The month of May, National Osteoporosis Month, served as a reminder that osteoporosis is an important part of taking care of members. This condition impacts approximately 10 million Americans (roughly 80% being women) and another 44 million have low bone mass, placing them at increased risk. A woman’s risk of fracture is equal to her combined risk of breast, uterine, and ovarian cancer. It is essential to provide the right services to enable the prevention, diagnosis, and management of osteoporosis.
Members often don't realize they have osteoporosis until after they suffer a low-trauma fracture. Unfortunately, osteoporosis is responsible for an estimated two million broken bones per year; yet nearly 80 percent of older Americans who suffer bone breaks are not tested or treated for osteoporosis, making the gap of care here more apparent. It is important to educate members and guide them toward the right tests and potentially toward an appropriate prevention or treatment plan.
The True Cost of Osteoporosis
Osteoporosis-related fractures cost members, their families and the healthcare system $19 billion annually. Few members will die directly from osteoporosis-related fractures but these events can have devastating effects on members’ overall mental and physical health as well as their quality of life. Every year, one-quarter of nearly 300,000 hip fracture patients end up in nursing facilities and half never regain their functional status.
Closing the Gaps in Osteoporosis Care
Osteoporosis can be successfully prevented, detected, and treated through appropriate screening, testing, and evidence-based management, thus minimizing members’ risk of suffering osteoporotic fractures and their associated ill-effects.
In addition to improving the members’ quality of life, Medicare Advantage plans closing care gaps related to osteoporosis stand to benefit from both the downstream cost-savings from avoided hospitalizations as well as improving their Part C Medicare Star Rating, specifically, the HEDIS Osteoporosis Management in Women (OMW) measure. For purposes of OMW, the Centers for Medicare & Medicaid Services (CMS) tracks the proportion of female members between the ages of 67 and 85 who suffered a fracture during the measurement year and who subsequently had either a bone mineral density test or were prescribed a drug to treat or prevent osteoporosis in the six months after the fracture. Most expert groups, including the United States Preventive Services Task Force, recommend screening all women for osteoporosis starting at 65 years of age, and in younger women with certain risk factors. The primary method for diagnosis of osteoporosis is the measurement of bone mineral density (BMD) with the most common method being dual-energy x-ray absorptiometry (DXA).
With osteoporosis prevention and management being vital to the health of your members as well as your Part C Star Rating, it is important to provide a comprehensive picture of your members’ overall health status. Members that have suffered a recent fracture are likely to be dealing with impaired mobility, pain, and loss of independence while recuperating. The known hurdles of treatment adherence (e.g., costs, lack of convenience, transportation challenges) are amplified significantly in a member suffering a fracture. These barriers and the lack of portability and relatively high costs associated with DXA make screening and testing for osteoporosis a significant challenge.
Fortunately, certain BMD screening tools other than DXA can be utilized from the security and convenience of a member’s home, providing holistic care where one feels the most comfortable.
As part of our Enhanced Clinical Services, bone density testing can be conveniently administered in-home alongside our comprehensive health risk evaluation to ensure your members are appropriately screened for this important life-limiting condition and to ensure your plan is meeting the requirement for the OMW measure.
Want to learn more about our Enhanced Clinical Services and address gaps in care? Schedule some time to speak with us.