Dissecting utilization trends for the 65+ population
For several years health systems have been adding programs that tailor services and care experiences for the rapidly growing population aged 65+. While it is no surprise that utilization trends for the 18 to 64 age cohort look different than those for the 65+ population, a closer look at utilization patterns reveals notable differences even within the 65+ age cohort. This underscores the importance of assessing patterns for distinct 65+ age groups, specifically 65 to 74, 75 to 84 and 85+. Only then can health system leaders proactively design care delivery models, workforce strategies and capital investments that are attuned to the specific needs of each segment. But first, as Figure 1 illustrates, a holistic look at patterns for the 65+ population across hospital cohorts and sites of care shows consistently high utilization as compared to the 18 to 64 demographic.
Segmenting the 65+ patient population among different dimensions
- Although the 65+ population represents a significant proportion of the patient base for comprehensive academic medical centers (AMCs), they represent a larger proportion of community hospital–based care, indicating a need for lower-acuity inpatient services.
- An increase in utilization across all sites of care will be driven by the 65+ population, as utilization among younger adults is projected to remain flat or even decline in some settings over the next 10 years.
- Looking at insurance enrollment trends, Medicare Advantage enrollment is projected to grow by 33% the next five years, while traditional Medicare is expected to decline by 8%. This will place additional pressure on capacity, given current challenges with prior authorization requirements for Medicare Advantage plans.
A closer look at emergency department utilization trends across hospital cohorts
Compared to academic medical centers, community hospitals see a higher share of older adults presenting to the emergency department, resulting in a greater volume of higher-acuity patients (see Figure 2). In 2024, 72% of ED visits for adults aged 65+ were classified as emergent, higher than the 65% rate for adults aged 18 to 64. This share is projected to increase further.
Over the next decade, ED emergent visit volume for the 65+ population is expected to grow by 28%, with the 75 to 84 age cohort alone projected to see a 45% increase—double the increase of each of the other two 65+ age cohorts. Given this trajectory, health systems must identify strategies to reduce patients’ reliance on the ED and acute care services by expanding access to primary and specialty care services and leveraging technology to better manage chronic conditions, thus improving care quality, hospital efficiency and capacity.
Select quality benchmarks for inpatient care
- Overall, more than 77% of IP admissions for older adults originate from the ED, with non-academic hospitals having higher proportions than AMCs.
- While AMCs typically report higher average length of stay due to their greater share of clinically complex cases, it is notable that the 65 to 74 and 75 to 84 age cohorts have a longer length of stay at AMCs than the oldest cohort, as shown in Figure 3.
- As Figure 3 indicates, patients aged 65+ have higher complication rates at AMCs compared to non-AMCs, though complication rates decrease with increasing age cohort.
- The 30-day readmission rate remains elevated across all 65+ age cohorts (from 11.2% to 12.4%) compared to the all-ages average (10.5%). While opportunities to significantly reduce these rates may be limited, health systems can better manage the impact through more robust capacity planning and enhanced transitional care models.
- Inpatient days are projected to increase by 17% over the next decade, according to the Sg2 Impact of Change® forecast. Notably, the 75 to 84 age group is expected to see a 40% increase, more than double the overall rate, reinforcing the need for focused planning and resource alignment for this high-growth cohort.
Assessing transitions to post-acute care
As expected, the 85+ age cohort has the highest proportion of discharges to post-acute care settings—more than double that of the 65 to 74 age cohort (see Figure 4). However, all 65+ age groups are projected to see an increased volume of discharges to some form of post-acute care, such as a skilled nursing facility, long-term care, home health or hospice, over the next decade. Once again, the 75 to 84 age group stands out, with projected growth nearly double that of the younger and older 65+ age cohorts.
Why it matters
- Leverage data analytics to diagnose the distinct needs of each age cohort within the 65+ population, help identify gaps, and align investments with future demand and community needs for the growing aging population.
- Build a cohesive System of CARE (Clinical Alignment and Resource Effectiveness) that has distinct service offerings for the population aged 65+, including primary care, chronic disease management, and postacute access and coordination. These approaches are critical to managing increasing acuity levels, improving outcomes and reducing avoidable hospital utilization among older adults.
- Expand capacity and improve access to care and resources to address the rising inpatient demand, especially among the rapidly growing 75 to 84 age cohort. Prioritize equitable access to acute, post-acute and community-based services to avoid bottlenecks, care delays and avoidable utilization, particularly in settings like the ED.
- Redesign care through targeted, age-friendly programs to address gaps in access and quality by launching dedicated, aging-focused initiatives that reimagine care for older adults.
Anthony Guth and Tori Richie
To speak with one of our experts about enterprise strategy and System of CARE planning for the 65+ population, contact membercenter@sg2.com.