You will need to produce a written paper. This individual project will focus on reviewing a case study about The Silver Sneakers program and writing a paper.
11-SHCD
September 1, 2013
Join the club: Improving senior health through exercise
For two million Medicare-eligible Americans, going to the club no longer means gathering for a
night on the town or meeting for a Friday night card game. Instead, they are meeting at one of
nearly 12,000 fitness sites nationally, courtesy of a partnership between their Medicare plan
and the SilverSneakers®Fitness Program, a well-being improvement program owned and
operated by Healthways.
The emergence of SilverSneakers
In 1992, Mary Swanson founded Tempe, Ariz.-based Healthcare Dimensions, Inc (HCD) with the
intent of creating unique programs that would advance both preventive behaviors and
population health for Medicare beneficiaries, and physician and employer groups. The genesis
of SilverSneakers, one of the initiatives under the HCD umbrella, originated in a very personal
experience: Mary’s father suffered a heart attack in his 50s, and Mary rightly believed that he
could have likely avoided this major health event had he been more physically active. He did
not exercise as regularly as his cardiologist recommended, but Mary also acknowledged the
dearth of fitness programs available and attractive to people her father’s age.
Clinical research findings showed that exercise reduced risks for colon cancer, breast cancer,
heart disease and diabetes, so Mary naturally deduced that health care costs would be reduced
in accordance. Integrating an exercise benefit into Medicare insurance plans would surely be
compelling to those insurance providers who could potentially reduce their costs while
improving the health of their beneficiaries. From that vision, SilverSneakers was born.
Over the next four years, with Mary at the helm of HCD, the SilverSneakers Fitness Program
transitioned from concept to reality. The objectives for the SilverSneakers effort were threefold: (1) Reduce lifestyle risk by getting older adults more active; (2) impact physical and mental
health and improve well-being by creating a social environment; and (3) lower costs for health
plans.
The idea, first articulated to forward-thinking health plans, was to offer a fitness center
membership to Medicare beneficiaries underwritten by their Medicare-contracted insurance
plan. In addition to having full access to the fitness center, SilverSneakers participants could
Kerry Hamilton, MBA, prepared this case on behalf of the Arizona State University School for the Science of Health Care Delivery. The case is
based on field research and interviews with representatives from health care organizations. The case was developed solely for the purpose of class
discussion and is not intended as an endorsement, primary data or an illustration of effective or ineffective management. Names and identities
have been changed to protect confidentiality.
Copyright©2013 Arizona State University. This publication may not be digitized, photocopied or otherwise reproduced without express written
consent from Arizona State University.
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Join the club: Improving senior health through exercise
attend specialized classes designed for the needs of seniors, to accommodate any physical
impairments they might have and also promote social engagement among their peers. The
framework of SilverSneakers was built around proven behavior change models to attract
seniors of any health status, even those unaccustomed to exercise. Also, fitness destinations
would be conveniently located for those living independently or in group or assisted living
environments. Program coordinators would create classes that welcomed and did not
intimidate, and could be adjusted to varying degrees of fitness and mobility. In 1996, HCD
secured its first SilverSneakers client, began collecting data to demonstrate the program’s
validity, and from there, the program soared.
In 2005, HCD merged with four other entities – a company that provided risk assessments and
telephonic lifestyle coaching, a web-based firm that provided online health and fitness tools, a
chiropractic managed care network, and a smoking cessation program – to form Axia Health
Management. Shortly thereafter, Axia was acquired by Healthways.
At the time, Healthways was primarily focused on chronic disease management and was
seeking a broader range of lifestyle resources in order to transition away from sick care and into
the well-being space. Axia brought a spectrum of expert and proven prevention and wellness
services to fill that gap. Today, Healthways is a publicly traded company and the largest
independent worldwide provider of well-being improvement solutions, serving 40 million
people on four continents. SilverSneakers is arguably Healthways’ most recognized and
marquee brand in the U.S.
Strength in numbers
As SilverSneakers grew in popularity and size, so did the competitive landscape. In order for
SilverSneakers to maintain its position as the nation’s foremost fitness program for the
Medicare population, Healthways (and its predecessors) acknowledged the need for robust
measurement of the program’s value to insurance providers.
