Improving Healthcare for Older Adults

Project Overview

Under a three-year grant from the SCAN Health Plan® Community Giving program, the Center has launched a strategic collaboration with the HealthCare Partners Institute for Applied Research and Education to undertake research, evaluation and dissemination initiatives aimed at improving healthcare for older adults.

Healthcare providers and health plans serving the senior population currently face challenges in engaging and activating patients with behaviors that promote well-being and sustainable positive health outcomes and in prospectively identifying patients that are at risk of becoming seriously ill and who will benefit most from intensive case management. Patients vary widely in their understanding, abilities, preferences and adoption of healthy behaviors and their engagement and interaction with their providers and the health delivery system. These issues are critical to long term successful patient-centered health promotion and disease management. Many factors can complicate a patient’s ability to undertake actions that will promote their own well-being. Such factors include psychosocial issues, cultural factors, limited reading/writing skills, health disorders, behavioral health and economic factors, among others. In addition, identification and proactive intervention to address future high-acuity, high-cost patients is complicated by the absence of large scale databases covering long time periods, which can be used to develop and test methods for accurately identifying future high-risk patients among a large senior population. The Improving Healthcare for Older Adults project is designed to investigate and add to our understanding of the issues, strategies and opportunities for addressing these challenges.

Our work is thus focused in three key areas:

  1. Behavioral Economics: Use of behavioral economics, such incentives, as a method to generate and increase Medicare patients’ participation in promoting their own health and effectively managing their chronic conditions.
  2. Patient Interactive Technology: Use of Interactive Voice Response (IVR) and other patient communications technology to support patients with chronic conditions by improving patient communication, engagement and activation through early identification of health exacerbations.
  3. High-risk Patient Assessment: Analysis of large scale databases to develop and test methods to prospectively identify high-risk, high-cost Medicare patients prior to their becoming high-utilization, high-cost patients.

Research and evaluation will delve into the effects of a series of pilot interventions on targeted senior populations to advance healthcare’s Triple Aims of lower cost, better care and better health. Efficiency. Effectiveness. Engagement.

In addition to research and evaluation, a major dimension of the project involves sharing of knowledge and best practices through rapid dissemination. A diverse array of planned dissemination mechanisms includes symposia, conferences, workshops, issue briefs, topical bibliographies and reports targeted to researchers and healthcare professionals. Our goal is to foster broad adoption of innovative, proven programs for older adults.

In partnership with:



The HCP Institute for Applied Research and Education is an independently operated 501(c)(3) foundation that designs, implements, refines, and disseminates patient-centered innovations within California’s leading integrated care organizations.


SCAN Health Plan® is the second largest Medicare Advantage plan in California. The health plan seeks to find innovative ways to enhance seniors’ ability to manage their health and to continue to control where and how they live by developing partnerships to deliver the right health care, in the right setting, and at the right cost while maximizing seniors’ ability to remain independent.