 reduction in duration 39 reduction in the
direct cost of care HHA
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Satisfaction Survey

• Care Coordinator verified current care situation
  and assisted with needs
• Explained the therapy in a manner that could
  clearly be understood
• Felt the therapy goals were reasonable and
  obtainable

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Satisfaction Survey

• HHA assisted with care needs adequately and
  appropriately
• HHA assisted with the home exercise program when
  the therapist was not present