To effectively articulate the value of the program through measurement, an understanding of
the SilverSneakers business model is essential. The financial model for SilverSneakers requires
contracted Medicare insurance providers to purchase SilverSneakers fitness membership
coverage for its beneficiaries from Healthways. In addition to a nominal, per-beneficiary
management fee collected by Healthways, the insurance provider only has to pay Healthways if
a given beneficiary activates the membership and then on a per-visit basis to the fitness center.
In turn, just as Healthways only receives payment from the insurance provider when a
beneficiary uses a membership, the contracted fitness center is only paid by Healthways for
11-SHCD 3
Join the club: Improving senior health through exercise
each time a beneficiary attends. This structure gives the fitness center motivation to utilize the
marketing resources and program coordination benefits provided by Healthways for member
acquisition and retention.
However, the contracted insurance providers, particularly those offering Medicare Advantage
plans which function like health maintenance organizations (HMOs) and comprise 60 percent of
SilverSneakers’ overall volume, have limited funds to spend on what are considered
“nonessential” benefits by the Centers for Medicare and Medicaid (CMS). Medicare Advantage
plans receive their funding from member premiums, which are usually quite low, and directly
from CMS. CMS funding is determined at the member level based upon a complicated riskadjusted formula that takes into account regional differences in health care consumption and
the members’ diagnoses. Each year, the health plans must submit their proposed benefit
designs and projected costs to CMS in a competitive bid process. CMS considers all bids in a
benchmarking process that includes Medicare fee-for-service expenditures in the same
geographic area. This leaves very limited dollars available for discretionary benefits, like vision,
dental or fitness coverage, which are not included in standard Medicare fee-for-service
coverage.
Further, CMS employs a quality rating program with Medicare Advantage plans, assigning from
one to five stars based upon achievement of certain standards of care. Higher star rating health
plans receive bonus payments from CMS. Medicare Advantage plans who earn the top
designation of five stars not only receive the highest compensation, but also have the
opportunity to market to prospective beneficiaries year-round as opposed to marketing within
a defined annual open enrollment period. Two of the star rating dimensions focus on fitness,
and providing SilverSneakers as a benefit can help those health plans maximize their star rating.
In addition to the “pay for play” revenue structure and the star rating implications, Healthways
also invests heavily in SilverSneakers program design and delivery options to create fitness
programs that match with the interests of prospective participants and build engagement. This
entails a wide variety of customization and an understanding of the physical and emotional
interests of the target audience, as well as a respect for their preferences by geography and
culture. For example, in Florida, where there is a significant Hispanic population, Zumba classes
prove wildly popular, but offering those same classes in rural Minnesota does not draw raves.
Seniors new to Medicare who are in good health and still feeling young at heart might prefer to
participate in classes offered to any age group or explore the entire fitness center, while others
who suffer from arthritis or mobility issues might require a low-impact class and feel
comfortable only among their peers. Yoga has become a high-demand fitness option, but
getting up from a yoga mat can prove challenging to some seniors. Thus, yoga classes designed
11-SHCD 4
Join the club: Improving senior health through exercise
to avoid floor work are more attractive to the target audience. Seniors who spend the majority
of the day indoors or who feel intimidated or overwhelmed by a fitness center might appreciate
a class held in a nearby park or local church. And while some prefer to engage in physical
activity independently and are accountable to themselves, still others respond best to the social
aspects of a regularly scheduled class filled with peers anticipating their attendance.
Communication to SilverSneakers participants includes use of online and social media platforms
as well as traditional hard-copy collateral, such as direct mail, flyers, posters and the like. All
highlight information about classes, program value and other relevant details. The most
engaged users are flexing their muscles through social media channels to remind fellow
participants about upcoming activities, issue fitness challenges and conduct other grassroots
outreach. Healthways also provides several online tools to support SilverSneakers participants.
