September has started with blockbuster health care news that carries major implications for the older adult market — and, by extension, the future of senior living.
Giants of retail and insurance are behind the latest headlines:
- CVS Health — parent company of Aetna — is to acquire Signify Health in a transaction valued at about $8 billion
- Walmart and UnitedHealth Group have forged an “initial 10-year, wide-ranging collaboration”
- Walgreens completed its planned majority share acquisition of CareCentrix, which coordinates home care needs for more than 19 million members
And this week has also brought some notable news from Upside, the startup previously known as UpsideHom. The company — which sets older adults up in specially vetted multifamily units, with wraparound services to support their wellbeing — is launching Upside+. This will enable Upside members to access health care delivered by certified nursing assistants, non-clinical care management and other services.
Upside plans to expand to 100 markets in 2022 and describes Upside+ as “a different kind of senior living.”
In this week’s exclusive, members-only SHN+ Update, I offer analysis and key takeaways for senior living providers related to these moves, including:
- Active adult and independent living providers have more options than ever for adding or unbundling care
- The “retail-ization” of health care will change older adults’ and their family members’ expectations of the senior living experience
Redefining sites of care
CVS, Walgreens and Walmart all have expanded beyond their long-standing pharmacy businesses to pursue more ambitious health care strategies in recent years, with a major focus on enabling more care for people in their homes.
By acquiring Signify, CVS is adding a company that performs home-based visits through a network of physicians and other clinicians, with the goal of identifying both clinical and social needs and connecting patients with the most appropriate resources and follow-up services. In 2022, the company expects to connect with 2.5 million people in their homes, in-person or virtually.
Similarly, CareCentrix claims to “empower health at home” in a variety of ways, including through a predictive analytics platform that identifies and connects patients with the most appropriate site of care after a hospital discharge, and by pairing patients with care transition teams.
Value-based care models form the financial underpinnings of the CVS and Walgreens strategies, as the companies recognize the significant cost savings that can be achieved for payers — including CVS’ Aetna arm — by enabling more care in lower-cost settings, particularly people’s homes.
This is also the driving principle behind the Walmart and UnitedHealth collaboration, which will start with 15 Walmart Health locations in Florida and Georgia but ultimately serve “hundreds of thousands of seniors and Medicare beneficiaries in value-based arrangements through multiple Medicare Advantage plans,” the companies stated Wednesday.
Walmart and UnitedHealth will launch a co-branded MA plan, and UnitedHealth will provide Walmart Health clinicians with analytics and decision-support tools to support their “collaborative, team-based” approach to care. The longer-term vision involves increasing access to food and other factors behind social determinants of health, as well as prescription, dental and vision services.
Senior living providers that view home care as a competitive threat are sure to be disturbed by these gargantuan companies throwing so much money and so many resources behind efforts to elevate at-home services. But I think that most senior living companies are taking a more nuanced view of these moves, and perceive emerging opportunities for new operating models. This is perhaps most apparent in the active adult and independent living sectors.
Consider Avenue Development, which is creating active adult communities under the Viva Bene brand. To incorporate care, the company is “working with some very large national names” in the value-based care space, with the intention of creating on-site clinics or connecting residents with community or virtual resources.
On the independent living side, Clover Management is one example of a provider offering health care access, through its connection to Geisinger Health System’s 65 Forward clinics.
Such arrangements will only become more viable in the years ahead, as CVS, Walgreens and Walmart locations increasingly become health hubs. Imagine an active adult or IL community — particularly one located in a mixed-use development close to one or several of these storefronts — paring back on in-house care while residents receive more in-person and virtual services enabled by Signify, CareCentrix, UnitedHealth and similar players.
In this model, care becomes increasingly similar to amenities such as dining. A well-located senior living community might pare back on restaurant spaces and culinary staff, while facilitating access to nearby restaurants. This would keep operating costs lower, enable more affordable rents and increase resident choice and autonomy.
One clear downside is the loss of control over the provision of health care, which might be especially concerning for higher-acuity providers. Such companies might choose to go the route of owning their own MA plans or find ways to go at-risk with payers, to glean more of the upside from their ability to closely manage and directly deliver care.
Being able to demonstrate just how much they contribute to health care savings also will put senior living providers in a stronger position when CVS or UnitedHealth or a similar company considers just how many of their beneficiaries reside in these communities — and the synergies they could create with existing business lines such as CVS’ long-term care pharmacy Omnicare. While they’re currently focused on buying primary care and home care companies, the day might inevitably come when they seek to own even more of the continuum, making senior living an investment target.
Effects of ‘retail-ization’
“Coordination” is a common word in the press releases that CVS and Walgreens put out regarding their big acquisitions. But there’s another “c” word that I think senior living providers need to keep top of mind: convenience.
That’s because CVS and Walgreens — and Walmart — all are aiming to not only drive more coordinated care but a more convenient consumer experience. That might mean increased access to telehealth visits or the ability to easily connect with a care team at a neighborhood location — and buy a carton of milk and pick up your prescriptions after your consultation.
To attract future residents and keep them satisfied, senior living providers must ensure that their lives and health care do not become less convenient after they move in.
Despite having so many services and amenities available for residents, senior living does not do a stellar job at making care more convenient. Too often, adult children are still playing the role of care team quarterback, and the senior living staff becomes just one more group that they have to interface with, along with a primary care team, specialists and an array of other providers.
I do see moves to address this situation, from the rise of care concierges to more on-site primary care and other services, including through innovative efforts and partnerships such as Belmont Village’s “Living Lab” in La Jolla.
Senior living providers cannot overlook how payers are driving convenience as well. Older adults who have been satisfied with a Walmart-branded Medicare Advantage plan might want continued access to those particular benefits even after moving into senior living. Or, if the Walmart plan is no longer appropriate, they might expect an alternative MA plan that is more specifically designed for their needs as a resident.
Finally, senior living providers need to consider the convenience factor that next-generation competitors such as Upside are offering to consumers. Starting at $6,000 a month in the South Florida market — and “one-bill simplicity” — Upside+ will connect each member with a dedicated care manager, a certified caregiver to assist with daily needs and referrals to physicians and specialists. That’s in addition to chef-prepped meals, transportation and other services.
The upshot is that senior living providers of the past might have attracted residents with the promise of less yardwork and cooking, but these lifestyle perks are now barely table stakes. Providers must keep upping their game when it comes to a convenient, seamless care experience, within and beyond the walls of the senior living community.