The older adult population is experiencing unprecedented growth as baby boomers continue to age into the category. 41% of the baby boomer generation is now aged 65 or older - representing 16% of the population. That amounts to more than one in every seven Americans.
As the population of adults aged 65+ continues to grow, the burden of falls will demand more resources and attention from health plans.
While the older population has increased dramatically over the last 20 years, the rate of falls has remained relatively steady. As the older adult population continues to grow, the cost of falls will rise at almost the same pace.
1 in every 5 falls results in a serious injury (like a fracture or head trauma), meaning that 4 out of 5 falls result in less serious injury and may go unreported or could be inaccurately coded. Serious fall-related injuries can also be inaccurately coded as primarily non-fall related. Due to the inconsistencies associated with coding of these events, quantifying the cost of falls is difficult.
To solve for these discrepancies, Nymbl contracted an independent actuarial firm, Axene Medical Partners, to develop a model to accurately quantify fall-related medical claims. Using data from the Centers for Medicare & Medicaid Services (CMS), Axene developed a model consistent with the methods used for prior models, leading to a 13% claim frequency.
Then, using algorithmic coding optimization, the team was able to identify costs not previously accounted for due to omission of fall-related diagnostic codes as well as those severe non-emergent fall-related injuries that often go unreported.
This improved identification of fall-related claims by over 60%. The final model identified an average prevalence rate of 21% for years 2017-2019 (based on 20M member months of claims data per year).