Walkadoo delivers daily fitness challenges and activity is tracked by a small device the user
wears that lights up red, yellow or green depending on what the user has accomplished by
certain intervals throughout the day. Walkadoo allows for team competitions and encourages a
buddy system, and results are posted online in shared forums. PACT is an online fitness
commitment program that follows the user’s activity and helps build a social network of family
and friends who cheer on the user to achieve stated goals.
The SilverSneakers delivery system is supported by Healthways Fitness and Physical Medicine
staff in Chandler, Ariz. The team is collectively responsible for designing, implementing and
communicating programming to encourage participation in the 50 states and Puerto Rico
where SilverSneakers is offered, to address the fact that two-thirds of SilverSneakers
participants have multiple chronic conditions and more than half have never stepped into a
fitness center prior to activating their membership. This commitment to creating engaging
programming is an added value to the health insurance providers, who can only reduce their
expenses if their beneficiaries actually use the SilverSneakers program. For Healthways, it is a
business imperative to generate revenue to support the sustainability of the program and to
advance well-being. But regardless of the investment Healthways makes in the SilverSneakers
program, health insurers still want solid evidence of the connection between participant
engagement and reduced health expenses before they will justify including the SilverSneakers
benefit in their plans.
Proof of concept
The most effective approach to keeping the SilverSneakers program thriving, and better yet,
growing in volume, is to prove to the insurance providers that the cost of underwriting a
SilverSneakers membership is less than the costs of the individual’s health care if he or she
11-SHCD 5
Join the club: Improving senior health through exercise
remained sedentary. “Medicare Advantage plans only have economic room for so many
benefits,” says one Healthways vice president. “We have to be viewed as a must-have benefit in
order to market our services. We must prove that we can improve health and lower costs.”
By demonstrating the efficacy of SilverSneakers in reducing health care costs in seniors, and by
extension, improving overall health, Healthways can drive revenue and volume, and most
importantly, support Mary Swanson’s original vision of advancing wellness through unique
programming targeting seniors. As Healthways states in one of its 2013 reports, “Despite the
conventional wisdom that exercise is good for you, many have questioned whether a fitness
program designed for Medicare beneficiaries really can improve well-being and reduce costs.”
Healthways captures data to prove that SilverSneakers can do just that.
Its own business model makes collecting preliminary information about SilverSneakers
participation relatively simple for Healthways. When a beneficiary activates a SilverSneakers
membership, Healthways receives confirmation from the fitness facility and matches that
information with the insurance provider’s list of members. Every time the participant attends
the fitness facility, the visit is captured to provide Healthways with statistics on participation on
a weekly, quarterly or annual basis. Healthways issues an annual survey to eligible beneficiaries
to inquire about their participation, gather information on health status, and assess overall
behavior within the program.
CMS already conducts a survey of Medicare Advantage beneficiaries in every market in the U.S.
called the Health Outcome Survey (HOS) to evaluate physical and mental health, chronic
illnesses, disability issues related to daily living activities and preventive behaviors. Cohorts are
followed for a two-year period and results are compared. Using some of the same instruments,
Healthways has designed a complementary survey for eligible SilverSneakers participants,
focusing on behavioral and well-being criteria. A survey responder is followed longitudinally even across health plans – for many years if that member still has the SilverSneakers benefit.
Survey data enables Healthways to evaluate changes in health status against health care claims
costs and exercise behavior, and review them in parallel to the HOS.
An excerpt of the survey typically includes the following questions on functional health to
assess how SilverSneakers is impacting a Medicare beneficiary’s ability to complete the
activities of daily living:
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Join the club: Improving senior health through exercise
1.
2.
In general, would you say your health is:
Excellent
Very good
Good
Fair
Poor
○
○
○
○
○
The following questions are about activities you might do during a typical day. Does your health
now limit you in these activities? If so, how much?
a.
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or
playing golf
Yes, limited a lot Yes, limited a little
○
b.
○
○
Climbing several flights of stairs
Yes, limited a lot Yes, limited a little
○
3.
No, not limited at all
No, not limited at all
○
○
During the past 4 weeks, how much of the time have you had any of the following problems with
your work or other regular daily activities as a result of your physical health?
a.
Accomplished less than you would like
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
b.
