New research on Juniper Communities’ Connect4Life model, completed by Anne Tumlinson Innovations, promises better outcomes for frail seniors and the potential for Medicare cost savings. The data demonstrate the promise of integrating health and senior housing to manage population health.

1. Integrated Care in Seniors Housing
that Meets the Triple Aim
Juniper Communities’ Connect4Life Model
March 22, 2017

2. Executive Summary
• New research on Juniper Communities’
Connect4Life model, completed by Anne
Tumlinson Innovations, promises better
outcomes for frail seniors and the potential
for Medicare cost savings
• The data demonstrate the promise of
integrating health and senior housing to
manage population health.
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3. About Connect4Life
• A pioneering model of integrated care for seniors housing
• Integrates medical services and coordinates care for mature adults in
seniors housing communities
• Is high tech, high touch, integrated via the electronic health record
(EHR) and coordinated via a “medical concierge”
• Can be a model for senior living providers seeking to be part of PAC
continuum
• Can differentiate senior living from home care as a triple aim
solution for HNHC individuals
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4. Slide | 4

5. Drilling Down: Three Key Components
1. Co-located services must include onsite primary care, therapy-
driven wellness programming, and pharmacy and lab services.
2. High tech includes connected services through electronic
transfer of clinical information and communication
3. Human navigators ensure seamless access to and coordination
with other services provided through strategic partnerships
and alliances.
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6. Four Key Research Findings Demonstrating Value
1. Juniper residents’ hospitalization rate was 50% lower than a
similarly frail Medicare population.
2. Juniper’s re-hospitalization rate was over 80% lower than a
similarly frail Medicare population.
3. Juniper residents’ emergency department use was 15% lower than
a similarly frail Medicare population.
4. Juniper residents use fewer services than a similarly frail Medicare
population in seniors’ housing.
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7. 1. Juniper Hospitalization Rate 50% Lower Than Similarly
Frail Medicare Population
0.25
0.62
0.30
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
All Medicare
Beneficiaries
Similarly Frail Medicare
Population
Juniper Residents
AverageNumberofEvents
perPersonperYear
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8. 2. Juniper Re-hospitalizations Over 80% Lower than
Similarly Frail Medicare Population
18
30
5
0
5
10
15
20
25
30
35
All Medicare
Beneficiaries
Similarly Frail Medicare
Population
Juniper Residents
Eventsper100hospitalizations
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9. 0.38
0.62
0.52
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
All Medicare
Beneficiaries
Similarly Frail Medicare
Population
Juniper Residents
AverageNumberofEvents
perPersonperYear
3. Juniper Residents’ Emergency Department Use 15% Lower than
Similarly Frail Medicare Population
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10. 4. Juniper Residents Use Fewer Services Than Similarly Frail Medicare
Population in Seniors’ Housing
0.66
0.55
0.30
0.52
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Inpatient ED
Similarly Frail in Senior Housing Juniper Residents
Average Number of Events per Person per Year
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11. Juniper Communities’ Medicare Population
11Slide | 11

12. Key Research Findings
• The Juniper population is much older than the overall Medicare
population.
• The Juniper population is a “hot spot” for high-need Medicare
beneficiaries.
• The Juniper Population is more cognitively impaired than the overall
Medicare population.
• Juniper’s population is similar to the typical assisted living
population.
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13. The Juniper Population is Much Older than the Overall
Medicare Population
17% 2%
46%
6%
26%
18%
11%
73%
0%
20%
40%
60%
80%
100%
All Medicare Beneficiaries Juniper Residents
85+
75-84
65-74
<65
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14. 83%
14% 18%
8%
41%
27%
4%
18%
18%
3%
15%
14%
2% 12%
22%
0%
20%
40%
60%
80%
100%
All Medicare Beneficiaries Similarly Frail Medicare
Population*
Juniper Residents
4 ADLs
3 ADLs
2 ADLs
1 ADL
0 ADLs
*The Medicare population that
is “similarly frail” as Juniper
residents receives help with at
least one activity of daily living
(ADL) or has cognitive
impairment.
Percentage of Population with Need for Supports and Services
The Juniper Population is a “Hot Spot” for High-Need
Medicare Beneficiaries
3%
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15. 4%
30%
34%
0%
5%
10%
15%
20%
25%
30%
35%
40%
All Medicare
Beneficiaries
Similarly Frail Medicare
Population
Juniper
Percentage of Population with Cognitive Impairment
The Juniper Population is More Cognitively Impaired Than
Overall Medicare Population
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16. Connect4Life Model Positioned to Generate
Medicare Savings
16Slide | 16

