Transforming care for an aging population

Learn more about the evolving needs and complexities of this older generation and innovative ways health plans can drive better health outcomes and lower costs.

The complexity of care increases with age; as individuals grow older, the number of chronic conditions they deal with frequently increases. By 2030, the youngest of the baby boomers will have turned 65 years old and by 2050, the number of Americans over 65 years old will grow by 50%. This aging generation with chronic conditions will place a significant demand on our health care ecosystem. To meet their needs, health plans will need to devise innovative ways to improve access to care. A simple, transactional type of care model will no longer cut it.

More seniors mean more polychronic patients

According to the CDC, polychronic refers to anyone who is living with three or more chronic conditions.

The growing number of seniors in the health care ecosystem translates to having more polychronic patients. The Milken Institute estimates that by 2030, as all baby boomers age in, we’re looking at in excess of 83 million patients living with 3 or more chronic conditions. This is a huge increase compared to 2015, when that number was around 30.8 million.

What polychronic conditions mean for the U.S. health care ecosystem

The American health care system has traditionally been rooted in treating acute conditions (conditions that have a single cause or problem) with a relatively rapid onset and defined duration of treatment. That approach to health care no longer works for this aging population and results in suboptimal care coordination and case management as well as recurrent admissions, all of which increase health care costs.

In 2023, the average health care cost for a patient living with a single chronic condition is $6,032 annually – five times higher than for an individual without a chronic condition. Moreover, polychronic patient care comprises 90% of the country’s more than $4 trillion spending in annual health care costs, according to the CDC. And it doesn’t stop there; the cost of chronic disease is expected to continue rising over time. Between 2016 and 2030, that number is estimated to be $42 trillion, as predicted by the PFCD.

In addition, the fee-for-service model that is in the roots of the American health care system is not sustainable for this population as they require a more patient-centered model. A fragmented and siloed health care system is also not sustainable in the long-run as more seniors prefer more holistic access to care in the comfort of their homes.

Care model considerations for health plans

Patient-centered, whole-person care provided through a connected, interdisciplinary care model is going to drive better health outcomes, increase patient satisfaction and bring down total cost of care. Health plans need to consider these three critical pieces when designing a care model for this aging population:

  1. It needs to be value-based. In order to better compete, health plans need to move away from a fee-for-service, transactional kind of relationship and shift over to value-based care model that improves costs, patient satisfaction and health outcomes.
  2. Annual wellness visits are key. Proactive annual wellness visits give health plans and providers an opportunity to detect new problems early on or changes in status that are simmering below the surface and might be approaching decompensation. It also allows for care planning conversations to happen early on. Moreover, it helps Medicare Advantage partners with their star ratings every time a patient completes a health risk assessment.
  3. Home-based care is no longer “nice to have.” It’s becoming an essential piece of a comprehensive care model for these polychronic patients that are a part of the aging generation. We were already seeing a gradual shift away from office-based or facility-based care over the last 10 years and we saw an acceleration of that movement in 2020 during the COVID-19 pandemic. We’ve also seen increased acceptance of technology which has enabled the ability to provide more high-acuity care in-home.

Download our latest report to learn more about the drivers behind the increasing polychronic population, the implications for patients and providers, and how care solutions are evolving.

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Home-Based Care
Evernorth Home-Based Care is a value-based approach with comprehensive in-home primary care solutions, including direct patient care and care enablement services. We work closely with 30+ clients (health plans, Medicare, dual eligible special needs plans (D-SNPs), commercial and more) — serving more than 26 million lives — to improve quality measures, reduce hospital readmissions, and upgrade the patient experience and care delivery coordination. Known for our flexibility, Evernorth is always willing to partner with your existing vendor relationships and clinical pathways to avoid disruption. This approach leverages our expertise and solutions while integrating our clients’ capabilities and third-party resources to maximize overall effectiveness.