○
Were limited in the kind of work or other activities
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
4.
○
During the past 4 weeks, how much of the time have you had any of the following problems with
your work or other regular daily activities as a result of any emotional problems (such as feeling
depressed or anxious)?
a.
Accomplished less than you would like
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
b.
○
Did work or other activities less carefully than usual
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
○
11-SHCD 7
Join the club: Improving senior health through exercise
5.
During the past 4 weeks, how much did pain interfere with your normal work (including both
work outside the home and housework)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
○
○
○
○
○
These questions are about how you feel and how things have been with you during the past 4 weeks. For
each question, please give the one answer that comes closest to the way you have been feeling.
6.
How much of the time during the past 4 weeks:
a.
Have you felt calm and peaceful?
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
b.
○
Did you have a lot of energy?
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
c.
○
Have you felt downhearted and depressed?
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
7.
○
During the past 4 weeks, how much of the time has your physical health or emotional problems
interfered with your social activities (like visiting friends, relatives, etc.)?
All of the time
Most of the time Some of the time
A little of the time
None of the time
○
○
○
○
○
Now, we’d like to ask you some questions about how your health may have changed.
8.
Compared to one year ago, how would you rate your physical health in general now?
Much better
Somewhat better
About the same Somewhat worse
○
○
○
9.
○
Much worse
○
Compared to one year ago, how would you rate your emotional problems (such as feeling
anxious, depressed or irritable) in general now?
Much better
Somewhat better
About the same Somewhat worse
○
○
○
○
Much worse
○
11-SHCD 8
Join the club: Improving senior health through exercise
Behavior changes equal cost reductions
Recognizing Healthways had to “come at it from a scientific perspective and needed to be
credible and valid to health plans that have medical directors who expect scientific proof,” in
the words of one executive, the company has regularly published data gathered from its annual
survey instrument and other well-being studies commissioned by Healthways’ Nashville-based
research team. The company summarizes many of these findings in a report called Well-being
Outcomes for Medicare Beneficiaries.
The Well-being Outcomes for Medicare Beneficiaries report is one of many reports culminating
from a partnership between Healthways and Gallup to measure well-being at the individual,
community, state and national level. Through telephonic surveys over a period of years,
Healthways could assess health trends over time in different regions, focusing on five specific
domains of wellbeing. In addition to the conclusions about the SilverSneakers program, the
study has also demonstrated that low well-being correlates with greater health issues and
higher health costs, and higher well-being is associated with greater productivity and less sick
time. Healthways’ commitment to research not only underlines the power of the SilverSneakers
program but has helped the organization define and position itself as a well-being company.
The following conclusions are published in the 2013 edition of the report on Well-being
Outcomes for Medicare Beneficiaries:
•
Participation in SilverSneakers is associated with better physical and emotional health,
higher functioning, and lower disability among seniors across many measures.
•
Over three years, SilverSneakers members demonstrate better trends than similar
seniors with respect to overall health status, health status change, emotional health,
social limitations due to health, overall disability level, and in ability to perform all 6
measured activities of daily living.
•
Greater frequency of exercise is associated with significantly better outcomes among
SilverSneakers members.
•
The provision of SilverSneakers can serve to improve quality of life and reduce the
burden associated with declining health and functioning as older adults age.
•
SilverSneakers participation resulted in reduced cost trends. Although SilverSneakers
participants had higher healthcare costs at baseline, their costs were the same as nonparticipants by year one and were significantly lower (average, -$500) in year two.
11-SHCD 9
Join the club: Improving senior health through exercise
•
SilverSneakers participants had significantly fewer inpatient hospital admissions in the
second year.
•
Greater participation was associated with higher savings—participants who averaged
two or more SilverSneakers health club visits per week had average savings of $1,252 in
year two compared to those with less than one visit per week.
•
SilverSneakers can help control health care costs for older adults with diabetes.
•
SilverSneakers participants with diabetes had $1,633 lower average health care costs
than the control group after one year in the program.
•
Year two costs were $1,230 less for SilverSneakers participants than the control group
and significantly fewer participants were hospitalized.
