Senior Whole Health: Wayne Lowell, Chief Executive Officer

by HCE Exchange on July 24, 2013

Wayne-Lowell-thumbRising healthcare costs, particularly in light of an aging population, is a challenge for healthcare and government leaders in the United States. One company in Massachusetts, however, is working to provide total care for seniors receiving Medicare and Medicaid benefits.

Focusing on wellness to save money

Senior Whole Health provides a healthcare plan for dual-eligibles, combining state Medicaid benefits and federal Medicare benefits in a way that improves individual health and saves money. The company has more than 9,500 subscribers in Massachusetts and New York.

With nurses, member-services employees, and pharmacists on staff, Senior Whole Health focuses on ensuring members receive the care they need to remain healthy and happy, from obtaining Meals on Wheels or moving into assisted living. But the focus is primarily on allowing low-income seniors to remain independent as long as possible, thus saving the system money overall.

“We cover the lives of our patients,” said Chief Executive Officer Wayne Lowell. “We have more than 3,800 members who, if not for our services, would need to be in a nursing home, which is typically a Medicaid benefit. On average, it would cost $60,000 to $70,000 per year to institutionalize these patients.”

Instead, the state pays Senior Whole Health to combine the healthcare needs of seniors with the social needs of low-income circumstances. Nurse aides visit members two to four times a year to check up on them and note any changes in behavior that should be reported to a primary-care physician. This allows almost 4,000 people to remain in their homes instead of being in a nursing home. Senior Whole Health estimates that this saves Massachusetts nearly $100 million per year.

“Our nurses ask members not only about their health, but also about their social life and other aspects of living necessary for an older individual to thrive,” Lowell said. “I am always amazed at the strong relationships these nurses build with our members.”

Senior Whole Health also offers transportation-assistance services to ensure patients are seeing their physicians on a regular basis and making appointments when they have problems. In many instances, low-income individuals will call an ambulance when they have a problem because they have no other means of transportation, and an ambulance trip to the emergency room is covered by Medicare. This creates thousands of dollars that can be minimized through social assistance and adherence to preventive-care measures.

Helping individuals navigate the system

Navigating the healthcare system is a challenge for well-educated Americans, but it can feel nearly impossible for people who are illiterate or don’t speak English as their primary language. Many of Senior Whole Health’s subscribers are illiterate, and subscribers speak 30 different languages, the most common being Chinese.

By integrating the benefits of Medicare, Medicaid, and Medicare Part D into one plan, members receive one membership card and one place to go to get questions answered. Members also have 24/7 phone access to a nurse care manager. Senior Whole Health is an approved Medicare Special Needs Plan and  Medicare Part D Plan.

Expanding to more states

Senior Whole Health started in Massachusetts, a state that has been a leader in healthcare reform, and recently expanded into New York City. Lowell said the company hopes to export its model to other states, but it is challenging because of obtaining licenses for each state and the difficulties in convincing states to embrace a program that integrates both state and federal benefits.

“We have about a dozen states east of the Mississippi River that are dedicated to integrating programs,” Lowell said. “We are poised to take what we’ve done in Massachusetts and export it to other places. We’ve seen the impact we have on members’ lives and the difference our nurses and pharmacists make.”

Although Senior Whole Health is a for-profit company, Lowell said 88 cents of every dollar received goes into healthcare. It’s not a business where a person will make a lot of money, but, as with most healthcare work, offering a better quality of life to low-income seniors presents its own rewards.

“We may not make a lot of money, but we are able to create a reasonable return for investors, save the government money, and provide incredible care for the people we serve,” Lowell said.

Senior Whole Health is a step toward a future with Accountable Care Organizations, where hospitals, physicians, and health insurers are all in a pool to manage the total health of the population for which they are responsible.

“ACOs involve assuming and managing risk, and there is more willingness of providers across the country to share risk,” Lowell said. “I think this trend is here to stay, and we are pushing hard to align incentives for prevention rather than diagnosing and treating.”

-by Patricia Chaney

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