How to adapt to the changing needs of those 65+

Older Americans know what they want from providers. It will be up to health care companies to address the needs of an aging population in a way that’s timely, cost-sensitive and convenient.

America is aging well, and that’s a good thing. Thanks to increasing life spans and falling birth rates, one in five Americans will be 65 years and older by 2030, according to projections from the U.S. Census Bureau.¹ But that demographic makeup is new for the country and will mean changes to the health care system.  

The good news is that baby boomers — the generation born in the years after World War II, who make up most of this novel group — have benefited from better access to health care and major advances in treatment, including joint replacements, cancer cures and new ways to prevent dozens of illnesses. About three out of four older adults rate their health as good or excellent,² showing that the stereotype of frail old age no longer holds true for everyone. Exceptional longevity is also expected to grow, with the population of centenarians (people 100 or older) reaching six times its current size by 2060.³

But age does bring a more complicated health picture. Older Americans tend to have more chronic conditions,⁴ and the American Hospital Association estimates that by 2030 the system will be dealing with twice as many hospital admissions and physician visits for baby boomers.⁵ At least two out of three older adults also are expected to need long-term care services, for an average of about three years in their lives, according to the U.S. Department of Health and Human Services.⁶ Delivering that care will mean shifts in process and priorities.

How can health care institutions promote healthy aging?

New systems will need to keep pace not only with more care but often care that’s more complex. “We have a serious challenge going forward,” says Jamie Sharp, MD, a physician and Vice President and Medicare Chief Medical Officer for Aetna^®, a CVS Health^® company. “We need to develop evidence-based guidelines for the kinds of chronic care management a majority of our older adults require, and make sure the entire health care system follows them.”

Data and an assessment of current challenges will need to lead the way, Dr. Sharp says. A recent report from the National Academy of Medicine, for instance, has mined the research for six strategies to improve care for older adults. Some of these strategies suggest developing and supporting an adequate workforce; redesigning palliative and end-of-life care services, as well as long-term care; and strengthening the role of public health in all aspects of growing older. Many of them will require “dramatic changes,” the authors note.⁷

Listening to older adults, notes Dr. Sharp, will be the most critical starting point for health care organizations. “At CVS Health, we’re working to engage people early on, to better understand what they will need,” she explains. “Not just financially and medically, but also from within their communities. How do they plan to stay active and involved as they grow older?"

On the ground, that means rethinking the kinds of programs offered to older adults — including those that meet their social and mental health needs — and how to use routine care visits in an age-friendly way. It also means exploring new avenues for staying connected in between health care visits. On all fronts, CVS Health is aiming to lead the move forward. “We’re envisioning a new landscape for the delivery of health care,” Dr. Sharp says. “We’re focused on creating that continuum of touchpoints with those 65 and older to help support them in staying healthier for a longer period of time.”

Strategies for better support of older adults

In light of these forces, CVS Health has already started to serve older Americans in new ways. Some strategies to do so include:

Putting self-advocacy first. Some older adults are hesitant to call their doctor with questions or concerns because they don’t want to “be an inconvenience,” says Amanda Lewis Arts, RN, executive clinical director of Medicare Medical Operations at CVS Health. Educating them about risks — and the power of their own voice — should be priority number one. In the Healthy Aging Support Program (HASP) from Aetna, which was launched a year ago, members participate in virtual group sessions to learn how to navigate a complex health care system and create habits for managing their chronic conditions.

But the real importance of HASP’s give-and-take format is that it encourages members to raise their hands when they need to. “It’s absolutely critical that we empower an aging population and their caregivers to use their voice and speak up for themselves when managing their acute or chronic medical condition,” says Lewis Arts. “Our goal is to encourage proactive health engagement instead of reacting to sickness. Persistence in seeking answers, education and support can prevent or delay a decline in health and improve their quality of life.”

Improving home-based care. Older Americans are keen to receive health care at home. According to polling from the National Health Project, a collaboration between Harris Poll and CVS Health, four out of five people 65 and older say they would prefer to receive care in their own residence rather than a medical facility. Pandemic concerns about infection in hospitals and long-term care facilities have strengthened this desire. The good news is that avenues for this kind of care have grown significantly, and more Medicare Advantage plans are offering supplemental, in-home services.⁸

One innovative program from CVS Health is looking to expand home-based care for those discharged from an acute care setting. The post-acute care transition program, slated to launch in spring 2023, will assign a nurse caregiver to the home and will provide other necessary resources. That might mean aiding patients by reconciling medications with their primary care provider, ensuring that the home is age-friendly, offering home visits or even helping arrange food and transportation services, Dr. Sharp says. A recent study published in the American Journal of Managed Care showed patients discharged to home health services like these were 60% less likely to be readmitted to the hospital within 30 days.⁹

Leaning into virtual care. Far from shying away from technology, older Americans warmed up to virtual care during the pandemic. Nearly half of people 65 and older have now used it, according to a report from the health non-profits West Health and United States of Care.¹⁰ “We were certainly pushed into virtual care due to COVID-19, which accelerated a transition,” Dr. Sharp says. “Virtual care is poised to be one of the strongest tools in fighting any provider shortfall — and it will be especially helpful in reaching those with mobility problems,” she says.

CVS Health Virtual Primary Care could be one way to manage the special needs of those 65 and older. Members have access to virtual, on-demand care as well as chronic condition management and mental health services — with an option of being seen in-person at an in-network provider, including MinuteClinic locations. 

"And remote health monitoring — devices that keep track of a person’s health status 24/7 — will also play a bigger role," says Dr. Sharp. "These devices can alert a provider about potential issues and document a patient’s health between visits — information that also can be sent to designated family caregivers," she adds.

Using prescriptions as an opportunity. Nearly nine in 10 adults 65 and older take a prescription, and half take four or more.¹¹ A visit with a pharmacist can be an opportunity to monitor and encourage health habits between visits, as well as answer patient questions. And research on what happens when prescriptions aren’t filled — because of the administrative challenges, mobility problems or difficulty paying for medicines — has been a driver on how to deliver better care.

Increasing convenience. Receiving medications through the mail offers a different kind of touchpoint and opportunity — and it’s on the rise among older adults, says Frank Moffett, senior vice president of PBM Government Programs at CVS Health. “Home delivery is critically important, whether it’s through the PBM mail service or a retail pharmacy. It makes things easier for older adults, which absolutely helps with adherence,” he says. PBMs make managing prescriptions easier for providers, too, since monitoring medications is an important part of age-friendly care.

It will take a combination of strategies to serve the growing population of older adults. The key will be to meet them in the places and ways they’re most comfortable getting their care. “We encourage those 65 and older to seek care in ways that are most convenient for them, including our brick-and-mortar locations staffed with clinicians, pharmacists and advanced care practitioners,” says Dr. Sharp. “For those who can’t come to us, we go to them.”