•
Higher program participation was associated with greater savings. Participants
averaging two or more fitness center visits declined in cost over two years and had
savings of $2,141 in year two relative to those with lower participation.
•
Medicare Advantage members with depression were as likely to join SilverSneakers as
members without depression.
•
Depression was associated with higher risk for lapses in participation, but only after 15
months.
•
Greater participation in SilverSneakers was associated with lower future depression risk.
•
Fitness programs, including SilverSneakers, and a workplace wellness program
demonstrated significant health care cost savings for participants.
•
Reduced hospital utilization was a common outcome across evaluated senior fitness and
wellness programs.
•
Fitness and coaching programs had significant outcomes in other important areas
including improved health-related quality of life, gait speed, self-care activities and
health behaviors.
•
Regular and sustained engagement was a key factor in program success.
11-SHCD 10
Join the club: Improving senior health through exercise
Building engagement
Using savvy marketing and research protocols to establish its value proposition, Healthways has
successfully grown the SilverSneakers program to include 10 million potential participants.
However, the program attracts just 20 percent of those eligible, with average age ranging from
72 to 74, signaling a significant amount of under-utilization. The large population of nonparticipants certainly affects the company’s revenue potential, but more importantly, it means
that eight million individuals who have an opportunity to transform their health and well-being
were not embracing the program. Healthways has leveraged their measurements, outcomes
and research findings to compel health insurance companies to provide the SilverSneakers
benefit to those covered by their plans. Healthways has also developed a framework for
SilverSneakers that supports customization to entice more participation. One of the company’s
ongoing objectives will be to explore new ways in which their documented research and proven
innovation can be utilized to improve engagement and optimize health for that absent 80
percent of eligible Medicare beneficiaries.
11-SHCD 11
Join the club: Improving senior health through exercise
Discussion
1. What epidemiological data were vital to justifying the creation of the SilverSneakers
program? Were these the appropriate data to rely on? Why or why not?
2. How might this model apply to other demographics (i.e. other age or ethnic groups, or
those with a specific disease) to improve health?
3. What measurements and outcomes have been used to determine the effectiveness of
the SilverSneakers program?
4. How might the measurements and outcomes of SilverSneakers be used to encourage
individuals to participate in physical activity?
5. Should 20 percent utilization of SilverSneakers be considered a success? Why and/or
why not?
6. What methods might you recommend to improve utilization among those eligible for
SilverSneakers?
11-SHCD 12
Join the club: Improving senior health through exercise
Appendix
Highmark Report on SilverSneakers
Humana Report on SilverSneakers
Medica Report on SilverSneakers
2013 Report on Well-being Outcomes for Medicare Beneficiaries
CaseStudy
Physical activity influences healthcare costs
A study of Humana members enrolled in the SilverSneakers® Fitness
Program showed significantly lower healthcare claims costs over three years.
Costs from the
SilverSneakers
group were 37%
lower than those
of the control
group.
Results from 2006, 2007, and 2008* cohorts demonstrated that
participation in the SilverSneakers Fitness Program positively
influenced health care costs across all groups examined in the study.
The study, commissioned by Humana, compared health care costs of
SilverSneakers members to Humana Medicare Advantage members
not participating in the program. Additionally, the study examined
whether or not belonging to the SilverSneakers Fitness Program
improved retention among members.
Key findings included:
Medical Claims in PMPM
$600
$500
PMPM
$400
$300
$200
$100
$0
2006
2008
2007
SilverSneakers
Control
The study used a proprietary methodology based on demographic
and medical risk variables, including prior year claim costs (excluding
prescription drugs) and HCC disease conditions, to determine a
propensity risk score for each member. To form the control groups,
Humana SilverSneakers participants were matched to Humana members
with similar baseline scores who had not participated in the program.
*The study group was limited to Humana members who attended a fitness center at least five
times each year between 2006 and 2008. Individuals in the non-participating comparison
group were continuously enrolled with Humana between 2006 and 2008.
SSFP0863.1009
• In each comparison made across all cohorts in the study,
SilverSneakers participants had an average of 22 percent lower
claims costs than the control groups.
