Raising awareness of falls and fall prevention among health plan members
Falls carry a heavy risk of injury:
- The Centers for Disease Control and Prevention (CDC) reported 36,000 deaths in the U.S. caused by falls in 2020 among adults 65 and older, making it the leading cause of injury death in that age cohort.
- The same CDC report also revealed that in 2020 falls led to 3 million emergency department visits for older adults and cost about $50 billion annually in medical expenses, with 75% of that covered by Medicare and Medicaid.
However, it is a risk that can be mitigated with effective patient and member outreach. A 2021 study found that fall prevention education improved awareness as well as some behavior change among older adults in community settings depending on the quality and evidence-based nature of the solution. Describing fall prevention education as a relatively inexpensive intervention, the study noted it was more effective when implemented by collaborative nurses or care managers.
“There is definitely a tie-in between the HEDIS Fall Risk measure and health education,” says Michael Lauber, Head of Payer Sales for Clinical Effectiveness at Wolters Kluwer, Health. “Fall prevention is an important aspect of care for an aging population, and it addresses an important HEDIS measure. With interactive, engaging health education that promotes fall prevention, payer and provider organizations can better manage the care of their members and patients while improving their HEDIS scores and Star Ratings.”
The value of health education to patients and members
Recent surveys reveal that eight out of 10 Americans still have questions after their healthcare visits and would welcome more educational material relevant to their care. This doesn’t surprise Allison Combs, Head of Product – Payer, Clinical Effectiveness at Wolters Kluwer Health, who points out the extraordinary amount of stress on providers to manage a nearly insurmountable workload. “Providers strive to do their best at helping patients like us” she says. “But providers are busy, and there’s not enough of them to handle the huge number of patients. When you add that to us patients also being busy or worried about our upcoming surgery or even something else in our lives, sometimes we don’t hear everything they’re telling us.”
That’s when a member engagement intervention can be a welcomed experience, she explains, helping the patient avoid possible physical and mental anguish and reducing healthcare costs and utilization. As an example, Combs cites abdominal surgery, after which many patients are not made aware that a common side effect is painful gas.
“If you didn’t realize that, just passing gas can be very stressful post-surgery,” she says. “So, you can wind up back in the emergency department just to be told, ‘No, everything’s fine. It’s just your abdominal muscles and system getting used to itself again.’”
This, she says, is one of many “preventable, painful, and scary scenarios” that member education could help alleviate by offering clear explanations of what to expect following a procedure, what side effects or symptoms are cause for concern versus what symptoms are common and likely to resolve on their own, and how to manage them.
What are some health plan interventions to help prevent falls?
Falling isn’t only an issue for older adults, notes Combs. It can affect patients and plan members of all ages, particularly when they aren’t properly prepared for the risks following a surgical procedure.
“You’d be surprised how many people fall after having a procedure done because they didn’t think about cleaning and preparing their house before the procedure,” she explains. “So, they didn’t take into account that they’d be on crutches, and they’d need a wider path. It wouldn’t have occurred to most people unless a care professional has gone through the effort of making sure that they were aware of it and took action in advance.”
While preparing members for the actual medical elements and after-effects of a procedure is part of most patient education programs, Combs says that engaging members on these important but often overlooked extras – such as cleaning, moving furniture and potential obstacles, and finding the appropriate assistance if these are tasks members cannot perform themselves – are just as essential to fall prevention strategies and “increasingly important in in Stars metrics as well.”
Asynchronous engagement helps with sensitive topics
It can be difficult to engage members, especially older members, on topics such as fall risk, Combs acknowledges, because it carries a stigma and “sense of embarrassment. There’s a real sense of loss of control or a loss of not being able to do everything that you used to be able to do when we talk about health issues like falls and mobility.”
When face-to-face discussions with providers prove to be too embarrassing for patients to properly absorb the information they need or to feel comfortable asking all of their questions, payers and health plans have an opportunity to fill the gap in ways that allow their members to feel more in control. “Payers need to offer mechanisms by which you can asynchronously help educate people in a more private setting, where they can review a video and take time to understand it and think about these issues. Then they hopefully have more confidence to talk to their loved ones or their provider or the care management nurse to seek additional help to prevent a health event from happening.”
Fall risk “gets compounded when someone is a little more isolated,” Combs says. The risk of fall increases by 23% in those that live alone and by 36% in those that report the least amount of social contact. In cases where members cannot make person-to-person contact easily with providers or care managers, asynchronous, interactive outreach materials can help raise awareness of fall prevention strategies and encourage the beginning stages of dialogue with care providers.
Member engagement solutions provide personalized outreach
Combs notes that payers need to meet vulnerable member populations where they are with educational materials that are accessible and personalized to their healthcare journeys. This will not only help improve their overall wellness and understanding of their health, but also reduce the potential risk of events like falls, while enhancing performance on Star Ratings and HEDIS measures.
Interactive, multimedia programs that are specifically geared toward care management, like the UpToDate® Guide member engagement solution, do this by:
- Providing health information they understand and can trust.
- Offering diverse, equitable, and inclusive content to represent people of varying ages, identities, and abilities.
- Communicating to members in ways that are easy to understand and act on, helping support healthy decision-making and close care gaps.
- Addressing the important healthy aging topics your members are most interested in, may not be comfortable discussing in person, or may have lingering questions about following provider visits.
Making a fall prevention outreach plan
When Combs thinks about putting together a fall prevention outreach plan to patients or health plan members, she offers the following suggestions:
- Employ different modes of contact: Phone calls are often more effective to initially engage senior members, Combs says. But all generations, including “today’s younger seniors are very digitally tech savvy,” she adds, requiring email or even text outreach. “They don’t view themselves as old. So, they’re not thinking about falls,” making it all the more important to engage them and educate them on risk factors at earlier ages.
- Tailor outreach for different kinds of member profiles, not just age. Since any age can be affected by fall risk, Combs would consider other factors, such as geographical location, in order to customize outreach. Fall prevention outreach and education can also be folded in to visits and care management programming for other related conditions or regularly scheduled healthcare check-ins “to help people think through that stuff a little more in advance and plant seeds along the way,” she says.
- Find creative ways to get members’ attention. In addition to educational programming, Combs suggests offering patients and members memorable “extras,” like checklists of top post-surgical preparation or fall prevention tips. “Give out yardsticks to patients,” she says. “Tell them to hold it horizontally and walk through the house to test if they have enough space for when they come from the hospital. In addition to the collateral, helpful stuff like that really goes a long way.”
- Be aware that not every member’s culture is the same. “You have to not just meet members where they are, but you have to speak their language and understand their perspective of where they are in life,” Combs says. Beyond having educational materials available in different languages, she notes that it’s also important to consider different voice user interfaces to represent different communities and to consider different cultural perspectives within engagement and educational materials. In cases where a person’s cultural background may impede their comfort level in speaking with a healthcare provider, “having those materials in an asynchronous way where they can explore them in privacy, it helps them separate from any embarrassment or from those cultural challenges,” she says.
“We don’t like admitting we have weaknesses, but when you’re dealing with healthcare, you have to get to the point where the goal of being as healthy as possible becomes paramount,” Combs says. It becomes the responsibility of healthcare providers and health plans to find ways to reach and engage patients and members in becoming active in their own care. “We as a system or as a society have to ask, have we given them enough tools to figure out how best to do that?”
eBook: Boosting Star ratings and HEDIS measures with member health education
To learn more about personalizing member experiences, download the eBook, “Boosting Star ratings and HEDIS measures with member health education.”