17. Non-Health Factors Contribute to Healthcare Spending
Succeeding in
population health
management will
require identification
and support of high-
cost populations as
defined by a full range
of bio-psycho-social
characteristics.
Functional
Behavioral
Social
Residential
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18. Functional Impairment Trumps Chronic Conditions In
Relation to Healthcare Spending
$7,228
$11,519
$17,961
$20,700
Any Chronic Condition 5 or More Chronic Conditions
No Functional Impairment High Functional Impairment
Source: ATI Fact Sheet: Functional Impairment and
Medical Spending, 2012
MCBS Cost and Use File, Analysis on Older Adults
Receiving Help with 2+ ADLs
Annual per capita Medicare
spending is twice as high for
beneficiaries with high functional
impairment (2+ ADLs) and chronic
conditions than for beneficiaries
with chronic conditions only.
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19. Spending 2X Higher for Similarly Frail Medicare Population
Annual per capita Medicare
spending is more than twice as
high for beneficiaries similar to
Juniper–who receive help with
1+ ADLs or have dementia–than
for overall Medicare population.
$2,155
$8,568
$5,975
$18,377
Inpatient Medicare Per Capita Total Medicare Per Capita
All Medicare Beneficiaries Similarly Frail Medicare Population
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20. Methodology and Contributing
Organizations
20Slide | 20

21. Methodology: Juniper Resident Acuity Data
• To analyze the acuity and healthcare utilization of the Juniper
communities, Juniper staff analyzed and reported data collected
through resident assessments, level of care determinations and
electronic health records for a sample of 471 residents of 10
separate assisted living communities. All of the residents included in
the study population had been living in the communities for over
one year.
• Data collected on the Juniper study population included functional
limitations, cognitive impairment, chronic conditions, ER use,
hospitalizations and re-hospitalizations.
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22. Methodology: MCBS Benchmarks
• A team from Anne Tumlinson Innovations analyzed the Medicare Current Beneficiary Survey (MCBS) Cost
and Use File from 2012 to evaluate the Medicare cost and service utilization of three comparison
populations.
• The first is all community-dwelling Medicare beneficiaries which reflects the average Medicare cost and
utilization experienced in the fee-for-service Medicare population not living in institutions. (n=50,038,595)
• The second group is refined to an LTSS need population living in the community– that is those who are
living at home and not in residential care who reported receiving help with at least one ADL or had a
diagnosis of dementia or Alzheimer’s disease. The team limited this population to those 65 years of age or
older. (n= 6,254,290) .
• The third group is refined to those with LTSS need living in a residential care setting that provides personal
care services who also reported receiving help with at least one ADL or had a diagnosis of dementia or
Alzheimer’s disease. The team included respondents 65 and older. (n= 418,797)
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23. Additional Study Details and Limitations
• Utilization for all services except readmissions was defined as events per person per year, whereas
readmissions were defined as all cause readmissions within a 30 period of the initial hospitalization per
100 hospitalizations per year. All-cause readmissions were calculated by identifying any hospitalization that
took place within 30-days of another hospitalization. Inpatient hospitalization counts include readmissions.
• The team was unable to match MCBS comparison populations with the Juniper resident population on
chronic conditions due to gaps in ICD-10 codes in the Juniper system. As with any study that attempts to
measure differences in utilization across population, there may be unmeasured differences between the
benchmark and Juniper populations that account for differences in utilization.
• The analysis is limited in that the healthcare utilization data in the Juniper population is not based on paid
healthcare claims and therefore is not independently verified. This analysis is instructive directionally in
evaluating outcomes for a senior housing population receiving an integrated care intervention.
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24. About Anne Tumlinson Innovations LLC
Anne Tumlinson has more than two decades of research and consulting
experience in post-acute and long-term care financing and delivery. Her consulting
firm, Anne Tumlinson Innovations, helps organizations respond to demographic
changes and delivery systems reform, with a special emphasis on addressing gaps
in financing for long-term services and supports for older adults. Her research
focuses on measuring the impact on Medicare acute spending for managing long-
term services of frail, older adults. Anne has testified before Congress and
appeared before the Long-Term Care Commission and the Bipartisan Policy
Center.
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25. About Juniper Communities
• Thought leader and innovator in assisted
living and memory care
• More than 20 communities in NJ, FL, PA and CO
• Pioneering Connect4Life – one of seniors
housing’s first truly integrated models of
supportive services and clinical care
• Serves more frail seniors than the average
Medicare population yet its Connect4Life
program has managed to reduce:
• ED Visits
• Hospitalizations
• Readmissions
JUNIPER’S MISSION:
To be the people, places and
programs that nurture the spirit of
life in each individual we touch
JUNIPER’S VALUES:
To be person centered, life
affirming, values driven, attentive,
responsive, compassionate,
competent, innovative, socially
responsible and environmentally
friendly, dedicated, efficient,
solution oriented and celebratory
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