• While year-to-year claims costs for both groups increased,
SilverSneakers participants experienced smaller increases. From
2007 to 2008, the control group’s costs increased by $85 per
member per month more than the study participants’ costs.
• Results from the study not only showed lower healthcare costs
among SilverSneakers members, but a growing difference in these
costs between the participants and the controls over time. By the
third year, claims costs from the SilverSneakers group were 37
percent lower than those of the control group.
• Savings produced by the study groups averaged more than twice
the cost of the program.
Member retention was notably higher
for SilverSneakers participants:
• SilverSneakers members with five or more visits in the first year
re-enrolled in Humana at a higher rate than Medicare members
in general.
• On average, SilverSneakers participants were over 40 percent more
likely to stay with Humana during the year-over-year studies than
members in the control group.
1445 S. Spectrum Blvd., Ste. 100 | Chandler, Arizona 85286 | 1.800.295.4993 | www.healthways.com
www.silversneakers.com
CaseStudy
Investigator: The Institute for the Study of Aging
Howard Fillit, MD, and Jerrold Hill, PhD
Health care costs
among members
enrolled in the
program were
11% lower
than among
non-participants
A claims analysis performed on data from Medica’s Medicare Plans
by the Institute for the Study of Aging (ISOA) provides significant
evidence that the SilverSneakers® Fitness Program reduced health care
costs and improved health status in the first year of program participation. The study examined the following hypotheses using health care
cost data and annual heath status surveys completed by participants:
1. Participation in SilverSneakers will reduce health care costs.
2. Among SilverSneakers participants, more frequent participation
in the program will result in lower health care costs.
3. SilverSneakers will improve the health status of participants
over time.
SilverSneakers Members vs. Matched Control Group
Regression-Adjusted Mean Costs in First Year
$4,500
$4,004
$4,000
Total Claims Costs
$3,500
$3,563
$3,000
$2,500
$2,000
$1,500
$1,000
$500
Research concluded that health care costs among members enrolled
in the program were $441 (11 percent) lower than among a matched
control group of non-participants. Significantly lower inpatient
hospital, skilled nursing facility, and home health costs were observed
among the SilverSneakers members. Baseline health care costs were not
significantly different between the SilverSneakers and control groups.
While the 11 percent savings was spread across the whole group of
members enrolled in SilverSneakers, there was a relationship between the
number of times they went to a fitness center and their health care costs.
Savings were driven by those members who went to a fitness center
at least twice a month. Those averaging 1.4 fitness center visits per
week contributed the largest savings — $1,018 over those who enrolled
in the program but barely participated. More frequent program
participation also increased the likelihood of members reporting
better health.
$0
Difference in adjusted first year costs = $441 per member.
Baseline costs were not significantly different.
For Medica’s roughly 3,000 members enrolled in SilverSneakers
through August 2004, this type of savings translates into approximately
$1.3 million for the members’ first year of the program.
www.silversneakers.com
MED10055
9280 South Kyrene Road | Tempe, Arizona 85284 | 1.800.295.4993 | www.healthways.com
Well-Being Outcomes for
Medicare Beneficiaries
A report on the benefits of fitness
programs for older Americans
April 2013
Well-Being Outcomes for Medicare Beneficiaries
Introduction
SilverSneakers® Fitness Program is an innovative well-being improvement program helping
Medicare beneficiaries stay physically active and socially engaged. The program includes
a fitness center membership and specialized classes that foster social interaction among
members and encourage them to live healthy, active lifestyles. Healthways has compiled a
series of longitudinal, peer-reviewed studies that consistently document improvement in
individual well-being and reduction in medical costs for Medicare beneficiaries who participate
in SilverSneakers.
Healthways strives to ensure that SilverSneakers is accessible and appealing to Medicare
beneficiaries regardless of their current health status and whether or not they are accustomed
to exercise. Program coordinators are trained to foster an environment that is welcoming and
accommodating to differing levels of fitness and mobility. In fact, two-thirds of SilverSneakers
participants have multiple chronic conditions and almost half report no previous fitness center
membership. A key focus of several of the studies in this volume is how well the program works
for beneficiaries with chronic conditions such as diabetes and depression. In some cases, the
findings demonstrate that the greatest opportunities to improve in health and reduce costs
lies with beneficiaries who have these conditions.
