Activating SilverSneakers Benefits for Seniors With Osteoarthritis

Exercise is an evidence-based strategy for managing osteoarthritis, but fewer than 15% of older adults exercise regularly. Lack of access to affordable fitness facilities and resources is often identified by older adults as a key barrier to regular exercise. However, more than half of U.S. older adults are enrolled in Medicare Advantage plans which include no-cost access to SilverSneakers or other similar exercise benefits. SilverSneakers benefits provide access to more than 15,000 fitness centers/gyms nationwide, and access to online- and in-person exercise classes taught at multiple fitness levels-all at no extra cost for older adults who are enrolled in participating Medicare Advantage plans. Remarkably, fewer than one-third of older adults use their insurance-covered SilverSneakers exercise benefits; with most unaware that they have access to these exercise benefits.

The investigators plan to conduct a pragmatic randomized controlled trial to compare the effects of Proactive Care, involving mailed material and phone calls plus a faxed information sheet for older adults' primary care providers, relative to Usual Care, involving the standard insurance-benefit information packet provided to older adults, on: (1) increasing participation in SilverSneakers exercise programs; (2) improving physical, social, and psychological outcomes identified as important to patients; and (3) reducing osteoarthritis-related health service use. Approximately 1,454 older adults who are enrolled in a Medicare Advantage plan at Humana and have no prior SilverSneakers use will be recruited across the United States. Participants will be followed over a 2-year period for key outcomes, with assessments conducted at baseline, 6, 12, and 24 months. Outcome measures will be obtained from Humana health claims databases and from self-report surveys.

The investigators hypothesize that, relative to the Usual Care group, the Proactive Care group will result in: (1) a greater proportion of participants who enroll in, and use SilverSneakers at least once; (2) a greater proportion of participants who use SilverSneakers at least one time per month at 2-year follow-up; and (3) greater mean improvements in physical functioning between baseline and 2-year follow-up. If these hypotheses are supported, and if proactive care procedures improve exercise participation and health outcomes and reduce costly health-service use, it could lead health insurers to adopt proactive care procedures more widely. Using proactive care procedures on a wider scale holds potential to help millions of older adults with osteoarthritis to access their insurance-covered exercise benefits, and improve the quality of their daily lives. Patient-, primary care-, community- and policy-level stakeholder partners will provide input throughout the project period to ensure the design, delivery and dissemination of proactive care procedures are patient-centered and incorporate diverse stakeholder perspectives.

• SilverSneakers Usage Frequency [Срок оценки: Obtained from Humana health claims databases at baseline and at 6-, 12-, and 24-month follow-up.]
• SilverSneakers Interaction Mode [Срок оценки: Obtained from Humana health claims databases at baseline and at 6-, 12-, and 24-month follow-up.]
• Moderate-to-Vigorous Physical Activity and Strength Training [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Pain (subscale) [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Fatigue [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Depression [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Loneliness [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Satisfaction with Participation in Discretionary Social Activities [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Social Networks [Срок оценки: Administered at baseline and at 6-, 12-, and 24-month follow-up.]
• Spoke to Primary Care Provider about SilverSneakers [Срок оценки: Administered at 24-month follow-up.]
• Number of Hip, Knee, or other Joint Replacement Surgeries [Срок оценки: Obtained from Humana medical claims databases at baseline and at 6-, 12-, and 24-month follow-up.]
• Number of Arthroscopic Surgeries [Срок оценки: Obtained from Humana medical claims databases at baseline and at 6-, 12-, and 24-month follow-up.]