Despite the conventional wisdom that exercise is good for you, many have questioned whether
a fitness program designed for Medicare beneficiaries really can improve well-being and reduce
costs. Healthways and SilverSneakers have a proven record of doing just that.
Contents
Impact of a Senior Fitness Program on Measures of Physical and Emotional
Health and Functioning
1
Managed-Medicare Health Club Benefit and Reduced Health Care Costs
Among Older Adults
2
Health Care Use and Costs Associated With Use of a Health Club Membership
Benefit in Older Adults with Diabetes
3
Depression and Use of a Health Plan–Sponsored Physical Activity Program
by Older Adults
4
Effectiveness of Health and Wellness Initiatives for Seniors
5
Well-Being Outcomes for Medicare Beneficiaries
Impact of a Senior Fitness Program on Measures of Physical and
Emotional Health and Functioning
Hamar, B, Coberley, C, Pope, JE, Rula, EY
Population Health Management, 2013
Abstract
The SilverSneakers® fitness program is a health plan benefit for Medicare beneficiaries that
provides older adults with fitness center membership, customized group exercise classes, and
a supportive social environment that promotes socialization among participants. This study
evaluated the impact of the SilverSneakers program on the physical and emotional health and
activities of daily living (ADL). A quasi-experimental retrospective analysis compared annual
survey responses from SilverSneakers members (Treatment N=5,586) to a matched national
random sample of Medicare Advantage Organization beneficiaries (Comparison N=22,344)
in the Cohort 10 Medicare Health Outcomes Survey. Matching was performed based on 6
demographic and 6 disease status variables. 2007 and 2009 survey responses were evaluated
using categorical and logistic regression analysis. The Treatment group presented significantly
better physical and emotional health and lower impairment in both 2007 and 2009, less
impairment for four of six ADLs in 2007 and all six in 2009, and a higher average number of days
of good health within the prior month for both years. Three-year longitudinal analyses indicated
a significantly more favorable Treatment group trend for nearly all measures of health and ADLs.
Members exercising less frequently had poorer health and functioning. Overall, participation
in the SilverSneakers program was associated with more favorable overall physical and social/
emotional health status and fewer activity impairments, suggesting that the provision of
senior-oriented group fitness programs may be a valuable approach to improve quality of life
and reduce the burden associated with declining health and functioning as older adults age.
Key Takeaways:
• Participation in SilverSneakers is associated with
better physical and emotional health, higher
functioning, and lower disability among seniors
across many measures
• Over three years, SilverSneakers members
demonstrate better trends than similar seniors
with respect to overall health status, health status
change, emotional health, social limitations due
to health, overall disability level, and in ability to
perform all 6 measured activities of daily living
• Greater frequency of exercise is associated with
significantly better outcomes among SilverSneakers
members
• The provision of SilverSneakers can serve to
improve quality of life and reduce the burden
associated with declining health and functioning as
older adults age
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POP-2012-0111-ver9-Hamar_1P
Type: research-article
Original Article
POPULATION HEALTH MANAGEMENT
Volume 00, Number 00, 2013
ª Mary Ann Liebert, Inc.
DOI: 10.1089/pop.2012.0111
Impact of a Senior Fitness Program on Measures
of Physical and Emotional Health and Functioning
Brent Hamar, DDS, MPH, Carter Coberley, PhD, James E. Pope, MD, and Elizabeth Y. Rula, PhD
Abstract
The SilverSneakers fitness program is a health plan benefit for Medicare beneficiaries that provides older
adults with fitness center membership, customized group exercise classes, and a supportive social environment
that promotes socialization among participants. This study evaluated the impact of the SilverSneakers program
on physical and emotional health and activities of daily living (ADLs). A quasi-experimental retrospective
analysis compared annual survey responses from SilverSneakers members (treatment N = 5586) to a matched
national random sample of Medicare Advantage organization beneficiaries (comparison N = 22,344) in Cohort 10
of the Medicare Health Outcomes Survey. Matching was performed based on six demographic and six disease
status variables. Survey responses from 2007 and 2009 were evaluated using categorical and logistic regression
analysis. The treatment group showed significantly better physical and emotional health and lower impairment
in both 2007 and 2009, less impairment for four of six ADLs in 2007, and all six in 2009, and a higher average
number of days of good health within the prior month for both years. Three-year longitudinal analyses indicated
a significantly more favorable survey response trend for the treatment group for nearly all measures of health
and ADLs. Members who exercised less frequently had poorer health and functioning. Overall, participation in
the SilverSneakers program was associated with more favorable overall physical and social/emotional health
status and fewer activity impairments, suggesting that the provision of senior-oriented group fitness programs
may be a valuable approach to improve quality of life and reduce the burden associated with declining health
and functioning as older adults age. (Population Health Management 2013;16:xxx–xxx)
Introduction
spending. Nearly 91% of people age 65 and older have one or
more chronic conditions; more than half of this population
are treated for five or more conditions and this group accounts for a disproportionate amount of spending (79%).5,6
Approximately one-fourth of people with chronic illness also
have one or more limitations in activities of daily living
(ADLs), such as walking, bathing, and dressing, and their
health care spending often more than doubles in cost.5,7,8 Not
surprisingly, most people with activity limitations are
Medicare members.5
In addition to disease-related morbidity and functional
decline, seniors often face loneliness, social isolation, and
depression, which can have additional negative influences
on their health and overall quality of life. These factors
working in combination with chronic conditions and impairments can seriously compromise seniors’ health and
well-being. Social interactions have been shown to be associated with positive physiological benefits that can promote
better health outcomes.9 A study conducted on the importance of self-rated health in myocardial infarction patients
T
he American population is undergoing a dramatic
shift toward an older demographic, and the associated
changes in the size and makeup of the US Medicare program
are rapidly increasing federal health care spending accounted
for by seniors in our society. In 2010, there were nearly
40 million adults age 65 and older covered by Medicare, a
number projected to reach 79 million by 2030.1,2 Overall US
health care spending is projected to rise from $2.7 trillion in
2011 to $4.6 trillion by 2020;3 spending on Medicare is projected to increase 6.9% per year from 2009 to 2019.4 The aging
of the baby boomer generation and the current economic environment are creating tremendous pressure on the fiscal viability of Medicare as it currently stands. The most recent
estimates (2011) are that the Medicare Hospital Insurance
Trust Fund will be depleted in 2024, 5 years earlier than was
reported in the year 2010 congressional report.1
Chronic disease and associated comorbidities also are
taking on an ever-increasing role in driving Medicare
Center for Health Research, Healthways, Inc., Franklin, Tennessee.
1
Well-Being Outcomes for Medicare Beneficiaries
Managed-Medicare Health Club Benefit and Reduced Health Care Costs
Among Older Adults
Nguyen, HQ, Ackermann, RT, Maciejewski, M, Berke, E, Patrick, M, Williams, B, LoGerfo, JP
Preventing Chronic Disease, 2008
Abstract
Introduction: Our study was undertaken to determine the association between use of a health
plan-sponsored health club benefit by older adults and total health care costs over 2 years.
Methods: This retrospective cohort study used administrative and claims data from a Medicare
Advantage plan. Participants (n = 4,766) were enrolled in the plan for at least 1 year before
participating in the plan-sponsored health club benefit (SilverSneakers®). Controls (n = 9,035)
were matched to participants by age and sex according to the index date of SilverSneakers
enrollment. Multivariate regression models were used to estimate health care use and costs
and to make subgroup comparisons according to frequency of health club visits.
Results: Compared with controls, SilverSneakers participants were older and more likely to be
male, used more preventive services, and had higher total health care costs at baseline. Adjusted
total health care costs for SilverSneakers participants and controls did not differ significantly in
year 1. By year 2, compared with controls, SilverSneakers participants had significantly fewer
inpatient admissions (-2.3%, 95% confidence interval, −3.3% to −1.2%; P
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